Bracing for ‘Logistical Nightmare’ of COVID Vaccine Distribution

The vaccines for coronavirus disease 2019 (COVID-19) continue on the fast track to approval by the US Food and Drug Administration. Approval for the Pfizer/BioNTech could come as soon as tomorrow. Workers and residents at long-term care facilities as well as healthcare employees in general will the first recipients of the vaccine. If they want it. That’s suddenly become a big if as questions arise about side effects. At most hospitals, employment depends on getting vaccinated against influenza. Healthcare administrators probably won’t make getting the COVID-19 vaccine mandatory because it’s so new, says infection prevention expert Sharon Ward-Fore, MS, MT(ASCP), CIC. But whatever happens, Ward-Fore tells Infection Control Today®, infection preventionists will most likely be involved. “I just want to arm them with a lot of information because that’s what IPs are good at: disseminating information and providing people with sources of truth to learn about things,” says Ward-Fore. “I would make sure that all the IPs are up to speed. What do the data show? What is the efficacy? What are the side effects? What group is going to be most affected? And really play up the healthcare role of ‘this is for your benefit, and for those you care for’, which is what we did with flu.”

Infection Control Today®:In your experience, how big of a role do infection interventionists play in the flu vaccination efforts that go on in hospitals?

Sharon Ward-Fore, MS, MT(ASCP), CIC: It depends on how the department is set up. Some infection preventionists are probably still under the heading of the occupational health or employee health nurse. They may operate a little differently than departments that have a separate occupational health/employee health component from infection prevention. Where I came from, infection prevention along with occupational health, employee health, and pharmacy, were the drivers for starting to prepare for flu season. They were all the stakeholders that would weigh in on what vaccine we would need and how to get it. And then we would work with nursing and pharmacy to figure out how to distribute this. I forgot to mention nursing. They play a huge part in this because they’re primarily responsible for providing the vaccine. IPs are not typically

Sharon Ward-Fore, MS, MT(ASCP), CIC

giving vaccines. Those that are nurses are able to do that, though. Regarding the COVID vaccine, I think there’s been a lot of press about it. And healthcare staff are hesitant to be the first people to receive the vaccine. I read an article yesterday in the Washington Post on it, and NPR has been talking about it and trying to get healthcare workers to understand that it actually is in their best interest to get this vaccine. But I can understand their hesitation. There’s got to be a lot of education about the safety and efficacy of this vaccine in order to get it accepted. Now flu vaccine, on the other hand, a lot of hospitals mandate it. It’s already a given that you will get it but there’s years and years of proven safety and efficacy. But there still are healthcare workers that decline. So right now, we probably shouldn’t compare the two. But wait and see what additional information we get on COVID. It’s probably going to be a reservation type system. And you can still socially distance. Normally they would have tables set up in big common areas. You could probably still do that keeping people six feet or more away from each other. As long as people are masked up, and you maintain that social distancing, it’s probably the best way to do it. Again, a reservation system may be how some are doing it to keep a crowd of people from congregating in a certain area. It just depends on the facility. Some people will have flu captains that will go around with carts to certain areas and give the flu. That’s also a good method, although that particular flu captain may have a repeated exposure to people. I think in the pandemic, there are a lot of those little details to work out. October was definitely the time to start getting staff vaccinated for the flu, because now we’re well into our peak season, which is really from December to February. And the flu vaccine does take a couple of weeks to become effective.

ICT®: We’ve been hearing from experts and seeing data that suggest that because many people are protecting themselves from COVID, that has cut down flu rates this year. Is that what you’re hearing?

Ward-Fore: Well, yes, right now, there’s not a lot of flu being seen. But last year, flu was late to get started. We may have a flu season like that again this year. But you’re absolutely right. With everyone masking preemptively, I would hope that our flu numbers would be drastically reduced. It’s kind of a wait-and-see approach. And a lot of people with flu don’t get tested. There could be flu out there that we’re not aware of. They just stay home and sort of tough it out. It does present like COVID, too, in certain symptoms. A lot of people want to stay away from a healthcare facility. They may be riding out flu at home. I know a lot of places are not testing for both right now. But maybe as we get more into our peak flu season, they will. So right now, not a lot of flu being seen.

ICT®: I’m assuming that places like the Mayo Clinic, Johns Hopkins and probably most hospitals in the country are in fact making plans concerning what they’re going to do when the COVID-19 vaccine comes out. How are they going to go about vaccinating their employees and how are they going to encourage their employees to take it? Is that what you’re hearing?

Ward-Fore: I queried a couple of academic medical centers to find out what they’re doing. And to be honest, they—because it’s so new with the rollout—they’re not quite sure how they’re going to handle it. Again, because it’s so new. I asked whether they were going to mandate it like most places do for the flu vaccine, and they said they’re very unsure about that right now. I think right now, there are a lot of areas where they just don’t have the answers yet. Ideally, it would be great if all healthcare providers were vaccinated against flu and COVID for their safety and the safety of those they care for. But I think there’s been a lot of negativity around receiving the COVID vaccine that needs to be overcome before people are more willing to accept it. And I think you know, Doctor [Anthony] Fauci said he would take it. [President-elect] Joe Biden said he would take it. Three former presidents said they would do it publicly. I think people need to see those efforts as it is safe, it is 95% effective. And it’s our best bet at overcoming this pandemic and getting our economy started too. I think I’m going to take it. I hope everybody does. But I understand their hesitation.

ICT®: What about possible side effects? Is that a legitimate concern that people have? If Doctor Fauci says “Don’t worry about the side effects” then you just don’t worry about them? I don’t know if people can do that.

Ward-Fore: What I know about the vaccine and how it was created, it’s modeled after a lot of other vaccines that are currently out there, which are safe. I believe Dr. Fauci. I believe his group will look at the data and make sure it’s effective. But on the other side of it, Pfizer’s reputation, and Moderna’s, is on the line. And I think they followed every step of their clinical trials that they needed to, and it’s been reviewed by the FDA, and the FDA is supposed to be an unbiased entity. I hope we’re all looking at the science of this vaccine. And not rushing into anything. And I don’t know if you saw the news last night, but Dr. Fauci was a little taken aback that the UK skipped over a step in their distributing the vaccine. We could look at them as our guinea pigs and see what happens there because it will be the same vaccine. And hopefully, there will be no side effects other than, you know, the normal: the burning at the site, maybe pain, maybe a little redness, but nothing beyond that. But I honestly don’t know all of the documented side effects from the clinical trials. But Dr. Fauci will know those.

ICT®: If you were the administrator of all hospitals, how would the infection preventionists be involved in A) flu vaccinations and B) COVID vaccinations?

Ward-Fore: A lot of infection preventionists are not nurses, so they can’t legally give vaccinations, but those that are would certainly be asked to chip in to help vaccinate people. If it were my institution, I would make sure that infection preventionists are educated on everything they need to know about the COVID vaccine, as well as the flu vaccine side effects. Maybe age groups that are most affected by both of these diseases. I just want to arm them with a lot of information because that’s what IPs are good at: disseminating information and providing people with sources of truth to learn about things. I would make sure that all the IPs are up to speed. What do the data show? What is the efficacy? What are the side effects? What group is going to be most affected? And really play up the healthcare role of “this is for your benefit, and for those you care for,” which is what we did with flu. It’s the same mantra, just this is going to benefit everybody and keep everyone safe.

ICT®: Are you worried about how the vaccine is going to be distributed? Who’s going to administer the vaccine? How fast can it be distributed? And who’s going to track it and how are they going to track it?

Ward-Fore: Those are all really good questions. And I watched a webinar on vaccine development that addressed those things quite a few months ago. But actually, the United States should have been looking at that years ago, in preparation for a pandemic. So yeah, I am worried because you heard that Pfizer had a little glitch with their supply chain, and now they slashed their doses in half, but then they said they’ll have enough. I am hoping it will be equitable. But I was just talking with someone yesterday about somebody hijacking a truck full of vaccine, and then it’s on the black market or something. I’m hoping it will be fair and equitable. I’m hoping the supply chain has in their back pocket a plan for all the different scenarios of what may happen. I think that the plan as it’s laid out right now with healthcare workers, and first responders, and then skilled nursing congregate settings, like skilled nursing facilities and jails get this vaccine is a good plan. Those are some of our highest risk patients and where we have our greatest number of cases. I think it’s been a thoughtful process. But I’m also not naive to know that there will be those that will feel that they weren’t included soon enough, and some were included too soon, and then others will try and find a backdoor way to get the vaccine. I’m glad I’m not in charge of this. Because it seems like a logistical nightmare. But there are a lot of good people working really hard to figure this all out.

ICT®: Who would be considered an essential worker who should get the COVID vaccine?

Ward-Fore: That essential worker term is kind of nebulous. In my head, I would think it would be healthcare workers, especially ICU workers, caring for the most critically ill. But we know it’s a two-dose vaccine. So already, we’re going to vaccinate those folks, and then try to have enough vaccine for them to come back later. I’m seeing some issues with we can probably do ICU workers, we should probably do COVID unit workers. But essential workers? I’m kind of with you that they’ve been exposed a lot. And, and if part of this is to get our economy going, then we need to vaccinate those that keep our economy going. And that would be just like you said, you know, it’s the people who stack the shelves and the bus driver and those folks. I don’t really know how they’re going to do this, because what we think is fair may not be what others think is fair. I agree with the skilled nursing facility, congregate settings. That can’t actually happen soon enough in, in my opinion. But I don’t know what’s going to happen. I’m a little concerned. And I guess we just hope for the best and hope that people understand that someone like myself—I’m not in the healthcare setting anymore. I’m at another age group level, but I have no comorbidity. I will probably be pushed back. And I’m OK with [being at] the end of the line, because I will still continue to socially distance and wear my mask and not engage in any risky behaviors that will put me at risk while I’m waiting for my vaccine. But my fear, which I alluded to before, is that we know this is two doses. I’m hoping we’ll be very successful with getting people to return for that second dose. But I’m always a little nervous about that, because it’s human nature. “Oh, I got one. It’s good enough. Why do I need the second?” Or “I don’t have time for the second.” We’ll see what happens with that.

ICT®: Is there anything about either the flu vaccination effort or the COVID vaccination effort that I neglected to ask you that you think is pertinent?

Ward-Fore: Well, I think it’s important that everyone get their flu shot if they haven’t already, because the rationale behind that is to take the strain off of our currently overwhelmed healthcare system. And, you know, there’s been a lot of information—I think even you alluded to it—about the number of people who die from flu. But that’s an estimate by the CDC that’s based on a whole bunch of algorithms that aren’t necessarily true. But just a word of caution regarding flu. In the 2019/2020 flu season, there were 22,000 deaths from the flu. You know, it pales in comparison to COVID. But those are 22,000, essentially, preventable deaths by a vaccine that we know is safe, and depending on the year, pretty effective. So that would be my word of advice. Get your flu vaccine. Continue to wear your mask correctly. Social distance, minimum of six feet, go for more. And just keep yourself safe until your slot in the COVID vaccine comes up and you’re able to safely get it. Because who wants to be the person who died right before the vaccine came out?

ICT®: Right. You just gave me a soundbite.

This interview has been edited for clarity and length.