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BOULDER— Nearly 2,000 COVID-19 vaccine doses could arrive in Boulder County hospitals within days, raising questions and suspense about what will — and should — happen next.
Who will get vaccinated first? Second? Third? How will vaccines be equitably distributed? Will there be mandates? What about our kids, teachers and schools?
The Boulder Reporting Lab compiled an explainer to help you sort through the information. We will update this story as we learn more.
While there are still unknowns, at least one crucial thing is clear: Boulder County residents should plan on donning masks and postponing gatherings well into the foreseeable future.
“It’s a middle step,” said Dr. Thomas Campbell, a virologist and infectious-disease specialist at the University of Colorado School of Medicine and UCHealth. Campbell is leading the Moderna Phase 3 clinical trial of 217 people at UCHealth on the CU Anschutz campus,one of 88 such trials nationwide.
“The beginning has been the vaccine development and the vaccine trials, and the next step is to start implementing the vaccine,” he said. “The end game will be when COVID-19 stops overwhelming our hospitals and stops killing people. The vaccine is not going to be the end of SARS-CoV-2.”
How many doses will Boulder County get?
Two Boulder County hospitals will receive 1,950 doses of the initial allocation of the Pfizer-BioNTech vaccine, according to a release issued by the Colorado Department of Public Health & Environment (CDPHE) on Friday morning. The hospitals are Foothills Hospital (Boulder Community) and Good Samaritan Medical Center. They will each get 975 vaccines.
(Click to see the hospital-by-hospital allocations in Boulder County.)
“These locations were chosen for their unique abilities to store, monitor, and handle vaccines in ultra-cold temperatures,” CDPHE said, “as well as their willingness to redistribute COVID-19 vaccine(s) to other providers in their regions.”
Eleven local hospitals will receive the Moderna vaccine.
Longmont United Hospital and Longs Peak Hospital will each receive 700 doses of the Moderna vaccine. Salud Family Health Center Longmont will receive 100 doses.
In total, 6,200 doses will be allocated initially at the county level.
As distribution continues, the CDPHE said Coloradans should expect to get 1.69% of the CDC’s weekly allocation. Allocations are based on each state’s population.
Will healthcare workers (or anyone) be mandated to take the vaccine?
No.
Colorado “will not be issuing a vaccine mandate,” the Colorado State Joint Information Center told The Boulder Reporting Lab.
In Campbell’s opinion, a mandate would not be sensible at this point.
The Pfizer and Moderna vaccines were designed to protect individual health — to prevent a person from getting ill once exposed. They’ve been about 95% effective at that. The hope is that the vaccines would also protect societal health by preventing the spread of the virus. But these clinical trials weren’t designed to evaluate transmission.
That’s “going to be evaluated by good epidemiology studies,” Campbell said.
Dr. Nancy Stolpman, director of pharmacy at UCHealth, agreed that a mandate is premature.
“There are so many unknowns right now — how long does the vaccine last, do we have to be vaccinated again, does it give us the herd immunity people are looking for?” she told The Boulder Reporting Lab. “I think it will be a while before a mandate will come out.”
Who will get the first doses in Boulder County?
The first doses will be available to “highest-risk healthcare workers and individuals” only, according to a phased distribution plan released by the CDPHE on Wednesday.
This would be Phase 1A. It would cover anyone who has “direct contact with COVID-19 patients for 15 minutes or more over a 24-hour period,” as well as residents and staff members of long-term care facilities.
Who will be next?
There are three phases.
Phase 1A, as noted, would begin as soon as doses arrive.
Under Phase 1B, “moderate-risk healthcare workers and responders” would be able to get vaccinated, likely later this winter. Members of this group include healthcare workers who have less direct contact with COVID-19 patients, workers in home health and dental settings, emergency first responders and correctional workers.
Phase 2 would begin in the spring and would include “higher-risk individuals and essential workers.” Also in this cohort would be individuals age 65 and older, people of any age with certain diseases or who are immunocompromised, workers who interact directly with members of the public (including teachers and grocery store employees), people who work in high-density environments like farms or meat-packing plants, and workers serving people who live in high-density setting.
Healthcare workers not included in Phase 1, and adults who received a placebo during a COVID-19 vaccine trial would also be part of Phase 2.
(Click to enlarge this image)
What about the general public?
Only in Phase 3, expected in summer 2021, would members of the general public –anyone age 18-64 without high-risk conditions — be eligible for vaccination.
Chana Goussetis, Boulder County Public Health spokesperson, said the department is “currently working with our partners to finalize a plan for distribution to the general public when enough vaccine becomes available.”
What about children under 18?
There remain unknowns about young children and the vaccines (see below), which is typical at this stage of vaccination trials.
It’s likely to be a long while before there is enough data to begin vaccinating children.
How will distribution move from phase to phase?
This will depend on vaccine availability.
“Our ability to vaccinate the various prioritized groups will be dependent on supply,” the Joint Information Center said. “We expect the initial supply of COVID-19 vaccines will be very limited.”
The CDPHE will be monitoring how many people get the vaccine through the Colorado Immunization Information System.
“As demand is saturated in one group, we need to be ready to move onto the next group before 100% coverage is attained to ensure that vaccines are used as effectively as possible,” the Joint Information Center said.
Plans have been rapidly evolving, the Center noted. The number of Coloradans in each phase has also been changing (and will change again when new Census data is released).
So far, the CDPHE has identified approximately 331,000 healthcare workers between Phases 1 and 2 and 214,000 long-term care residents and staff statewide.
How much will it cost residents to be vaccinated?
Nothing.
“As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers will not be allowed to charge individuals for the vaccine or administration of the vaccine,” the CDPHE guidelines say.
“Providers will also not be allowed to turn away an individual because of their inability to pay or medical coverage status.”
This is not unprecedented. The State of Colorado allows individuals without private insurance, Medicare, Medicaid or Child Health Plan Plus (CHP+) to receive other recommended vaccines for free at select healthcare providers.
When will the different vaccines be administered in Boulder County?
The first doses will be from Pfizer-BioNTech. On Friday, the FDA approved the vaccine for emergency use.
Campbell, who leads the Moderna trial at UCHealth, said Moderna’s vaccine is about a week behind Pfizer’s in the FDA approvals process.
“We know that after the FDA review, the U.S. government has said they are prepared to start shipping out the vaccine in 24 hours,” Campbell said. It will be entirely up to the CDPHE how each vaccine is distributed within the state, he noted.
Both the Pfizer and Moderna vaccines require two doses. Pfizer’s booster must be administered three weeks after the first shot, and Moderna’s has to be given four weeks later. While Pfizer’s vaccine needs a deep freeze of -70 degrees Celsius, Moderna’s requires a milder freeze of -20 degrees Celsius.
The third-most promising vaccine, produced by Oxford-AstraZeneca, is also in a late-stage clinical trial at UCHealth’s northern Colorado hospitals.
Are there any concerns about the deep-freeze requirement?
Administering vaccines at local hospitals that lack ultra-low freezers will be “challenging, although doable,” Stolpman, the UCHealth director of pharmacy, said. Preparation has been long underway.
The Pfizer vaccine, she explained, will be coming in a storage container that can extend the drug’s shelf-life by 20 days, without an ultra-low freezer. Upon the shipment’s arrival, pharmacists need to replace the dry ice, extending the vaccine’s life by five days. They can do this up to three times before placing the drug in the refrigerator, where it can survive an additional five days.
“You can get 20 days just using the ultra-low containers to get you going,” Stolpman said. “That’s going to be really, really helpful when we have to start vaccinating the mass population.”
Many hospitals already had ultra-low freezers, she explained. At two rural UCHealth hospitals, the state provided the freezers. (Click and scroll down to see where these freezers are in Boulder County.)
Once vaccines from other companies begin to arrive, Stolpman said she envisions a positive but complicated situation, stressing that providers will need to avoid intermixing the different drugs.
“If you have multiple vaccines on hand, for medication safety, you have to really have some good processes in place to ensure the right vaccines are administered,” Stolpman said. “This whole thing is still fluid.”
How will the county ensure the vaccine is distributed equitably?
Goussetis of Boulder County Public Health said the state’s distribution model inherently accounts for equity, as many of the individuals in priority categories are members of populations who have been disproportionately affected by the virus.
“For example, many workers in high-risk settings, such as long-term care facilities, often are new immigrants or non-English speaking residents, and many essential workers who directly interact with the public are part of our Latinx/Hispanic communities,” she said.
“What will be most important is ensuring that populations who have been most impacted have accurate and timely information about where and how to get vaccinated should they choose to do so,” she said.
The city and county will rely on “a cross-sector collaboration of Cultural Brokers beyond city and county government” to deliver that information to vulnerable communities, according to Guillermo Estrada-Rivera, the program coordinator for Boulder County’s Cultural Brokers Resilience Program.
Cultural brokers act as bridges between groups of different cultural backgrounds to advance racial equity and social justice.
“Cultural Brokers have already been working on this capacity by sharing resources and updates from original sources,” he said.
What are some important unknowns about the vaccines at this point?
1. How long protection will last.
Both the Moderna and Pfizer Phase 3 clinical studies will last two years to determine the durability of the vaccine’s protection. (That’s standard for a Phase 3 trial.) Researchers are only four months into the COVID-19 trials.
“We need to know what happens over the long-term and whether protection diminishes,” Campbell said. “And of course, if it does, there might be a need for another booster dose at a later time.”
2. The vaccine’s effectiveness in children under 18.
There are question marks about whether the current vaccines could be effective in individuals under the age of 18. Pfizer only recently began enrolling adolescents in its studies, and Campbell said he knows of no trials involving younger children.
“The answer to that question lies in what are these vaccines intended to do?” he said.
The initial intention of vaccine development, Campbell stressed, has been to prevent the occurrence of COVID-19 illness rather than stop the transmission of the SARS-CoV-2 virus.
In a school environment, this means that the goal of vaccination would be to protect the teachers from becoming sick if they were exposed to SARS-CoV-2, rather than eliminate the virus’s existence entirely.
“If we protect the vulnerable part of the population that is at risk for getting very sick, then it’s possible that schools could open even without getting children vaccinated,” Campbell said.
“It’s really a question of how much the infection of children contributes to the current spread of COVID-19. We won’t know that until we see what the effect is of vaccinating adults. The important things to monitor will be hospitalizations and illness of COVID-19.”
Other resources:
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State of Colorado’s Phased Approach to COVID-19 Vaccination (CDPHE)
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Boulder County Covid Illness Data (Boulder County)
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Boulder County Covid Outbreaks (CDPHE)
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Infection and Mortality by Race/Ethnicity in Colorado (The COVID Tracking Project)
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Colorado Coronavirus Live Updates (Colorado Sun)
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New Data Reveal Which Hospitals Are Dangerously Full. Is Yours? (NPR)
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Find Your Place in the Vaccine Line (New York Times)
