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Taking a look at Montana's COVID vaccine distribution plan

By: Matt Holzapfel

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On Monday, the Montana Department of Public Health & Human Services announced a statewide team that will help answer some questions surrounding COVID vaccines, and released a draft plan for the distribution process. The COVID-19 Vaccination Plan Coordination Team, made up of Montana medical, tribal, government, and community leaders, will also give feedback as the process rolls out.

Montana Immunization Program Manager Bekki Wehner stressed that this is just version one of what she expects to be several iterations of the state’s COVID-19 Vaccination Plan.

With evolving guidance coming from the Centers for Disease Control and Prevention, the Food and Drug Administration, and other agencies and organizations, it’s likely that Montana’s plans to distribute a COVID-19 vaccine will have to adapt to that changing guidance. Even so, the first plan is here, and this is what it says:

There will be three phases of distribution for the vaccine. In Phase One, there will be a limited supply of the vaccine, and it will go to infrastructure workers and people who are at increased risk for severe illness as a result of COVID-19. In Phase Two, which the DPHHS estimates will be about three to six months after the initial vaccines arrive, people who are at increased risk of contracting the virus will be prioritized. Then in Phase Three, when the vaccine is widely available for anyone that wants to get it, healthy adults with limited or no chronic health conditions can get the vaccine, along with anyone who has not yet gotten it. State officials estimate Montana will enter this phase at least six months after the vaccines start being distributed, if not longer.

Click here to read the complete plan (PDF).

So when will the U.S. approve and start distributing these vaccines to states? U.S. Health & Human Services Secretary Alex Azar said on Tuesday that the country could begin distributing COVID-19 vaccines as early as mid-December. In fact, his exact words were “if all goes well, we could be distributing vaccine soon after December 10.”

If that’s the case, Montanans that fall under the categories listed in Phase One could begin receiving these vaccinations as early as a few days after that.

DPHHS says the vaccine will not be mandatory, and that everyone who wants to get it will be able to eventually.

Wehner said that it’s likely the vaccine will need to be administered in two separate doses. Because of that, she estimates that the state will need between 90,000 and 100,000 doses of the vaccine just to vaccinate all frontline healthcare workers in Montana. It’s not known yet how many doses will be included in the first shipments to states.

It’s also not clear which vaccine the FDA will move forward with. Moderna and Pfizer have been the forefront of vaccine development in the United States recently, but the University of Oxford and pharmaceutical company AstraZeneca also recently announced some successful vaccine trials. While each vaccine has its advantages, only two of those, Moderna’s and Pfizer’s need to be stored at sub-freezing temperatures. Oxford-AstraZeneca’s can be stored at normal refrigerator temperatures.

That could have an impact in how facilities prepare to store the vaccine. Wehner says Montana has six or seven ultra-cold storage sites around the state to store vaccines. Despite the differences in storage temperatures, time required between each dose, and other things, Wehner doesn’t think it will have a major impact on when the vaccines can begin being administered in Montana.

“The cold storage units aren’t a critical component of vaccine allocation, they’re just a piece of the puzzle,” she explained. “So, if there are concerns that there are no ultra-cold units in a certain geography of Montana, that won’t preclude there being a vaccine allocation in that area.”

One question that came up a lot back in March when Stay-At-Home orders were being put into place around the country involved the term “essential worker.” Now, some of those same essential workers will be among the first people to receive this vaccine in Montana.

According to the official draft of the COVID-19 Vaccination Plan released by the Montana DPHHS, “Critical Infrastructure Workers”, those that will be receiving the vaccine in Phase One, include the following occupations: healthcare professionals such as pharmacy staff, school nurses, and EMS workers. Phase One also includes workers identified in pages 7 through 23 of this document published by the U.S. Cybersecurity & Infrastructure Agency. According to the information on that document and Montana’s COVID-19 Vaccination plan, a lot of the people were considered essential workers in March will retain that designation as vaccines are given out.

The Montana DPHHS is currently in the process of enrolling hospitals and some other facilities around the state as COVID-19 Vaccine Providers, a process that including a fair bit of training and preparation. According to the Vaccination Plan, “The Immunization Program is obtaining primary contacts and emails for all potential Phase 1 COVID19 vaccine providers identified as having the ability to reach Phase 1 critical populations. The Immunization Program will prioritize processing Phase 1 enrollments initially and progress to providers in other phases as the vaccination effort develops.”

The Montana DPHHS is also utilizing the state’s immunization program to assist with this entire process, from training providers to administer vaccines and teaching them how to store the vaccines to how to report vaccine data to the state.

So what else? Wehner says that with every vaccine order, the distribution facility will also receive a supply kit. That kit will include, among other things, a card that people who receive the vaccine can use for two things. First, it will remind them when they need to go get their second dose (required timing between the first and second dose varies based on which vaccine you are getting). Second, it can be used as proof that they did, in fact, receive the first vaccine.

Wehner also announced during the meeting that the plan is to provide this vaccine free of charge, even to people without health insurance. “The vaccine will be provided by the federal government without cost,” she said. She went on to add that the cost to distribute the vaccine will be covered by your healthcare provider, and that anyone who does not have healthcare should be reimbursed for any cost they might have to pay to receive the vaccine.

One question that was brought up near the end of the meeting: How will the state handle vaccinating active COVID-19 patients? Medical guidance recommends not getting a flu shot if you have a fever, so does the COVID-19 vaccine come with the caveat? Wehner said she did not have the answers to those questions readily available, and more information is needed from the FDA and the ACIP to provide an accurate answer.

Lastly, if you’re looking to get your child vaccinated, that will likely have to wait, though it’s not clear how long. Wehner says that there is currently no data available about the efficacy of any of these vaccines in children. Because of that, the state is currently not recommending that anyone under the age of 18 get any of these vaccines.

Do you have questions about Montana’s COVID-19 vaccine plan? Email them to me at Matt.Holzapfel@krtv.com, and we’ll try to get answers.

RELATED NEWS

As of mid-day on Monday, November 23rd, MTN News is reporting a cumulative total of 628 deaths in Montana due to COVID-19, an increase of seven since Sunday. There are currently 467 people hospitalized, a decrease of 10 since Sunday; there have been 2,377 total hospitalizations since the pandemic began. There were 1,192 new COVID cases reported in Montana within the last 24 hours, and there are currently 15,665 active cases. There has been a cumulative total of 56,743 cases; of those cases, 40,450 are now listed as recovered. There were 4,965 new tests within the last 24 hours, for a cumulative total of 617,974.

COVID-19 Vaccination Plan Coordination Team

Health systems and hospitals: Heather O’Hara, Montana Hospital Association; Vicky Byrd, Montana Nurses Association; Joyce Dombrouski, Providence Montana
Local health departments: Eric Merchant, Association of Montana Public Health Officials; Lora Wier, Montana Public Health Association
Tribal governments: Laura Upham, Blackfeet Nation; Lauren Corcoran, Chippewa Cree Tribe; Chelsea Kleinmeyer, Confederated Salish and Kootenai Tribes; To be named, Crow Nation; Jennifer Show, Fort Belknap Tribes; Kaci Wallette, Fort Peck Tribes; Molly Wendland, Little Shell Tribe; Janet Wolfname, Northern Cheyenne Tribe; Elizabeth Williams, All Nations Health Center; Kim Brown, Billings Urban Indian Health and Wellness Center; Todd Wilson, Helena Indian Alliance; Shannon Parker, Northern American Indian Alliance; Angela Troutt, Billings Area Indian Health Services; To be named, Indian Family Health Clinic
Long term care facilities: Rose Hughes, Montana Health Care Association
Correctional facilities: Cindy Hiner, Montana Department of Corrections
Emergency Management Services: Mike Radke, Disaster and Emergency Services; KC Williams, Yellowstone County Disaster and Emergency Services; Dale Butori, Fallon County Disaster and Emergency Services
Rural health: Cindy Stergar, Montana Primary Care Association
Pharmacies: Stuart Doggett and Michael Matovich, Montana Family Pharmacies
Business and occupational health organizations: Todd O’Hair, Montana Chamber of Commerce
Health insurance issuers and plans: Tim Wetherill, Blue Cross Blue Shield of Montana; Dr. Stephen Tahta, Allegiance; Richard Miltenberger, Mountain Health CO-OP; Matt Bell and Jen Hensley, PacificSource Health Plans
Organizations serving individuals with disabilities: Bernie Franks-Ongoy, Disability Rights Montana; Scott Birkenbuel, Statewide Independent Living Council; Travis Hoffman, Summitt Independent Living; Joel Peden, Montana Independent Living Project; Deb Swingley, Montana Council on Developmental Disabilities; Patrick Maddison, Montana Association of Community Disability Services
Educational agencies and providers: Clayton Christian, Office of the Commissioner of Higher Education; Diedre Murray, Montana University System; Kirk Miller, School Administrators of Montana
Churches and religious leaders: Kendra Wilde, Our Redeemer’s Lutheran Church; Student Rabbi Erik Uriarte, Congregation Beth Aaron
Organizations serving racial and ethnic minority groups: Kathe Quittenton, DPHHS State Refugee Coordinator; Bonnie Sachatello-Sawyer, Hopa Mountain; Allison Paul, Montana Legal Services Association; Judith Hielman, The Montana Racial Equity Project
Organizations serving people with limited English proficiency: Vicki Thuesen, Montana Migrant and Seasonal Farmworker Council
Community representatives: Eric Bryson, Montana Association of Counties; Liz Moore, Montana Non-Profit Association
Mental health representative: Matt Kuntz, National Alliance on Mental Illness-Montana
Behavioral health: Mary Windecker, Behavioral Health Alliance of Montana
Adult and child congregate group homes: Matt Bugni, AWARE, Inc.
Home health workers: Jacquie Helt, SEIU 775 Healthcare; Janessa White and Katie Spaid, Consumer Direct
Childcare and early childhood: Meghan Ballenger, Montana Child Care Resource and Referral Network; Patty Butler, DPHHS Early Childhood and Family Services Division/Child Care Licensing
Homeless shelters: Amy Allison Thompson, Poverello Center
Organizations on aging: Nancy Anderson, AARP; Kris Spanjian, Big Sky 55+; Adrianne Cotton, Montana Area Agencies on Aging Association
Unions: Emma Merle Hunter, Montana Federation of Public Employees