Montana prepares for initial COVID-19 vaccinations

The first doses could arrive as early as next Tuesday, and will be prioritized for health care workers and assisted living facilities.

When 9,750 doses of the Pfizer COVID-19 vaccine arrive in Montana as early as next Tuesday, the delivery will mark the beginning of a complex distribution plan organized by public health officials, hospital administrations and commercial pharmacies.

The goal of the initial round of distribution, state officials say, is to get the vaccine to as many frontline health care workers as possible. As of Tuesday, Montana reported 17,293 active cases, with approximately 70% of the state’s ICU beds full, and 38% of those occupied by COVID-19 patients. Scores of health care workers have had to stay home sick or quarantine because of exposure to COVID-positive patients.

After the Pfizer vaccine is cleared for emergency use by the Food and Drug Administration, which plans to discuss the proposal on Thursday, hospitals will begin to administer the first batch of vaccines to a fraction of the state’s health care workforce, particularly in more populated cities and towns.

Officials with the state Department of Public Health and Human Services say the coming vaccines are a crucial tool in fighting the disease.

“The vaccine is a really good opportunity to help us get through this pandemic and reduce the burden of the virus on our communities,” said Bekki Wehner, who heads the department’s Communicable Disease Control and Emergency Preparedness Bureau. “The hard part is that there are going to be times when there are limited supplies of vaccine. We just need to work our way through it and take it day by day.”

During the state’s preliminary stages of distribution, officially designated as Phase 1a, health care workers and adult care facility residents and staff are considered top priority. Later phases will include more groups that the Association for Professionals in Infection Control and Epidemiology (APIC), a nonprofit professional organization, has recommended be moved to the front of the line, including designated essential workers such as firefighters and education employees. The state has said it will rely on those recommendations to guide its distribution plan.

In the short term, the distribution of the small number of early doses from Pfizer is full of hurdles for health care officials to navigate. The state is including only a handful of well-resourced hospitals in the early round of vaccine administration because those hospitals already have access to the necessary storage facilities: ultracold freezers that can keep the Pfizer vaccine at its required temperature.

The Montana facilities that have been cleared to receive the doses from the state are Billings Clinic and St. Vincent Healthcare in Billings, Bozeman Health Deaconess Hospital, St. James Hospital in Butte, Benefis Health System and Great Falls Clinic, St. Peter’s Health in Helena, Kalispell Regional Medical Center, and Providence St. Patrick Hospital and Community Medical Center in Missoula.

Larger hospitals are considered appropriate recipients of the first distribution batch because they have more employees. Pfizer’s vaccine shipments contain a minimum of 975 doses. Hospitals and health care providers that employ a significantly smaller number of frontline health care workers, Wehner said, weren’t considered a good fit for the initial distribution.

In the coming weeks, Wehner said, a COVID-19 vaccine manufactured by Moderna, which is also awaiting emergency use authorization from the FDA, may be a better fit for health care facilities in rural and remote communities. That vaccine is expected to ship in smaller packs of 100 doses, and does not require the same access to cold storage.

“In those [rural] communities, the Moderna vaccine makes more sense,” Wehner said. As the state progresses through subsequent phases of distribution, she continued, the department might also look to orchestrate a “hub and spoke model” by which the vaccine could be ferried to remote communities from centralized locations.

Other players involved with securing vaccine shipments and overseeing distribution include CVS and Walgreens, which have federal contracts to supply vaccinations to long-term care facilities, and the federal Indian Health Service, which several tribal nations in Montana have opted to work with.

Once the vaccines become more widely available to people outside the health care professions and adult care facilities, communities across the state will be working to minimize a range of other barriers to access.

In a state with a population density of roughly one person per square mile, ensuring that residents can easily receive the vaccine is no simple task, said Sophia Newcomer, an assistant professor of epidemiology at the University of Montana.

“If people have to drive far, if they have to take time off work, if there’s transportation challenges, those are certainly barriers to vaccine access,” Newcomer said, adding that now is the time for health officials and community members to think holistically about how to facilitate distribution.

“There are some strategies that we’ve looked at in the past, such as mobile vaccination clinics, that may not work as well with some of these initial vaccines that do have very specific temperature requirements,” she said. “But I think now is the time to be creative and make sure that when specific locations have these vaccines, that we can make it as easy as possible for people to present and get those vaccines.”

Another logistical hurdle, Newcomer said, is the necessity of administering a second shot three to four weeks after the initial dose of either the Pfizer or Moderna vaccine. Planning for rigorous follow-up communication with recipients and appointment scheduling will be key to ensuring the vaccine’s effectiveness.

Across the Flathead Reservation, the Confederated Salish and Kootenai Tribes are planning for exactly those kinds of difficulties. The tribes have decided to work with the state to receive vaccine distributions in the coming weeks, but are still discussing the logistics of storing and administering the doses.

“[Driving to get the vaccine is] impossible for a lot of people, because they just don’t have transportation. And then getting people to give them a ride is going against that social distance piece,” said Chelsea Kleinmeyer, director of the Tribal Health Department’s Community Health Division. “You know, we’re telling people to only be with the people in your immediate household. Well, if they need to get a ride to go get a vaccine, then there’s always that other exposure piece involved. And so, it is complicated.”

Besides the inherent complications of making vaccines available across rural communities, Kleinmeyer said, Tribal Health is also working to build confidence about the shots and encourage the community to participate.

“I think part of [the hesitation] is the perception that this was a very quick process, and we’re trying to dispel that. Vaccines do go through a very rigorous process. The process this went through was, in regards to clinical trials, it was the same [as] for any other vaccine,” Kleinmeyer said.

Preparing to address community concerns and vaccine skepticism should be built into the state’s distribution strategy, Newcomer said.

“People need to have confidence that the vaccine is safe and effective. It’s OK to have questions about vaccines. And we should have ways that people can get answers from trusted, knowledgeable sources,” she said, referencing the value of messaging from nurses and doctors in particular.

“First and foremost, I think it’s important that our medical workforce in Montana has the information that they need to have those effective vaccine conversations,” Newcomer said. “And then I think there is a need for just general public education about the vaccine.”

Some of Montana’s public officials are working toward that same goal. Gov. Steve Bullock’s administration has organized a coordination team comprising representatives from labor groups, community organizations and local governments to offer education about the distribution plan. The group will hold its second planning meeting on Thursday, Dec. 10.

Sen. Steve Daines has also been a vocal proponent of clinical trials and vaccine research over the last several months. He recently announced that he and his wife participated in the Pfizer trial.

“My goal is to help build confidence and trust for Montanans and the American people wondering if they should take the vaccine when it is approved,” Daines said in a press release issued in November. “This is about saving lives. This is about supporting our healthcare heroes. This is about protecting Montana jobs & workers and rebuilding our economy.”

Daines said he trusts Montanans to “use commonsense and practice personal responsibility” in the coming months by consulting with their doctors and opting to receive the vaccine when doses become available.