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COVID vaccine Phase 1B

Changing guidelines, unknown number of doses make planning distribution a waiting game

A vaccine is administered in Phase 1A in December. The second phase — Phase 1B — is scheduled to start the first week in February. (Liz Martin/The Gazette)
A vaccine is administered in Phase 1A in December. The second phase — Phase 1B — is scheduled to start the first week in February. (Liz Martin/The Gazette)
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Since the first COVID-19 vaccines were delivered just before Christmas, health officials in Henry, Jefferson and Washington counties have met challenges nearly every day.

To start, the counties received fewer doses than expected.

As they plan for the second phase of the vaccine rollout, the rule changes continue. Thursday, Gov. Kim Reynolds announced people 65 and older will be eligible to receive the vaccine, the threshold lowered from 75 years old.

As of Friday, the number of vaccines that will be delivered to each county is unknown. Washington County Public Health Administrator Danielle Pettit-Majewski said Friday they’re expecting 200 doses to be delivered initially for Phase 1B, but they don’t know about delivery numbers beyond that. Henry and Jefferson Counties still don’t know how many they’ll be receiving.

“There’s a lot of information that’s changing really quickly,” Pettit-Majewski said last week. “We anticipate that will probably happen again.”

The scary part: The hard task — getting vaccines to residents in the far reaches of the rural counties — still lies ahead.

Local public health departments are in a waiting game to see how they’ll be able to roll out COVID-19 vaccines to more residents.

That’s not to say there have not been many successes.

Phase 1A of vaccine distribution, which included health care workers and long-term care facilities, is coming to completion in Henry, Jefferson and Washington counties. Henry County Public Health Coordinator Shelley Van Dorin said they have little vaccine left and are in the process of finishing up second doses.

Henry County was set to receive an extra 100 doses for Phase 1A, but since the county was close to being done vaccinating for that phase, the doses were allocated to another county. The county wasn’t able to keep them for Phase 1B.

“We’ve got very little vaccine left because we’ve gotten them in people’s arms,” Van Dorin said.

Counties that complete phases may need to assist other areas by reallocating their own supply to counties in need, said Lina Tucker Reinders, executive director of the Iowa Public Health Association.

“Before the Iowa Department of Public Health can declare Phase 1B open for business, they want to make sure to saturate Phase 1A at a statewide level,” Tucker Reinders said. “The concern is if among 99 counties, one-third still is vaccinating 1A and one-third is in Phase 1B and one-third is in Phase 1C, it would be chaos. In general, they want a progressive wave instead of a spike.”

Phase 1B

Phase 1B of vaccine distribution is set to begin in early February. According to the Iowa Department of Public Health, those eligible to receive a vaccine in this phase include people aged 65 and older, along with people who are “vulnerable to high risk of exposure or severity of illness,” including:

•People with disabilities dependent on attendant care staff and their attendant care staff.

•Correctional facility staff and incarcerated people.

•People working at or living in congregate settings not yet mentioned, including shelters, sober living homes, behavioral health treatment centers and detention centers. College dormitories are excluded.

•Where public health data indicates outbreaks or clusters of disease among food, agriculture, distribution and manufacturing workers whom work in or live in congregate settings that do not allow for social distancing. For example, working in a meatpacking or manufacturing production line or migrant workers whom live in bunk-style housing.

• School staff, early childhood education, and child care workers.

• First responders.

•Inspectors responsible for health, life and safety, including those in hospital and long-term care settings, child and food production safety.

• Government officials, including staff.

CLINICS PLANNED

Henry County has announced two clinics to vaccinate groups in Phase 1B on Feb. 2 and 4, but emphasized that these are subject to change as new information comes in or the vaccines are not delivered. Washington County had been developing plans to distribute the vaccine but has changed its preparations after the eligible population was widened.

Jefferson County Public Health Administrator Christine Estle said not knowing how many vaccines they’ll receive and when makes it difficult to plan. She said the county is working with the school district, Chamber of Commerce, hospital and Fairfield Economic Development Association to start figuring out where vaccines will be sent when they get them.

“We can have the best plans in place and then we can’t do anything until we have that vaccine in our hands,” Estle said.

Jefferson County hasn’t yet scheduled any clinics because they’re not sure if they’ll have enough vaccines to justify one. Pettit-Majewski said the state tells counties on Sunday evenings how many vaccines they will receive for the week.

Operation Warp Speed, the federal COVID-19 vaccine initiative, notifies states of their vaccine allocation on a week-by-week basis — meaning long-term planning is often challenged.

Pettit-Majewski said Iowa is currently receiving 19,000 Moderna vaccines a week to distribute to counties and 19,000 Pfizer vaccines a week to split 50-50 between long-term care facilities and other places capable of housing it, such as larger hospitals. The Pfizer vaccine must be stored in freezers capable of keeping a temperature of -94 degrees Fahrenheit, as opposed to the Moderna vaccine, which can be stored at -13 degrees to 5 degrees Fahrenheit.

There are around 500,000 Iowa residents over the age of 65, Pettit-Majewski said, and while some of them were vaccinated in Phase 1A, there are plenty more that local health departments still need to get to.

Homebound residents

Another factor making Phase 1B a larger hurdle to overcome is the inclusion of groups that might find it impossible to make it to a vaccine distribution site. Some people 65 years and older are homebound, and also included in this phase are people with disabilities living in a home setting dependent on care staff.

Each county is thinking about how to reach homebound residents, but don’t have set plans yet. Van Dorin said they know they’re going to have to figure out how to get vaccines to people’s homes, but there are so many moving parts that it’s hard to pin down a plan.

County public health departments, both in rural and urban areas, will rely on hospitals, retail pharmacies, clinics and other health care providers to help administer shots to residents. Local public health officials will distribute doses shipped to their county to these providers.

Approximately 1,700 pharmacies and clinics have signed on to store and administer the vaccine to Iowans, according to state public health department. That includes more than 500 pharmacies across the state, the largest subcategory of vaccine providers, said Kate Gainer, executive vice president and chief executive officer of the Iowa Pharmacy Association, an advocacy organization representing pharmacists in the state.

However, Pettit-Majewski said, the state is not currently allocating vaccines to pharmacies and not recommending that counties give doses to pharmacies to distribute. Pharmacists can be utilized at county-ran clinics to help administer the vaccine.

Van Dorin mentioned working with Hy-Vee to help vaccinate businesses, but it all depends on the number of doses they receive.

For people confused or frustrated with slow-coming information on vaccinations, each county’s public health administrator said it’s important to be patient. They know many people want to know when they’ll be able to receive a vaccine, and they’re getting information out as quickly as they can get it.

“Just because Phase 1B begins Feb. 1, we’re not going to be able to vaccinate everyone that first week,” Pettit-Majewski said. “It takes time,”

The Gazette’s Michaela Ramm contributed to this report.