We seem to be grappling with the latest existential “COVID-19 and I” question every week. Early on it was, “Should I wipe my Amazon subjects?” And then: “How do I get my nursery school to join Zoom with its teacher?”
These days, the Big Coronavirus question has been posed to OPB reporters: “When do I get the vaccine?”
The short answer is: we really can not say. The Oregon Health Care Advisory Committee, a diverse group of public health experts and community representatives selected from 400 Oregon applicants, met for the first time Thursday to decide who will be vaccinated next and in what order. So far no decisions have been made.
The longer answer for Oregonians is: distribution problems at the federal level and logistical challenges at the local level have delayed the implementation of the state and delayed further planning. Oregon was supposed to vaccinate 100,000 people by the end of December. On Friday, November 8, Oregon was just two-thirds of the goal. And with more than 300,000 health workers in the state, there is still a long way to go.
But it’s much more complicated than that. And saying “we do not know” does not help much. That is why we answer all your questions with what we do know and why there is still so much in the air. Is most of the kind of mischievous, funny in baseball? Yes, kind of.
Is Oregon vaccination slower than other states?
The Oregon Health Authority says Oregon is in the middle of the pack when it comes to state vaccination efforts. At the end of last week, 1.5% of Oregon’s total population was vaccinated. Forty states and Washington, DC, District of Columbia, vaccinated a higher percentage of the population than Oregon.
The number of vaccinations a state receives, and when they arrive, depends primarily on the federal government. But that alone cannot explain the reasons for Oregon’s slow rollout.
Another measure is to look at the percentage of vaccines administered. On Friday, Oregon was 36th. So far, Oregon has used just under a quarter of the vaccine doses.
How do I know when I will be vaccinated?
First, you need to find out in which phase of the deployment you can be vaccinated. It is divided into four phases and several sub-phases.
Who came up with the phases?
The vaccine rollout phases were designed by the CDC’s Advisory Committee on Immunization Practices. This advisory panel consists of virologists, outbreak specialists and medical ethicists. They issued recommendations for states to follow at each stage of vaccination of the vaccine.
Here is who the CDC’s advisory panel recommends that the state vaccinate in each phase:
- Phase 1: Frontline workers and high-risk people.
- Phases 2, 3 and 4: Not yet determined. The Immunization Practices Advisory Committee has not yet made any recommendations. It is safe to say that if you are not part of phase 1, it will take several months before you receive the vaccine.
Phase 1 is divided into several sub-phases, and these are the groups of people currently being vaccinated.
Who decides who is in which phase?
ACIP gives recommendations for who gets the vaccine when, but ultimately the states have the power to determine who gets vaccinated when. Just to make it even more confusing, individual hospital systems and provincial health programs may have additional priorities and strategies for administering the vaccine.
This means that no two states vaccinate people in the same way. There are similarities – all states follow the CDC’s Advisory Committee on Immunization Practices to some extent, but each state can choose to define ‘frontline workers’ and ‘people with pre-existing conditions’ just as they prefer. The committee also provided guidelines on how to prioritize people in each phase.
Oregon has a vaccination advisory committee that meets regularly to decide how best to follow federal recommendations in Oregon. Who recommends the CDC’s advisory committee to be vaccinated in phase 1, and when?
It divides phase 1 into three groups. Phases 1a, 1b, 1c.
Phase 1a are health workers and residents and staff of long-term care facilities. States can define the terms however they choose.
Phase 1b includes frontline workers (otherwise defined as essential workers), as well as people over 75 years of age. The federal government recommends prioritizing the elderly because people over the age of 65 make up about 15% of the U.S. population, but 80% of all COVID-19 deaths. By prioritizing the elderly, many deaths can be avoided.
Phase 1c includes ‘essential workers’, people aged 16-64 with high-risk medical conditions and people over the age of 65.
The Advisory Committee on Immunization Practices recommends that everyone else be vaccinated in a different group.
The committee defines ‘essential workers’ as workers whose work is necessary to keep the state and country going. Front workers are a subgroup of essential workers who have close contact with other people. For example, a utility maintenance specialist is considered essential, while a cashier in a grocery store is considered essential as a front line. The cashier will be vaccinated first because they are most likely to get sick.
How does Oregon’s plan differ from the federal recommendations?
Oregon has adopted some major deviations from federal recommendations compared to other states.
Phase 1a includes health practitioners who have direct contact with patients. Unlike some states, Oregon prioritized non-medical hospital staff such as order guards, housekeepers, and phase 1a cafeteria workers, as well as physicians and nurses. Hospital staff and administrators should not be vaccinated in phase 1a, but this has not prevented local hospitals with excess vaccine from providing it. Oregon also includes home care workers in Group 1a.
It is controversial that workers are admitted to correctional facilities in Phase 1a, but not prisoners. To prevent a lawsuit, Oregon will now allow inmates to receive the Phase 1b vaccine.
Related: Oregon faces a questionable legal position as COVID-19 continues in prison case
Phase 1b in Oregon includes essential workers and people over the age of 75 in Oregon. Oregon was one of the first states to focus on vaccinating teachers in Phase 1b, when Oregon Gov. Kate Brown called for teachers to be “first in line” to help reopen their school.
In a press conference on Friday, Brown confirmed that teachers will be given first priority in the next round of vaccinations: even before people older than 75 years.
Who are we vaccinating with now?
We are entering phase 1a. Initially, Oregon tried to prioritize groups in Phase 1a, so that emergency personnel and staff working with high-risk patients had to be vaccinated first. But triage was a challenge and delayed implementation. Now all members of phase 1a are vaccinated.
There are more than 300,000 people in Phase 1a, and Oregon is only a fraction of them. Initially, Oregon had planned to begin vaccinating people in Phase 1b by mid-January, but it now seems unlikely that 1b will start here before February.
Oregon Health Authority officials were reluctant to set fixed dates for the next spate of vaccinations, citing unpredictable deliveries of vaccines and conflicting information from federal agencies.
Are other states still trapped in phase 1a?
Many other states, including Washington and Arizona, are going to start vaccinating people in Phase 1b or have already started. Some are on track to complete the phase before Oregon first begins.
What is Oregon doing to speed up vaccine vaccination?
Anyone in Phase 1a – that is, all healthcare professionals and long-term care providers – can get the COVID-19 vaccine. On Monday, three-quarters of the COVID-19 vaccines in Oregon were not administered. By enlarging the pool of suitable people, the Oregon Health Authority hopes to expedite the process.
OHA also says it will also expand the pharmacy program and build a partnership with unions and other organizations to get the vaccine more in hand.
How will Oregon prioritize people in Phase 1b? Who is vaccinated first? Teachers? Or elderly people?
At least we’m not sure yet.
Oregon Governor Kate Brown has asked the Oregon Health Authority to put teachers first when phase 1b begins. This would be a direct contradiction of the recommendations of ACIP, which suggests that those over 75 should prioritize above the frontline workers.
It was initially unclear whether teachers would be vaccinated with older people at high risk at the same time. Controversial it no longer seems that way. Government Brown on Friday unequivocally declared that teachers would be vaccinated in front of any other group.
Related: Government Kate Brown wants 15-year-old Oregon children on campus, but many teachers will not be vaccinated by then
Oregon’s vaccine advisory committee met Thursday to decide how to prioritize people within each group. They were told to consider the best ways to slow down the spread of the virus quickly, while the spread is fair and meets the needs of the communities they represent.
Many members expressed concern about the speed of vaccination of the vaccine and about the balance between the urgency of the situation and the willingness to carry out the following phases correctly.
Muriel DeLaVergne-Brown, director of the Crook County Department of Health, urged members to give rural health officials the flexibility to vaccinate out of action, especially if there are unused vaccines. Representatives of other smaller communities said this flexibility would help them vaccinate faster and waste fewer doses.
No decisions have yet been made, and the committee did not take them through their full agenda before the meeting ended. The group has planned to meet every Thursday, but because there is so much to do and so little time, they hope to schedule additional meetings sooner. Patrick Allen, director of OHA, said during Friday’s press conference that he expects the vaccine advisory committee to be ready by phase 1b by the end of the month.
The conclusion:
The rollout of vaccines will look different in every community and in every healthcare system. Depending on how much vaccine is available locally, some areas may move much faster than others. Rural areas are also likely to move much faster than urban areas.
The rollout plans for vaccines are fluid. Like Tuesday’s decision to open vaccinations to everyone in Phase 1a, it appears that even when decisions are made, they have not been stoned.
So when do you get a vaccine? Unless you work in healthcare, the most straightforward answer remains: “not yet.”