County health departments are tasked with preparing for the COVID-19 vaccine rollout in the Rio Grande Valley, even as they’re constantly reminded that plans are subject to change on a daily or weekly basis. A critical piece of the preparation — the vaccine to be first released — is unknown but could greatly impact the supply sent to the region.
For months, weekly calls are exchanged between the state’s Department of State Health Services, Texas Division of Emergency Management and local public health officials. It’s part of the state’s Phase 0 in their COVID-19 vaccination plan.
With vaccines still pending approval from the FDA, the state stresses the need to keep planning “flexible but as specific as possible.”
Three vaccines, Moderna, AstraZeneca, Pfizer and BioNTech, are nearing the finish line — the award of an emergency use authorization permit from the FDA. That will allow them to distribute and market their products in the United States. Only Pfizer and BioNTech submitted their request Nov. 20 for their BNT162b2, an mRNA vaccine. Moderna is expected to follow.
Vaccination will be voluntary, but thousands of providers have already registered with the state to be prepared for the shipments.
As of August, over 11,000 Texas providers registered, according to the state.
Hidalgo County Health & Human Services Chief Administration Officer Eddie Olivarez said there’s about 170 providers who signed up and have been accepted in the county.
More would be best, he said.
“Our goal is to try to get our numbers above 200 to 240.”
Starr County has about 19 sites, according to Thalia H. Muñoz, Starr County Memorial Hospital CEO. The number registered in Cameron County remained unclear as of press time.
“The caveat is that not all providers have the capability to store the vaccine,” Olivarez said.
The vaccines will need to be refrigerated, but there’s a difference in the kind of refrigeration needed between the two front-runners.
Pfizer and BioNTech’s vaccine — the one closest to market — will require ultra-low temperature freezers to keep them at -70°C±10°C, or -158ºF±-10ºF.
“Very few of our areas have that capacity,” Olivarez said. The county is among them.
“For the ultra-cold vaccine, we have very limited capabilities. We are capable of ultra-cold but not large amounts of doses. That’s an area that we’re looking to expand into, but it’s very difficult,” Olivarez said.
He added, “Those are big challenges we have: access to the ultra-cold equipment and access to the dry ice. Those are challenges that are nationwide, not just here in Hidalgo County.”
There are similar issues in the private sector.
Larger pharmacies may be equipped, but “a lot of the doctor offices and small local folks may not have that capacity for ultra-cold.”
However, some of the major hospitals in the Valley — DHR Health, Mission Regional Medical Center, Knapp Medical Center and Harlingen Medical Center — said they’re prepared or preparing for storing both options.
The FDA is scheduled to discuss Pfizer and BioNTech’s vaccine on Dec. 10.
The vaccine with the refrigeration capacity most accessible to providers is a step behind the front-runner.
“For shipping and longer-term storage, Moderna expects that mRNA-1273 will be maintained at -20°C (-4°F), equal to most home or medical freezer temperatures, for up to six months,” the company announced on Nov. 23.
Muñoz said Starr County’s public hospital is best equipped for the latter.
“We do have the refrigerators that we need for the Moderna vaccine, and we’re already in line to get the freezer for the Pfizer vaccine,” she said.
Details regarding refrigeration and ultra-cold capabilities in Cameron County also remain unclear.
“I feel very confident of our storage capacity for the refrigerated vaccine,” Olivarez said.
Vaccines will be free of cost to the public, but an administrative fee may be attached by some health insurance companies, Olivarez said.
There are some certainties the state is anticipating.
Initial vaccine availability will not keep pace with demand. The state will be deciding how the supply is distributed according to data, but they’ll be prioritizing the first of four phases to target vulnerable and front line populations.
The first phase could begin 24 hours after the first vaccine receives the FDA’s emergency use authorization permit. Health officials speculate that could start as early as mid-December.
The general public will have to wait until the second phase for their turn to get vaccinated.
Counties have developed fluid plans for this process that could start months later, close to spring.
“It’s going to be like a one-stop shop,” Cameron County Health Administrator Esmeralda Guajardo said of her county’s plans.
A data team will be registering people over 16 years of age as they enter. Nurses will administer the vaccine, and people will hand in their paperwork.
Long-standing lines will likely not be part of the plan.
“This is COVID-19, we don’t want a lot of people in the building,” Guajardo said.
A drive-thru isn’t ideal either.
“It’s not that easy. We need to observe people for at least 15-20 minutes after they get the vaccine,” Olivarez said of Hidalgo County. “There are some people who have reactions to the vaccine and there’s some people who don’t like needles and faint. If you’re driving, I wouldn’t want you to faint.”
An additional challenge will be the second dose. Depending on the vaccine, people will have to return 21 or 28 days later.
“We’re also incorporating a mechanism to start calling people on like the 19th day,” Guajardo said, adding “it makes it easier to follow up with them.”
During the same phase, registered private sector providers — doctors’ offices, pharmacies, and clinics — will also receive doses. Those with insurance will have that option.
The county public health sites will prepare to serve largely the uninsured.
Guajardo said Cameron County identified four primary clinics that will be operating on an 8 a.m. to 5 p.m. schedule, but it could expand to 12-hour days. If there’s a greater need, they have four additional sites to which they can expand.
County clinics, mobile clinics and mobile partners will serve as vaccination sites in Hidalgo County, according to the need. They can also set up pod sites at schools through agreements set up in the Strategic National Stockpile and Response Plan, Olivarez said.
The state discourages waste and inefficiency of the vaccines, and encourages a plan to serve both, a large and small turnout for the voluntary vaccine.
Phase 3 is expected to have sufficient supply availability. By then, the focus will be reaching populations with low vaccination uptake or coverage. If required, Phase 4 may include boosters or annual vaccines.