Two coronavirus vaccine candidates are poised to be approved for emergency use in the United States very soon. U.S. Health and Human Services Secretary Alex Azar told CNBC on Nov. 16 that about 40 million doses of vaccine, made by Pfizer and Moderna, should be available by the end of this year. 

What does that mean for the District? You may have heard that a CDC independent panel, called the Advisory Committee on Immunization Practices (ACIP), recommended health care workers and residents living in long term care facilities be vaccinated first. States and localities are not bound by the CDC recommendations. 

“It would be highly unusual for the District of Columbia to adopt a priority scheme that was different from the recommendation from the ACIP,” said DC Health Director LaQuandra Nesbitt in a Council call on Wednesday. “With the shared vaccines we will be receiving at the beginning and in subsequent allocations, it is not possible for us to address them as a homogenous group of health care workers and long term care facilities. We will have to make some stratifications.”  

Mayor Muriel Bowser’s administration has been planning for this moment since May. DC Health first submitted its vaccination plan to the federal government Oct. 16 and has revised it since as more information became available. The latest draft, dated Nov. 27, is posted online.  

“It’s best to probably think about it as a living document,” said Nesbitt. 

Who gets vaccinated first? Keeping with the CDC guidelines, the first group (called Phase 1A) is health care workers. DC Health estimates this to be 85,100 workers. D.C. will receive 6,800 doses in the first allocation, Nesbitt tells the Council, so the city will have to prioritize groups within Phase 1A. Nesbitt says they’ll begin with emergency personnel. The city will then be methodical about who goes next, like considering which personnel are likely to come in close contact with a respiratory illness or COVID-19. 

“We don’t have to completely finish vaccinating one group before we move to the other,” said Nesbitt. “We will allow people to [move] up in the prioritization if they are more willing to adopt and accept a vaccine then the remainder of people in another group who are kind of watching and wanting to continue to use personal protective equipment.” 

A potential problem D.C. faces is that roughly 75 percent of its 85,100 health care workers live outside the District, and the federal government is sending its shipment of vaccines based on residency. A DC Health spokesperson says they are asking nearly every day that the allocation be based on workforce and not local population. But the federal government does not seem willing to budge. A spokesperson for the federal health department says “Residents from outside the District of Columbia who come into the district for work will be reflected in the allocations of the states in which they reside.” They also sent a clip of Azar saying in a recent briefing that they’ve received supportive feedback from governors who want to keep it simple. While the District is communicating with neighboring jurisdictions, the current process is undoubtedly more complicated. 

When will people get vaccinated? Nesbitt anticipates D.C. getting the first doses of the vaccine by mid-December. She warned vaccinations will not be immediate because providers need to be trained. “We recognize the sense of urgency. We are not asking for people to be bureaucratic with these processes … but recogniz[e] we want to keep medical errors down and low with the rollout,” she said. Nesbitt added “it’s going to be awhile” for the general population to be vaccinated. This group could be vaccinated in March or April. After the first allocation, D.C. expects weekly or biweekly shipments, but Nesbitt does not know how many doses will be released in these subsequent shipments. (The Moderna and Pfizer vaccines require two doses, spaced over three to four weeks.) This makes planning challenging, but DC Health has guiding principles they are keeping in mind.  

Can D.C. store these vaccines? The COVID-19 vaccine developed by Pfizer needs to be kept extremely cold, colder than winter in Antarctica. DC Health identified multiple sites with ultra-cold freezer capacity, including a number of its hospitals, Kaiser Center for Total Health, and a Walgreens Community Pharmacy in Southeast. In the first phase, D.C. is relying on acute care facilities to receive and allocate the vaccine.

Will people even take the vaccine? This is something that DC Health is actively thinking about. Based on polling, the agency knows that some are hesitant about safety and efficacy given how fast these vaccines were developed. Nesbitt told the Council DC Health is working with the health care industry and labor groups, along with the Black Coalition Against Covid and the Latin American Youth Center, to identify community voices that can help talk about vaccination.  

Questions about the vaccination plan? Let us know by responding to this newsletter or email me directly. 

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