COVID-19 brings ‘the most massive vaccination effort in a century’

Kristen Jordan Shamus

While Gov. Gretchen Whitmer declared last week that “hope is on the horizon” with two COVID-19 vaccines produced by Pfizer and Moderna, the state’s chief medical executive Dr. Joneigh Khaldun said she knows there will be challenges in the enormous job of vaccinating Michigan’s 10 million people.

From prioritizing who should get vaccinated first to finding enough trained health care workers to both care for sick COVID-19 patients in Michigan’s hospitals and run vaccine clinics, Khaldun called it “the most massive vaccination effort in a century” in a Friday interview with the Free Press. 

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The first doses of the vaccines, which await regulatory review, could be ready to be injected into people’s arms before Christmas.  

“It’s important to note that when Michigan gets a vaccine, it will be available in a very limited quantities,” Khaldun said.

“We are still awaiting word from the CDC (U.S. Centers for Disease Control and Prevention) on exact numbers of doses Michigan will receive in that first allocation. Because there will be such a limited amount in the beginning, our first priority would be to keep our health care systems operating and to protect those who are the most vulnerable. Right now, this means that we are prioritizing vaccinating front-line health care workers.”

After that, Khaldun said, health officials are hopeful that in January, they will be able to expand vaccinations to people who live and work in long-term care facilities and nursing homes, and then offer vaccines to other essential workers and people at high risk for severe COVID-19 illnesses.

“But all this is dependent on how quickly additional vaccine becomes available from the manufacturer,” Khaldun said. “We hope to be able to have vaccine available to the general public by late spring.

“Even at that point, it will take some time for the vaccines to get distributed appropriately throughout the community.

“I’m so hopeful and I know that 2021 will be a better year, but I think everyone right now really must focus on keeping these case numbers down and keeping our front-line workers and our health care systems as safe as possible by … doing the right thing,” such as wearing masks, social distancing, washing hands and avoiding large gatherings. 

A lightly edited transcript of the Free Press interview with Khaldun follows:

QUESTION: Although data from Pfizer and Moderna suggest the vaccines are 95% and 94% effective, respectively, how will you address concerns people have about the vaccines’ safety and fears that they were brought to market?

ANSWER: We are absolutely very concerned about people having what I call vaccine skepticism. … There are a lot of unknowns. It’s been a very hectic year. It is a new virus and people, I think, also don’t really understand the vaccine approval process.

We recognize this. We are already working on communication strategies, engaging community groups, engaging our health care providers, engaging minority populations who we know for good reasons have historically been more hesitant to receive vaccines.

So, we do have a strategy. It’s really about getting information out to the public, understanding that the vaccine approval process — while it has been condensed — no steps are being skipped.

We still have the world’s best scientists and vaccine experts — people who think about immunizations every single day of their careers — who will be reviewing the data. They will not approve the vaccines unless the data is valid.

Q: Both Pfizer and Moderna have created two-dose coronavirus vaccines, which means people will get one immunization, wait for three to four weeks, and then come back for a second dose. How will you ensure that they come back for that second dose?

A: Every time someone gets a first dose of the vaccine, they will actually … leave with a card that goes with them that kind of gives you a reminder for your next appointment, if you will, or your next dose when it’s due.

We also have a text messaging system where, when you get put into our system with your first vaccine, you’ll be able to get a text message to remind you that it’s time for your next one.

There’s going to be some responsibility for everyone to make sure they go back and get their second dose of their vaccines. You will have to get the same type of vaccine that you received in the first dose, meaning you cannot go from the Pfizer on the first dose to the Moderna on the second one. We have to make sure of that, but it is something that is going to be a challenge.

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Q: Will there be enough doses of the vaccines initially to ensure that everybody who gets the first dose will be able to get a second one within the recommended time frame?

A:  It all depends on the federal government, the supply chain. I have no control over how much vaccine is allocated to the state of Michigan.

We know that in the very beginning, it will be limited. We know that is why we have to prioritize and we have prioritized according to CDC (U.S. Centers for Disease Control and Prevention) recommendations and the Advisory Committee on Immunization Practices. We are aligning with their recommendations on prioritization. 

We hope, based on the supply chain from the manufacturers, that by late spring we will be able to start making this available to fight COVID in the general population outside of those … priority groups.

Q: Will health care workers be required to get the vaccine for work, like many health systems already require them to get flu shots?

A: I have not heard of anyone in the country who is requiring the COVID vaccine at this point. I’ll just leave it at that.

We, at the state level, are not looking at it at this point and I’m not aware of any hospital systems that are looking at requiring it.

Q: How many doses of each of the vaccines has Michigan requested and where will they be delivered?

A: That number changes, literally, by the hour. I don’t have an exact number off the top of my head, but we are engaging with the federal government. We are participating in requesting the Pfizer and Moderna vaccines, and we are enrolling many providers across the state so that they have … access to the vaccine.

The day when they say it’s available, that is what we will understand where the vaccine is going.

Q: Has the state received any of the doses of Pfizer or Moderna vaccine yet?

A: We have not. We are waiting for our allocation.

Q: Given that health care workers are already stretched right now caring for critically ill COVID-19 patients in hospitals, who will administer the vaccines in Michigan? When you consider that we have 10 million people in the state, and everyone will need two doses, that’s 20 million immunizations. 

A: One of the things that’s important in vaccine distribution is the staffing. Literally, to your point, who is going to administer it? 

Our hospital systems are already working on the staffing plan, and to be honest with you, that’s part of the reason why our health care workers are prioritized for getting the vaccine first. It is because we need our health care system to remain healthy. You need staff in emergency departments and on medical floors and ICUs to be able to take care of all patients.

So that’s actually part of the reason why we’re prioritizing that group first. … We are engaging, of course, hospital worker staff but also staff who work in primary care, the staff at local health departments who on a regular day run immunization clinics.

We also are engaging with the National Guard to see where it may be appropriate for them to support, and also entities like emergency medical services. Many of them have a clinical background, and so we are looking at how can they participate in administering vaccines as well.

Q: I read about a plan in Nevada to enlist veterinarians to help vaccinate people. Would Michigan consider anything like that?

A: I have not spoken to our veterinarian community at this point, but we certainly will be looking at what makes sense and who has the appropriate clinical skills to administer these vaccines.

Q: Is there an immunization threshold we need to reach when we can say that we’ve reduced the risk of COVID-19 spread and we don’t need to wear masks anymore? And if so, what is it?

A: This is a very new virus. We’re still looking at data. I don’t know the day or the threshold where we will say that we don’t need to wear masks when we’re within 6 feet of other people.

I do know that the day that this vaccine becomes available to the general public, we will still need to be very vigilant with washing hands and wearing our masks. 

But we do know that for this concept of herd immunity, the best estimates are you need at least 65% of the population to be immune to disease. And so that would mean we would need at least 65% of the population to be vaccinated.  

Q: What about paying for these vaccine clinics and paying for staffing them. How much do you estimate it’s going to cost to pull all this off in Michigan and where will we get the money?

A: We are very concerned. We … have requested of the federal government additional funding to be able to staff this, the most massive vaccination effort in a century.

We will need millions more dollars to be able to do this effectively. 

Q: Winter is fast approaching, can you talk about the logistical challenges that poses with the idea of drive-up vaccine clinics? How will those work in Michigan in January and February? And if we bring vaccine clinics indoors — perhaps at places like Ford Field or the TCF Center — how do you plan to make those indoor environments safe and avoid COVID-19 community spread?

A: This is a very different situation where we … need to maintain social distancing while we are executing on our vaccination plan. Our local health departments have all year been innovative and creative when it comes to making sure this process is as safe as possible.

I’ll also say we’ve learned a lot. We’ve learned a lot because of our massive testing that has happened across the state. There’s been mobile testing; we’ve had drive-through testing.

So I think our cities in our local health departments have learned a lot and they will build on that to be able to implement these vaccination plans. 

Q: Detroit Mayor Mike Duggan said recently that it would take about three to four months to vaccinate all 700,000 Detroiters if health officials could immunize them at a rate of 5,000 people a day. Do you have any daily goals for vaccination statewide and how long do you estimate it’ll take for all of Michigan immunized?

A: A lot of this depends on what we get from the federal government. We know we will not get nearly enough vaccines from the federal government in this initial time. So, you know, for us to be able to get 70% of Michigan’s adult population vaccinated, the federal government will have to keep up.

When this vaccine becomes available, it’s still going to be important for people to do the basic things like wearing masks, washing hands, and keeping distance.

It won’t be available for the general public until late spring at the earliest. And even at that point, it will take some time for the vaccines to get distributed appropriately throughout the community. 

 Contact Kristen Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus. 


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