EAST HARTFORD, Conn. With the prediction of the coronavirus vaccine expected to swell over the next few months, states and cities are rushing to massive vaccination sites that could inject thousands of shots a day into the arms of Americans, a Biden government approach seized as essential for achieving herd immunity in a country of 330 million.
The Federal Emergency Management Agency also joined in: it recently helped open seven mega-sites in California, New York and Texas, relying on active-duty troops to man them and plan much more. Some mass sites, including Dodger Stadium in Los Angeles and State Farm Stadium in suburban Phoenix, aim to inject at least 12,000 people a day as soon as yields increase; the one in Phoenix already works 24 hours a day.
The sites are a sign of growing momentum to vaccinate every willing American adult. Johnson & Johnson’s single-dose vaccine received emergency approval from the Food and Drug Administration on Saturday, and both Moderna and Pfizer promised much larger weekly vaccines earlier this spring. In addition to the use of mass seating, President Biden wants pharmacies, community clinics serving the poor and mobile vaccination units to play an important role in increasing the vaccination rate.
With only about 9 percent of adults fully vaccinated to date, this type of scale may be essential for mass species, as more and more people become eligible for the vaccines and as more infectious variants of the virus multiply in the United States.
But while the sites are accelerating vaccination to meet the current overwhelming demand, there are clear signs that they will not be able to handle another challenge ahead: the many Americans who are harder to reach and who are reluctant to shots.
The drive-through mass vaccination site at a secluded airport here in East Hartford, outside the capital of Connecticut, shows the promise and disadvantages of the approach.
The site is run by a non-profit health clinic and has become one of the largest distributors of shots since it opened six weeks ago, and its effectiveness has helped Connecticut become a success story. Alaska, New Mexico, West Virginia and the Dakotas alone administered more doses per 100,000 inhabitants.
Most people who run mass websites learn right away. Finding enough vaccines, which are already challenging for some sites, can become a bigger problem as they multiply. Local health care providers or faith-based groups based in communities are likely to be more effective at reaching people who are wary of the shots. And many of the big sites do not work for people who do not have cars or easy access to public transportation.
“Very motivated people with a vehicle – it works great for them,” said Dr. Rodney Hornbake, who serves as a vaccine and as a physician at the East Hartford yard, calls for adverse reactions. “You can not get here by city bus.”
Susan Bissonnette, the nurse in charge, prepared enough bottles of the Pfizer vaccine and diluent for the first few hundred shots of the day before dawn on a recent raw morning. At 7:45 a.m., her team surrounded her in a semicircle, pounding the snow off their boots and warming their fingers for the hours of injections that lay ahead.
“We start with 40 bottles, eight per trailer,” she said. Bissonnette shouted for the group of 19 nurses, a doctor and a subdued dentist who wanted to help voluntarily. ‘OK, then remember it’s Pfizer, right? Show three milliliters, right? ”
The site vaccinates about 1,700 people on a good day, in part because Connecticut is small and receives fewer doses than many other states. It is a well-oiled machine, with a few dozen National Guard troops directing cars in 10 lanes, checking in people who have to make appointments in advance and making sure they have completed a medical questionnaire before moving down the runway to their shots.
Troops also patrol the area at the end of the runway where people wait 15 minutes after their shots – or 30, if they have a history of allergies – in case of severe reactions.
In between are the vaccines, two per car track, on and off between the arms. When they need to warm up, they pull back into heated trailers to set up doses and fill out vaccination cards.
“If you just open with 10 lanes, it’s going to be chaos unless you have teams on the way to the checkpoints, according to the plan you set up,” said Mark Masselli, president and CEO of the Community Health Center. which opened the East Hartford website on 18 January and has since opened two smaller versions in Stamford and Middletown. “You have to marry a few groups – people with health care and people with a logistical mind.”
The premises met within six days as the staff of mr. Masselli has worked frantically with the state to install trailers, generators, lights, a wireless network, portable bathrooms, traffic signs and thousands of orange cones to mark the tracks. Each worker has two key devices: a walkie-talkie to communicate with all stations and supervisors, and an iPad to verify appointments or enter information about each patient into a database.
The vaccine they use is Pfizer, which offers complexity because it has to be stored at 70 degrees Fahrenheit. The inventory is stored in an ultra-cold freezer installed by the Community Health Center at the adjacent University of Connecticut Soccer Stadium. Me. Bissonnette and other supervisors rush there several times a day in bumpy golf carts to grab more bottles, which only last two hours at room temperature.
The first cars roll in at 8:30 a.m., often driven by adult children or grandchildren of those who get shots.
Door clinics can be better for infection control, some experts say – people roll down their car windows just for the injection – and more comfortable than standing in line. But a month after the Connecticut website came into being, its weaknesses are also evident.
Traffic can be trapped on the busy road to the site, and bad weather can shut it down, requiring hundreds of appointments to be rescheduled at short notice. Spotty vaccine supply, which recently had to close premises in California for a few days, could also wreak havoc.
More importantly, you need a car, gas money and for some seniors a driver to get to the site. At this point, white people make up 82 percent of those looking for shots at East Hartford grounds, up from 90 percent in early February; their over-representation is partly because the older population now eligible is less diverse than the state at large.
To address access and equity issues, FEMA is opening many of its new mass sites in low-income, heavily black and Latino neighborhoods where vaccine fears are higher, vaccination rates were lower and many people do not have cars. In addition to the mass centers, the Community Health Center, which serves a large number of poor and uninsured people in clinics across the state, also plans to send small mobile teams to neighborhoods to achieve their vaccinations.
The East Hartford site has hired several dozen temporary nurses and trained its dentists and dental hygienists to help with the shots. Yet it is a daily challenge to man 22 people with 22 inmates, which will grow nationwide as more people are eligible for the shots.
Dr Marcus Plescia, chief medical officer for the Association of Civil Servants and Public Health Officials, said the need for massive vaccination sites may decrease as more and more low-hanging fruit – Americans who are highly motivated to be vaccinated as soon as possible – chosen.
“I think they have worked well in the current demand that significantly exceeds the supply, and they pull out a lot of people who are eager to be vaccinated,” Dr Plescia said. “As supply increases and we have vaccinated the eager ones, we may find that settings for lower volume are preferable.”
Mobile vaccination clinics will hesitate to come up with some of the vaccines. But Dr Plescia said people who are insecure and scared can best be served by doctors’ offices or community health centers, where they can discuss it with healthcare providers they know.
“They are not there to advise you,” he said of mass websites. “You’ll get the chance, end of story.”
Dr. Nicole Lurie, who was the assistant health secretary for preparedness and response under President Barack Obama, said that instead of just asking FEMA for help, state and local governments should seek input from private companies used to attract large crowds. keep it going – while keeping it safe and happy.
In one such example, the company that runs Boston’s mass vaccination sites has a contract with the event management firm that runs the Boston Marathon to handle the daily logistics. Several companies operating large coronavirus testing operations are also involved in mass vaccination.
“These sites need to be motivated to make it a great experience for the client, especially because they work with a two-dose vaccine,” said Dr. Lurie said. “If it’s really sore in the neck, why would you wait in line again a few weeks later?”
Most websites say their biggest challenge is not having enough supply to supply the demand. But with 315 million more doses of Pfizer and Moderna promised at the end of May, and Johnson & Johnson promising to supply 100 million doses of its newly authorized vaccine to the United States by the end of June, the complaint could soon fade.
The biggest headache for the East Hartford website was the appointment booking system, an awkward online registry known as VAMS used in about ten states. Many people aged 65 and over have become so difficult that most end up calling 211, the telephone number for health and social services, to make appointments instead.
As the hours go by, the ever-smiling inents in East Hartford get tired – and sometimes bone-cold. But sometimes there are unexpected boosts, like when John Rudy, 65, pulled up with his mother, Antoinette, in the back seat.
“We have a 100-year-old!” Jean Palin, a nurse, announced as she prepared Rudy’s shot.
The site usually closes at 4pm, but there was a problem: that day there were no more performances than usual in the middle of a snow week, and there were 30 unused doses. Words went out from nurses at the site, including people working in a nearby department store, who are not all eligible, but may qualify for a vaccine if the alternative throws it away.
“It’s just a precision game at the end of the day,” she said. Bissonnette said.
At 5:15 Greg Gaudet (63) drives away in tears of excitement. He learned from one of the nurses, a former high school classmate, that there was a shot available.
“I have a sleeping cancer, but my immunity is low,” he said. Gaudet said, an architect who was diagnosed with leukemia six years ago. “I’m so grateful.”
“How much the site will cost over time remains a question we would like to work through,” he said. Masselli said. Community Health Center spent about $ 500,000 to set it up and spends about $ 50,000 a week on labor and other costs. It receives a fee for each shot the insurance can pay for – the Medicare rate is $ 16.94 for the first dose and $ 28.39 for the second – but also counts on state and FEMA compensation for start-up and other costs.
Still, the expense did not prevent Mr. Masselli could not propose an expansion.
“There’s another runway there,” he said, gesturing behind him. ‘Between the two, with two shifts, we can do 10,000 a day. March 14 it is daylight. we are going to pick up warmer weather, more light. The timing is right. ”