The Cooper administration is turning to the phases strategy again for a key COVID-19 initiative — this time for vaccine distribution.
The state Department of Health and Human Services submitted the first version of its distribution plan to the federal Centers for Disease Control and Prevention by Friday's deadline. The submission was 148 pages.
Dr. Mandy Cohen, the state's health secretary, said the "goal of the plan is to immunize everyone who is eligible for and wants a COVID-19 vaccine."
However, both Cohen and Cooper acknowledged with the submission that phases of distribution would be necessary because of an expected limited initial vaccine supply.
There is an expectation the first round of vaccines could be ready for limited distribution between November and April, and that individuals will require at least two doses.
As expected, those at the top of the priority list include health-care providers and emergency responders who are at high risk for exposure, those who are vital to the initial COVID vaccine administration efforts, and staff in long term care facilities.
DHHS estimated that up to 951,000 individuals could receive vaccine doses in Phase One.
Although there is not a specific DHHS tracking of COVID-19 case and death totals for health-care providers, there has been with long-term care facilities.
As of 4 p.m. Friday, there have been 18,535 COVID-19 cases and 1,990 virus-related deaths involving long-term care facilities, which represent 7.6% of cases statewide, but 50.5% of deaths.
DHHS said the next priority will be for individuals at high health risk for COVID and at high risk for exposure, including residents in long-term care facilities, those over age 65, staff of congregate living settings (migrant farm camps, jails and prisons, and homeless shelters) and anyone with two or more chronic conditions identified by the CDC to be high risk for COVID complications.
Historically marginalized populations and teachers also are represented in this prioritization groups.
Remaining phases will includes lower-risk populations, and have more of a focus on decreasing transmission through the population.
North Carolina’s prioritization was developed based on the National Academy of Medicine framework and in consultation with an external COVID-19 Vaccine Advisory committee convened by the N.C. Institute of Medicine.
A co-chair of the vaccine advisory committee is Dr. Goldie Byrd, director of the Maya Angelou Center for Health Equity at Wake Forest University.
"Leaders from across sectors came together under tight timelines to collaboratively develop a vaccine plan that leads with equity and prioritizes building trust," Cohen said.
"We will continue to update this plan as we learn more from the science and data on vaccines and in response to the needs of North Carolinians."
DHHS said the first phase involves developing the distribution plan, which includes: "finalizing priority populations for vaccination based on risk of exposure and risk of morbidity and mortality from COVID-19 with input from the external advisory committee; designing a process to identify and enroll providers who are able to reach the priority populations."
The second phase represents the initial distribution of vaccine once doses are allocated to North Carolina with a "focus on the logistics required to receive and administer vaccines to prioritized populations." It is expected to cover between 1.18 and 1.5 million North Carolinians.
The third phase commences when larger amounts of vaccine are available. The focus at that time will be "on building capacity of providers to order vaccine based on local demand." It is expected to cover students and other workers and between 574,000 and 767,000 individuals overall.
The fourth phase would cover everyone else — between 3.6 million to 4 million — and go into effect when "there is sufficient vaccine to immunize anyone in the state who wants to be vaccinated in more established delivery channels similar to influenza vaccination campaigns."
Mike Sprayberry, director of the state's Emergency Management division, said the overall vaccine distribution plan "engages the state’s resources down to a county and local level and allows for flexibility based on data so we can pivot quickly and get the vaccine to those who are most in need."
It remains unclear how soon North Carolinians will be able to receive a COVID-19 vaccine.
There are multiple vaccines in development and clinical trials, but none have been presented to the Food and Drug Administration to consider for authorization and distribution.
"Promising vaccines are being manufactured at the same time they are being tested, so there will be an initial supply when the science shows which vaccines are found to be safe and effective," DHHS said.
Vaccine advisory committee members said they understand part of the challenge for a successful vaccine distribution is convincing North Carolinians to participate.
For example, a recent Gallup poll released Tuesday found that half of Americans say they are hesitant or unwilling to take an FDA-approved COVID-19 vaccine. That's down from 66% in July and 61% in August.
The DHHS submission cited a September WRAL/Survey USA poll that found just 23% of North Carolinians "are willing to be vaccinated as soon as a COVID-19 vaccine is released, with Black (9%), female (13%) and rural residents the least likely."
"There is considerable uncertainty, particularly among Black (19%) and rural (21%) North Carolinians who say they are not sure when they would likely get a vaccine."
Dr. Art Apolinario, a family medicine physician at Clinton Medical Clinic and board member of the N.C. Medical Society, said that "my patients have taught me how important it is to recognize the mistrust that the current health care system has created with non-white communities."
"We worked to ensure that racial disparities and equity in delivery of care were recognized and put in the forefront of this COVID-vaccine decision making process."
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