Here’s what a vaccine rollout might look like for Oregonians under 12 and over 65
Pfizer just announced that a small dose of its COVID-19 vaccine prompted a strong immune response in kids ages five to 11. Oregon Health Authority Director Patrick Allen tells us what a vaccine rollout would look like for youth in this state if it gains approval. We also ask about booster shots for Oregonians over 65.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: The latest on COVID-19 vaccine shots indicate that more people could be allowed to get those shots soon. Some for the first time. Others for the third. Pfizer and Biontech announced that a small dose of their COVID-19 vaccine prompted a strong immune response in 5- to 11-year-olds. They have yet to release the data publicly, but once they do, and federal authorities are satisfied, kids in that age group could get their first shots before Halloween. Meanwhile, a panel of scientists has recommended to the FDA that people 65 over along with people at risk of severe COVID-19 illness should be allowed to get 3rd dose booster shots. Patrick Allen is the Director of the Oregon Health Authority. We talk about these recent developments. What was your first reaction when you saw the not entirely unexpected news from Pfizer?
Patrick Allen: There was a lot of public back and forth, more than you’d usually see around this, in the weeks leading up to the decision. Everybody seemed to be telegraphing that there was going to be some kind of a decision, short of everybody getting a booster shot. And what came out ultimately was pretty consistent with that. A little bit of a surprise about 65 versus 60 and a bigger surprise about six months after your second shot versus eight months after your second shot.
Miller: I should say that we’re talking first about this recommendation from scientists. So we have yet to see the final decision from federal authorities. But assuming that 65-year-olds and other people at high risk for COVID-19 will be allowed to get these third dose boosters, how is it going to work in Oregon?
Allen: A quick point about the process. The FDA itself needs to make a decision based on the advisory committee recommendations that it got last week. Then the CDC’s Advisory Committee on Immunization Practices or ACIP needs to make itself a recommendation based on what the FDA authorizes and the CDC ultimately will make the decision that we’ll put into practice in terms of who gets boosters and on what timing and all those kinds of things. Also there’s a Western States Review Committee that will take a look at the CDC work the day after.
So this should all get wrapped up by the end of this week. And so boosters would become available next week. Some things are different about boosters now and some things are a little bit the same. The biggest difference is that we now have over 1,000 clinics and pharmacies that have Pfizer shots available. That wasn’t the case back when we were first rolling out vaccinations. What’s going to be different is that because of the surge that we’re in right now, we’re not going to have the capacity within hospital systems to set up the same degree of large mass vaccination sites. So we’re going to really be dependent on those clinics and pharmacies as the primary way of delivering those boosters.
Miller: But do you have a sense for if you would even need everybody-to-be-giving-shots mobilization right now, given the limited populations, not just in terms of age, but in terms of the initial dose you got? If you didn’t get the Moderna or Johnson & Johnson vaccinations and only Pfizer, will you even need all those other places to have the shots ready?
Allen: Well, it’s really hard to say actually, Dave. It’s a good question because part of what we don’t know is what the demand for boosters is going to be. Will it be exactly the same as for first shots? This difference between six months and eight months is actually a fairly big deal. If, as we had been expecting over the last several weeks, the FDA recommended a booster after eight months. That would make about 50,000 people eligible right out of the gate six months adds a lot of people to that. Perhaps as many as 400,000 more people. So we’re, right now, trying to figure out the implications of how many people we really are going to see and what systems are available for being able to meet that much demand? We have a lot of capacity now with those pharmacies and clinics, but that’s a lot of people.
Miller: This has given me a weird kind of of déjà vu because for the first couple months when you and I would talk about vaccinations, [many] members of the press were focusing on some of the rocky days of the rollouts where people who desperately wanted to get shots couldn’t get them for whatever reason because there just weren’t enough. And that was the ultimate reason. And then obviously those days in their own way, seem like the good old days. Because we were just talking about problems that had technical solutions as opposed to now where so many Americans who have been eligible for months and months are choosing not to get vaccinations. Is it possible that we’re going to go back, at least briefly, to that earlier set of issues where there are people who now are eligible for a shot and they won’t be able to get it , at least for a little while?
Allen: You know, there’s an old saying that history seldom repeats itself but it rhymes. I think this is going to rhyme but not be quite the same as what happened in the beginning. There just wasn’t another vaccine. Now there’s plenty of vaccines. And so the challenge is going to be, how quickly can the locations that we have available to administer shots be able to do that. But that’s very different because you will get your spot in line and you will get a shot and it will happen in a fairly predictable length of time where before we just didn’t know when vaccines were going to come, when production would increase. There are all these unknowns in the system that really have been worked out now. So everybody can’t get through the door on the first day. There will be some challenges as we begin to roll this out, especially if it’s six months after your first shot. But it’ll feel very different than it did at the beginning of the process.
Miller: Will it be up to individuals to contact their pharmacy or a local clinic or their doctor or will people be getting calls because their information is in some kind of system that has their age and the brand of the shot they got X number of months before?
Allen: It depends a little bit on the setting. We still have lots of folks who are going to get vaccinated in their residential care setting, which was the beginning of the rollout previously. And so people who are in nursing homes where they have doctors and nurses and pharmacies on staff, those folks will be taken care of at those facilities. We are working on the rest of the long term care facilities and making sure we’ve got vaccine that’s able to be delivered in those kinds of settings. We’re still reacting to this six months versus eight months issue. Eight months wasn’t going to necessitate any kind of a big call system, at least not initially. We’re working through what, by adding as many people as they just did late last week, will imply for that. So that could possibly be one of the channels we used. But right now the systems are out there. I just looked at this yesterday, my own local Safeway’s got all three vaccines available for people who still haven’t gotten their first dose yet, including Pfizer for people who need those boosters. So they’re just much more easily available for people to just make a call and get an appointment.
Miller: We’re talking about news of booster shots that likely will be coming soon in terms of availability for people 65 and over. This is booster shots for people who initially got the Pfizer vaccine as well as people who are at risk of severe illness from COVID-19. And we’re also turning to the movement towards some kind of emergency use authorization for the Pfizer vaccine for kids ages 5-11. What was your reaction to that news this week from Pfizer?
Allen: Well, we’ve certainly been waiting for a while for this. We’ve anticipated that being the next step in vaccination and it’s you know, with kids that you not only need to figure out the safety and effectiveness of the vaccine, which is what Pfizer made an announcement about today. But you also have to do a lot of work on the proper dosing because you know, kids aren’t just little adults. They’re actually different. And there’s a lot of work that has to go into what’s the appropriate dose.
Pfizer hasn’t actually submitted any of this data to the FDA or released any of it publicly. So we are still a few steps away from the process. I think you mentioned in the intro people getting shots before Halloween. I think it may not be quite as quick as that. Having approval by Halloween is what we’re given to understand. But it will be the same process. They’ll submit data. The FDA will analyze that. They’ll assemble their advisory committee, make a final decision, and it will go to the Advisory Committee on Immunization Practices at CBC. The Western States Review will go through all those same steps. But it’s really good news because while case trends are looking better today than they were a couple of weeks ago, we had a big drop in cases this last week. We are seeing a little bit of an increase in cases in school age kids who, right now, aren’t eligible for the vaccine and so getting them eligible and getting them vaccinated I think is really crucial.
Miller: In some ways Halloween is a purely arbitrary day. But I am curious because I’ve seen, in a couple different news articles, the idea that if things go right, there could be shots in kid’s arms by Halloween. You’re saying that based on the schedule, the best case schedule that you’re looking at at the state level, it wouldn’t be until November when that might happen.
Allen: I think maybe we’re only a little bit more than four weeks out from the end of October so I think the federal processes are going to bump up a lot closer to the end of the month again. So it’ll be sometime right around that end of the month, that we would likely be able to start unless something goes haywire between now and then.
Miller: You mentioned that the Western States Scientific Safety Review Work Group, the official name for this consortium of Washington, Oregon and California that’s been set up since the beginning to essentially (correct me if I’m wrong) to review the work of federal authorization at these State’s levels. But has there ever been a case where this Western States group did not go along with what the FDA or the CDC recommended?
Allen: No, this group was set up out of an abundance of caution. Early in the process when there were concerns about was there going to be interference potentially in the scientific process? I think that generally has not panned out. It’s been a very useful process nevertheless to have amongst the States. You may remember at one point, California paused administering the Moderna vaccine based on a little bit of a cluster of some allergic reactions. This group was able to review data and kind of give the all clear for everybody to either continue administering or resume in the case of California. And so it’s basically an additional check and balance that’s useful to have but it has not um country indicated anything that FDA and CDC have recommended.
Miller: Does it still seem worthwhile or is it not just belt and suspenders but belt and suspenders and whatever else you might need to keep your pants up, if after all these various third checks, nothing has ever been changed. Is it still necessary?
Allen: I think given the degree of hesitancy out there and concerns that people have and given that it only tends to add perhaps a day or sometimes two, to the process, I think it’s absolutely worth continuing to have.
Miller: I’m curious what you learned from the rollout vaccines for ages 12-15. This was back in May and that was the last time that a group of miners was found to be eligible for the vaccine if in some number of weeks, five or 6 weeks or whatever, the one age group down is going to be eligible. Are there lessons that could be applied from the group 1 age group up?
Allen: Sure. I think probably the biggest lesson was that school districts were a huge partner in being able to get those kids vaccinated. It was toward the end of and after the school year, which is a little different dynamic than we’re in now. But we had mass vaccination sites in more locations that we don’t have now. Being able to work with school districts to do vaccination clinics on site and arrange transportation issues to remote locations, if we’re able to vaccinate that way, that partnership is a really critical piece of being able to get younger kids vaccinated
Miller: Right now, only 51% of Oregonians ages 12-17 are fully vaccinated. It’s hard to imagine that say 6-year-olds are going to have a higher rate than 16-year-olds. That doesn’t exactly bode well for a really high rate of vaccinations among this new age group. What are you expecting?
Allen: Well, I think the other fact that’s worth keeping in mind though is that even though that’s the lowest rate of any age group, but they also have the fastest growth rate of vaccination. And so we’re continuing to add lots of adolescents to the pool of vaccination. I would expect the same kind of pattern to develop that will have really, really rapid growth amongst younger kids right out of the gate. It will eventually start to slow down but continue to be fairly robust as we move forward.
Miller: Before we say goodbye, just a brief look at the overall numbers here. You mentioned this briefly, but it’s worth spending a second on. Deaths, hospitalizations, new cases and test positivity have all been down in Oregon in recent weeks after spiking in every way as a result of the delta variant. What’s your take on where we are right now and where we seem to be heading?
Allen: We’re heading in the right direction. As you say, cases are coming down, hospitalizations are down. ICU utilization is down but a little bit less because people tend to be hospitalized longer and be a little bit sicker with the delta variant. So it’s going to take longer for those beds to open up. Deaths are going to continue to come down again at a slower rate because they lag behind hospitalizations. And the serious hospitalization rate for young kids, school age kids has begun to turn up a little bit. That’s not surprising with kids coming back to school, not just being in school, but doing all the other things that go with school around sports and activities and those kinds of things. I think that’s what we’re going to need to keep an eye on. Does that become something that’s reflective of what’s going on in communities or does that drive more infection and turn that curve‚ overall for the state, back around again? I’m hopeful. I’m hopeful that it won’t, I think being able to get kids vaccinated, having them wear masks in school and all the other things that we’re doing to try to minimize spread will help with that.
Miller: So much of what we’re dealing with right now as a state and as a nation are the result of two things, the fact that we still have a ton of unvaccinated people in this country and the fact that the delta variant has proven to be so much more contagious than the original variant of the coronavirus that spread through the world. Is it possible to prepare at the state level right now for the next variant?
Allen: I wish that it were easy to be able to say what the experience is going to be and be able to chart it and then take a set of actions. The delta variant is a good example. We knew the delta variant was coming. And we knew it was more contagious, but I think we did not have a good handle on how much more contagious it was. If you go back and look at the modeling that Dr. Peter Graven at OHSU does, week by week, in that second couple of weeks of July and beginning of August, he was increasing the number for contagiousness for that virus. To the point that it’s within spitting distance of being as contagious as chickenpox, we had no modeling at all back at the end of June early July to prepare for that. And I worry that we don’t know what the next variant is going to be. We’ve heard lots about the lambda variant and the mu variant and how they perform against vaccines. But really until they get to a big, populous country like the U.S., with lots of easy travel and those kinds of things, I think you’re unfortunately really, a little bit in the dark about what that is really going to look like and what the best steps are to try to prevent it.
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