Getting a vaccine to frontline health care workers is the first step in the state’s plan for distributing an anticipated COVID-19 vaccine.
The draft plan was discussed during the first COVID-19 Vaccination Plan Coordination Team meeting held Tuesday on Zoom.
The Montana Department of Public Health and Human Services announced the creation of the team on Monday. The team is comprised of more than 60 members across the health sector, tribal governments, and representing minorities and people with disabilities.
As approval of a vaccination looms closer in the United States, Montana is preparing to administer those vaccines through a phased approach.
When, or which, vaccines become available, and how much will be initially sent to Montana, is still unclear, said Bekki Wehner of DPHHS.
Globally, there are 13 vaccines in Phase-3 large-scale efficacy trials, six that have been approved for limited use and none that have been approved for widespread use, according to the New York Times coronavirus vaccine progress tracking website.
No COVID-19 vaccine has yet been approved by the Food and Drug Administration in the U.S.
On Friday, Pfizer requested emergency use authorization from the FDA. Pfizer has reported its vaccine is more than 90% effective.
Moderna is also reportedly on track to make the same request to the FDA.
Both vaccines require an initial shot and a booster about three weeks later.
A third major COVID-19 vaccine, developed by AstraZeneca, may also become available soon.
DPHHS is also waiting to hear recommendations on how to administer the vaccines and who should take priority from the FDA and the Advisory Committee on Immunization Practice (ACIP).
The state has drafted a three-phased plan to begin distributing vaccines out, first targeting health care workers until culminating in phase three, where every Montanan could choose to be vaccinated.
Phase 1, taking place in the first two months after a vaccine rolls out, would focus on distribution to people at the highest risk of life-threatening infection and those in Montana's "critical infrastructure workforce."
Current estimates put Montana at having anywhere between 45,000 and 60,000 health care workers, including those who work in the hospital settings but are not care providers — meaning the state is estimating it would need roughly 90,000 to 100,000 doses of a vaccine for frontline health care workers.
Phase 2, three to six months after the state begins to distribute vaccines, will continue to target critical workforce, provide second dose vaccines and begin to expand vaccinations to prioritized groups.
Who exactly falls into those groups is still being ironed out, but includes those with underlying health conditions, those 65 years and older and populations who have been disproportionately affected by the virus — like Native Americans.
“None of those populations have been formally created,” Wehner said.
According to the initial draft, populations of focus for COVID-19 vaccinations may fall into five tiers:
- Tier 1: Critical infrastructure workforce including health care personnel
- Tier 2: People at increased risk for severe COVID-19 infections
- Tier 3: People at increased risk of acquiring or transmitting COVID-19
- Tier 4: People with limited access to vaccination services
- Tier 5: Healthy adults with limited or no underlying medical conditions
The state's third phase will reach Tier 5 Montanans, otherwise healthy adults, and a tentative timeline puts the state reaching Phase 3 after six months.
Vaccines will currently not be recommended for anyone under 18 years old, Wehner said.
The Pfizer vaccine, which may be the first vaccine approved for emergency use in the U.S., requires transportation and storage at an extremely cold temperature.
The "ultracold" storage required could make the vaccine more difficult to distribute to rural areas, Wehner said.
The vaccines are shipped in containers that stay at the required temperature for 10 days, but each shipment contains a minimum 975 doses which could make it difficult to administer all doses within that timeframe.
“In Montana we have at least seven known ultracold storage sites, very nicely spread geographically around the state,” Wehner said.
Those storage units won’t be used to stockpile a vaccine, she stressed. The current plan is to order and use the vaccine as needed rather than to order and stock the vaccine.
DPHHS won't act as a depot, rather the distributor or the pharmacy company will ship directly to vaccination sites across Montana. That would also eliminate extra cost of redistributing the vaccine for the state.
Most tribal governments across the state have chosen to have the vaccines allocated by the federal government, with the exception of the Confederated Salish and Kootenai Tribes and the Helena Indian Alliance which will use the state to allocate vaccines.
Some pharmacies, like Walgreens and CVS, have a federal contract with the CDC to administer vaccines. Other organizations, like some long-term care facilities will also source vaccines from the federal level.
The Centers for Medicare and Medicaid Services said it will pay for any COVID-19 vaccine, and private insurance should cover vaccines.
For those un- or underinsured, Wehner said they were working to get those vaccinations paid for or establish a reimbursement system.
Training information on storing or administering the vaccine hasn’t been formally provided to DPHHS from the FDA or the CDC, she said.
“We’ll wait on the advisory committee (ACIP) to provide us final recommendations, with the idea that everything we planned for may change,” Wehner said.
The state is currently working to enroll vaccine providers. Enrollment, which Wehner described as “lengthy” ensures providers are able to store and handle the vaccine appropriately.
“Right now we’re in the process of enrolling our larger hospitals, critical access hospitals, pharmacies and public health departments,” she said.