Nevada and other states are working through a complex set of problems to ensure the COVID-19 vaccine is distributed quickly and effectively when it arrives.
Logistical challenges and the rise of vaccine hesitancy amidst the contentious approval process are at the top health providers’ minds.
Moderna and Pfizer have both announced very promising results for vaccines in clinical trials.
Earlier this week a panel of infectious disease experts co-hosted by the U.S. PIRG and Doctors for America examined how their cities and states are planning to manage vaccine distribution.
“I can not overemphasize how overworked and understaffed they already are,” said Trudy Larson, MD, an infectious disease physician and professor at the University of Nevada, Reno who is also currently serving on the Governor Steve Sisolak’s Medical Advisory Team for COVID-19
“When we look at a massive rollout, it’s just another task that’s going to be extraordinarily difficult to complete,” Larson said.
Lack of manpower is one of the state’s top challenges, said Larson, and the logistics around distribution make the lack of healthcare infrastructure in the state, with vast distance between population centers, all the more difficult.
“Not having staffed health departments in each one of these smaller communities means that people have to move to help,” said Larson.
A statewide physician shortage continues to be an issue in Nevada as the state ranks in the bottom five in three major healthcare categories.
According to American Association of Medical Colleges, Nevada is 45th for active physicians per 100,000 people, 48th for primary care physicians per 100,000 people, and 50th for general surgeons per 100,000 people.
The state will need to rely on a medical reserve corps, those who have retired but are available to assist if needed, said Larson. The Nevada State Board of Nursing has been active in preparing nurses to administer vaccinations.
“It’s an eight hour drive between Reno and Las Vegas,” said Larson. “And between those two big urban centers there’s a few isolated communities who do not have health departments.”
In Nevada the distribution plan calls for directing the state’s initially limited supply of injections toward frontline health care workers and other virus-vulnerable populations, including those with underlying medical conditions and people over the age of 65.
“Even if a clinic is in a remote rural area the vaccine has to get there,” Larson said. “Our state is very concerned about the need to redistribute and how we’re going to get sufficient dry ice to move the vaccine to where it needs to go.”
A copy of the state distribution plan shows the vaccine rollout will be quarterbacked by the Nevada Division of Public and Behavioral Health, which plans to coordinate with many of the same doctors, pharmacies and other immunization providers the agency has worked with during past pandemics.
Health officials are working to recruit and enroll enough providers to offer the vaccine at hospitals, pharmacies, nursing homes, mobile health clinics and a host of other locations, according to the plan.
Larson added that unlikely vaccination partners like pharmacists, nursing students and even veterinarians could also help alleviate the need for manpower.
Getting at least 70 percent of Nevadans vaccinated, the percentage needed for community immunity, is a hurdle in itself.
Nevada reported the lowest vaccination rate in the country during the 2018-19 flu season, according to the Centers for Disease Control and Prevention. Only 37.8 percent of people 6 months or older received a seasonal flu vaccine. (For comparison, on the opposite end of the spectrum, 60.4 percent of Rhode Islanders received a seasonal flu vaccine.)
Nevada also had the lowest flu vaccination rates in 2016, 2015, 2013 and 2011.
Additionally, Nevada has a growing number of citizens with “vaccine hesitancy” – the reluctance or refusal to vaccinate despite the availability of vaccines.
“Just because you build it does not mean they will come,” said Larson. “I can not agree more about the need to send a strong message about the effectiveness and safety of this vaccine.”
Even small mundane issues, like weather, are expected to require massive coordination, said Larson.
“There’s just a lot of distance and few settlements with sufficient manpower,” said Larson.
The lack of a national strategy has caused communication issues, said Larson, adding that states now have to work on improving communication between pharmacy and state health officials in order to preserve the distribution chain.
“We do not want wastage of any vaccines. They have to communicate,” Larson said.
Nevada’s vaccination playbook has been developed by Nevada’s Department of Health and Human Services, and is described as a “living document” updated as knowledge about the pandemic increases. The plan is being reviewed by the Centers for Disease Control and Prevention and is subject to an approval by the federal agency. It was submitted on Oct. 16.
“I want to emphasize that there is a plan, we’ve done this before,” Larson said.