Maine’s monthslong planning effort to prepare for the arrival and deployment of a coronavirus vaccine kicks into gear this week amid high hopes and plenty of uncertainty.
The state’s first shipments of a vaccine developed by pharmaceutical giant Pfizer and its German partner BioNTech arrived at some priority hospitals and long-term care facilities on Monday.
“We are delighted to say that Northern Light Mercy and Northern Light Eastern Maine Medical Center each received a shipment of the Pfizer vaccine product this morning,” Dr. James Jarvis with Northern Light health said in a virtual press conference Monday.
Northern Light appears to be the first health care system in Maine to receive the doses. Shipments to other hospitals, including Maine Medical Center, are expected to arrive this week.
Monday’s deliveries are the first installment of three that state officials say will vaccinate 50,525 people by Christmas, or about 4% of Maine residents. That figure includes shipments of a vaccine developed by Moderna, which first needs to receive emergency authorization by the U.S. Food and Drug Administration, an approval that could come later this week.
The first vaccinations will soon begin at Maine hospitals and long-term care facilities hardest hit by COVID-19, the disease caused by the coronavirus. Jarvis says vaccinations for Northern Light’s staff will begin Wednesday. Older residents and people with multiple illnesses will be next, followed by workers deemed essential to keep society running and at high-risk of infection, older adults and school staff. Children, young adults and other essential workers will be next.
The vaccination plan developed by the Maine Center for Disease Control largely follows recommendations by the U.S. CDC and prioritizes health care workers at high risk of contracting COVID-19, first responders and residents of long-term care facilities such as nursing homes. But prioritizing within those groups will largely be left to the discretion of hospitals and long-term care facilities, which could be confronted by difficult ethical choices in the early stages of the rollout, especially if it’s complicated by supply chain issues.
“Our prioritization list really is staff who come into contact with individuals who have COVID-19. So that would include our providers, our nursing staff, our EVS housekeeping staff, our dieticians. Those who work on those floors,” Jarvis says.
The timing of the state’s four-phase plan will not only depend on the supply reliability but also the yet-to-arrive federal funding to help states recruit and hire additional vaccinators, technology to monitor immunizations and public awareness campaigns.
It’s unclear exactly how much Maine will need to execute its plan, but officials in the Mills administration have continued to hammer the need for additional funding and more transparency about how the federal government is allocating shipments of the vaccine that are about one-third less than originally anticipated.
The request for federal funding, pegged at $8.4 billion across all the states, will become a more acute focus as states prepare for mass vaccinations in the later stages of their respective plans.
In the near term, states like Maine are trying to make sure high-risk people are at the front of the line.
“We right now are focused on the three weeks ahead of us,” Department of Health and Human Services Commissioner Jeanne Lambrew said last week. “The vaccines we expect to get in those first three weeks don’t even cover half of who is in (Phase 1A), health care workers and long term care residents, which is what the U.S. CDC advisory group recommends. … We certainly will be returning to (Phase 1B and C) and phases two and three shortly thereafter. But everything is on the table.”
In addition to prioritizing vaccination groups, the state is also grappling with how to notify people when it’s their turn. The task might be easier for health care workers or residents of long-term care, but it will grow increasingly difficult as the vaccination program advances.
Maine CDC director Dr. Nirav Shah says employers might play some role in notifying workers, but the details are still in development.
“That’s a challenge. It’s one that I know 49 other states and territories are thinking through right now as well,” he said.
Public health officials in Maine and across the U.S. say successfully navigating those challenges are key to finally controlling a pandemic that is currently raging uncontrolled. Maine, which once had one of the lowest infection rates in the country, continues to set daily case count records, forcing Gov. Janet Mills to order additional restrictions to curb the outbreak. Maine has recorded 16,349 cases of COVID-19 and 259 people have died with the disease as of Monday.
The arrival of a vaccine comes with hope that the U.S. and other countries can bring the pandemic to heel. But that hope hinges on achieving herd immunity, the threshold at which a population can be protected from a virus with vaccination.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the Harvard Gazette last week that if 75-80% of Americans are vaccinated in the 2nd quarter of 2021 that herd immunity could be reached and life will begin a slow return to normal. But there are forces working against that objective, including misinformation about the safety of vaccines, the deadliness of COVID-19 and pandemic politics that have turned preventative measures partisan, such as mask wearing.
A Gallup poll taken in November showed that 58% of Americans are willing to get vaccinated. Among those unwilling to get the vaccine, 37% worried about the rushed timeline for its development. Another 26% said they want to be sure the vaccine is safe, while 12% said they don’t trust the vaccine in general.
Maine officials’ ability to navigate those hurdles as well as vaccination logistics will become more clear in the coming weeks.
The following are some commonly asked questions and what is known based on documents and interviews with the Maine CDC and public health officials.
How much vaccine is Maine getting and where is it going?
The state has placed two initial orders totaling 50,525 doses to the federal government, which is handling distribution of coronavirus vaccines through Operation Warp Speed.
Those first two orders will be roughly evenly divided between hospitals and long-term care facilities currently with high case numbers.
The distribution to long-term care facilities has not been publicized, but the state did provide allocation totals to hospitals. Maine Medical Center will receive 1,885 doses of the Pfizer vaccine, followed by 975 doses each to Northern Light Eastern Maine Medical Center in Bangor and Northern Light Mercy Hospital in Portland. MaineGeneral Medical Center in Augusta will receive 825 doses, followed by St. Mary’s Regional Medical Center (500 doses) and Central Maine Medical Center (475) in Lewiston and Northern Light AR Gould Hospital (215). Many of those same hospitals will receive another shipment next week.
Rural hospitals could also begin to receive shipments next week, but those will be for the Moderna vaccine pending approval by the FDA, which could come this week.
Maine’s initial allotment is nowhere near what it will require just to vaccinate the priority group, also known as 1A and 1B. Both the Moderna and Pfizer vaccines require two doses about 20 days apart.
Who will get vaccinated first and why?
The U.S. CDC recommends that health care workers and first responders treating COVID-19 patients get vaccinated first.
The reason is fairly simple: Health care workers are not only at higher risk of getting the disease, a surge in cases threatens to deplete their ranks at a time when they’re needed most.
The overwhelming of the health care systems is one of the primary reasons why states implemented restrictions to help slow the spread of the disease. Those efforts worked in Maine over the summer, but now hospitalizations are on the rise. In other states hospitals are completely overwhelmed and there are no intensive care beds to treat COVID-19 patients or others who might need acute care.
Who comes next and what about the general public?
Vaccinating health care workers is in what’s known as Phase 1A of the state’s plan.
Phase 1B includes people suffering from multiple illnesses that put them at higher risk of complications and death, as well as older adults in congregate care settings.
Phase 2 includes workers in industries essential to keeping society operating, people of all ages with underlying conditions that put them at moderate risk of COVID-19, teachers and school staff and people in prisons, jails and detention centers.
Phase 3 includes school children, young adults and other workers not included in Phase 1 or 2. Phase 4 is the remainder of the population.
The timing for phases beyond the first one is unclear and dependent on vaccine supply chain and distribution by the federal government.
How will I know when it’s my turn?
People working or living with organization supports, such as health care settings or schools will likely be notified by those organizations.
Reaching people working outside of those systems is a work in progress, according to state officials. Some employers may be asked to notify their workers. In other cases primary care physicians and health clinics might play a role.
Who will be administering the vaccines?
The state’s plan leans heavily on health care, first responders and pharmacy networks.
State agencies such as the Department of Education will also play a role, as will local health agencies in larger municipalities like Bangor and Portland.
The state also needs to recruit and hire additional vaccinators, but those efforts will largely hinge on the arrival of federal funding, which has not yet been approved by Congress.
Is there a difference between the Moderna and Pfizer vaccines?
The primary difference is about storage. The Pfizer vaccine requires ultracold freezers, which is one reason why the initial shipments are going to larger hospitals. The Moderna vaccine can be stored at traditional temperatures for other medicines and vaccines.
Flu vaccines contain a live but weakened form of the virus it seeks to fight. That’s not the case with the Moderna and Pfizer vaccines, which essentially work by telling the body to produce a protein that can help it recognize and fight the coronavirus.
Are there side effects to the vaccines?
A fact sheet distributed by the FDA last week notes that the Pfizer vaccine may cause some people to experience symptoms common with the cold or flu — fatigue, headache, muscle and joint pain or nausea.
The FDA also says there is a remote chance some people will experience severe allergic reactions, such as swollen face or throat or dizziness, that will require medical attention.
The FDA recommends telling your health care provider or approved vaccinator if you have the following medical conditions before getting vaccinated: allergies, fever, a bleeding disorder, immunocompromised, pregnant or plan to become pregnant.
What is the threshold for herd immunity?
There are varying estimates. Some health experts say herd immunity, also known as collective immunity, can be achieved when 70-80 percent of the U.S. population is vaccinated. Others say it might need to be closer to 90 percent.
Either way, it’s going to take some time to get there. And it will also depend on how effective states’ vaccination programs are, whether they’re adequately funded by the federal government and whether health officials can maintain and increase public confidence in getting vaccinated.
Will I still have to wear a mask and physically distance after vaccination?
Yes to both — at least until there’s more study of the vaccines.
One reason is that both the Moderna and Pfizer vaccines require two doses. Full protection doesn’t occur until after the second dose and that may take a week or two, according to public health experts.
The other reason to mask up and stay apart after vaccination is that there hasn’t been enough study to determine whether the two vaccines protect people from infection or just symptoms of the disease. In other words, people who are vaccinated might never feel sick, but it’s not yet known if those people could still get infected and infect others, too.
Answers to other frequently asked questions can be found on the U.S. CDC website here.
Maine Public reporter Patty Wight contributed to this story.