Forging Ahead: DHEC leaders break down South Carolina’s COVID-19 vaccine distribution plan

Forging Ahead: DHEC leaders break down South Carolina’s COVID-19 vaccine distribution plan

COLUMBIA, S.C. (WMBF) - With less than two months to the close of 2020, we are on the cusp of an anticipated rollout of a COVID-19 vaccine.

States and jurisdictions across the country have been tasked with submitting their own vaccine distribution plans in order to prepare for the delivery of the first doses.

South Carolina’s interim vaccine plan was submitted to the federal government, successfully meeting the expectations of the Centers for Disease Control and Prevention and Health and Human Services. But states are expected to add to their plans as more information becomes available on the vaccine and how it needs to be distributed.

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Supplies are expected to increase over time to the point where all adults should have the capacity to be vaccinated in the next year, according to the CDC.

The road ahead is expected to be long, but South Carolina health officials and community leaders are eagerly planning their next steps in hopes of altering the trajectory of a worldwide pandemic toward the hope of a vaccine available for all.

WMBF Investigates is taking you along that journey forged.

At the reins: South Carolina’s Department of Health and Environmental Control

South Carolina officials submitted their COVID-19 Vaccine Plan on October 16, after federal officials called on each jurisdiction (such as states, territories, select cities and counties) to submit a plan by then.

A Unified Command Group will oversee the Vaccination Task Force. This group includes DHEC’s director, the state’s Emergency Management Division’s director, the adjutant general and the state epidemiologist.

The Task Force structures itself as follows:

  • Logistics
    • DHEC leads; SCEMD and SC National Guard supports
  • Planning
    • DHEC leads; SCEMD, SC National Guard, SC Hospital Association supports
  • Finance
    • DHEC leads; SCEMD, SC National Guard supports
  • Communications
    • DHEC leads; SCEMD, SC National Guard supports

The Vaccination Task Force will also receive input from the established Vaccine Advisory Committee, which includes stakeholders from various groups with interests in hospital work, family health, minorities, abilities, faith, rural health and more.

The committee is to use a “weighted ranking of risk and follow a consensus-based approach to submit recommendations to DHEC for prioritizing target populations to be phased in for vaccination as vaccine availability allows.”

This committee meets weekly and involves representation from over 20 organizations.

“The Vaccine Advisory Committee has been an important source of discussion around the ethical and equitable distribution of a vaccine, and appreciating who are the at-risk communities, and the representation is quite diverse,” explained Dr. Jane Kelly, South Carolina’s assistant state epidemiologist.

Charting a phased approach

South Carolina’s plan structures itself by three phases, which is specified in the CDC’s playbook that was provided to help jurisdictions “plan and operationalize a vaccination response to COVID-19.”

“Because we are early in production, there will only be a limited supply available initially,” said Stephen White, DHEC’s director of immunization.

The first phase of COVID-19 vaccine distribution assumes this minimal availability. The focus will rest on reaching targeted populations that include healthcare personnel, people at high risk, and critical infrastructure workers.

The number that has not been articulated is just how many doses South Carolina will receive in the initial phase. It is with that unknown that state officials have to be strategic and ethical with how they begin distribution.

“As we’ve been discussing at our Vaccine Advisory Committee, we’ve been discussing this exact question of what’s an equitable framework,” said Kelly. “And the number one overarching goal is preventing or reducing mortality.”

She said that is why the highest priority will go to workers in healthcare settings first, who help save lives.

“Because if they get sick, they are out of work, then we run the risk of overwhelming our hospital systems,” she said.

This would be just the beginning stages and would entail close monitoring of inventory, distribution and handling requirements of the vaccine, in order to make sure the process of distribution is followed through completely. Only a limited number of providers would be utilized during this stage.

In the event of insufficient vaccination supply, subsets are specified within this phase as well - Phase 1-A and Phase 1-B. The advisory committee will also provide recommendations for even further sub-prioritization within these groups.

According to the state’s vaccine plan, Phase 1-A would be whittled down to include “paid and unpaid people serving in healthcare settings who can potentially or indirectly expose patients or infectious materials and are unable to work from home.”

Kelly said those receiving the vaccine within Phase 1-A would be decided in part by local conditions.

“A big city hospital with a great many healthcare workers, for example, who may have very specific expertise in intensive care unit care are at a very different situation,” Kelly said. “They’ve got more surge capacity than a small rural facility, for example, who may have a much more limited number of personnel in certain areas. And when I talk about personnel, I’m not just talking doctors and nurses; there are a great many other individuals who are involved in working in healthcare settings that are critical to saving lives.”

Phase 1-B would include those who “play a crucial role in sustaining essential functions of society running and cannot socially distance in the workplace.”

This is defined as healthcare personnel and emergency/law enforcement personnel not included in Phase 1-A, food packaging and distribution workers, teachers/school staff and childcare providers, as well as those at an increased risk for a severe case of the virus (such as people aged 65 and older).

Eventually, the state would enter Phase 2 when a large number of vaccine doses become available. According to the plan, officials would focus on ensuring access for those Phase 1 targeted groups who still had not been vaccinated, followed by expanding to the general population with the help of an expanded provider network.

And finally, a third phase would entail a sufficient supply of vaccine that would be available for the entire population, with even a surplus of doses. The focus would shift to “ensuring equitable vaccination access in the whole population.” During Phase 3, officials would be monitoring the uptake, and working to increase it in communities that are found to have low coverage.

“We understand from the federal government that the vaccine itself will be free,” Kelly said, “But we also want to make sure that insurance companies cover any administrative costs; we want to make sure that this vaccine is free and available to everyone.”

When we can see a vaccine

The Advisory Committee on Immunization Practices is the group that gives the CDC recommendations.

During the group’s meeting in October, an optimistic “jurisdictional readiness” date of Nov. 15 was identified as what was being worked toward in the next steps for vaccine implementation.

This date has long since passed. Similarly, South Carolina’s interim plan made an assumption that limited amounts of a vaccine could be available nationwide by the end of October.

“I’m not certain where some of those figures came from. I think they were optimistic,” Kelly said.

Kelly said Nov. 15 functioned as a theoretical construct.

“I think we all want to be prepared, so we set dates for framework to make certain that as soon as a vaccine is available, that we would be ready to go,” she said.

Pfizer and Moderna this month have made announcements of great rates of effectiveness. However, Kelly cautions, it is very preliminary news.

“We would have to wait to see when they [Pfizer] complete their Phase 3 trials, and part of FDA’s ensuring safety, is that they require a median time after the second dose of vaccine, for that Phase 3 trial - a median amount of time - two months - after the Phase 3 was completed to look for safety concerns,” Kelly explained.

She said most adverse effects occur within the first six weeks of administering a vaccine, so that’s why federal officials employ a safety time period.

“Then the FDA will need at least two weeks to review their EUA [Emergency Use Authorization], and then there’s yet another step with the ACIP review as well,” Kelly said. “Even if everything goes picture-perfect, we can’t anticipate realistically having any vaccine in hand available for vaccinating people until mid-to-end December.”

Distributing a vaccine with the help of providers

South Carolina health officials said they feel confident in being ready to handle a vaccine in its storing and distribution, which will require the help of providers.

According to the state’s vaccine plan, of the 387 providers who responded to a survey, 80.1% of them indicated an interest in participating.

Providers can include institutions such as chain and independent pharmacies, urgent care centers, hospitals and nursing care facilities.

“We’re currently working with providers through the recommendations from the Vaccine Advisory Committee and other partners to assure that we have a significant number of vaccinators that we are working on identifying which sites are going to be selected as the first sites that would receive doses, especially as we have very limited doses to start,” said White.

White said providers will have to be enrolled with the DHEC as a provider in order to “gain access, to receive the vaccines, in order to administrate it.”

Providers must have the capacity to both receive the vaccinations and be able to administer it. They agree to store and maintain the vaccines and log them into federal and state information systems.

“A vaccinator provider will have to enter into a required CDC enrollment,” White said.

Open enrollment is currently ongoing which can be found online through DHEC. DHEC hasn’t set a number of desired providers at this time, but they are reaching out to providers to help answer questions and guide them through the process.

In the state’s vaccine plan, DHEC does state that they are exploring additional avenues to get certified vaccinators to help administer a vaccine in case DHEC becomes a COVID-19 vaccine provider during Phase 1.

“These certified vaccinators will potentially administer vaccines at vaccination sites,” according to the distribution, which could include existing Points of Dispensing or mobile clinics.

When someone is a provider, they will have to document inventory levels, including any wastage levels.

Over the course of the pandemic, DHEC has established a number of dashboards and information portals to track the development of COVID-19 in South Carolina. DHEC expects to provide regular updates to the public on vaccine administration as well, though the level of detailed tracking information that they will post online has not been decided yet.

Ultimately, DHEC officials said, the state’s overarching goal is to have a “fair and equitable distribution of the vaccine across the state” as agencies and key partners continue to stay connected and review new information from the federal government on how best to proceed.

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