Boosters, contracts: How public health leaders are preparing for pandemic’s next phase
As Missouri scrambled to get COVID-19 shots into arms in July, state officials signed a deal with a newly-formed coalition to aid vaccination efforts that will last through November 2022.
The Missouri Department of Health and Senior Services also wants to contract with the state pharmacy association for COVID and other vaccinations through May 2024. And the agency intends to hire Washington University to provide testing into October 2022.
Even as health leaders emphatically urge everyone to roll up their sleeves in hope of controlling the virus, government leaders are laying the groundwork for a continuing pandemic response that will last another year or more. The contracts and bid solicitations are an acknowledgment that officials don’t expect the virus to go anywhere soon.
Instead, public health leaders are preparing to approach COVID-19 as a long-term problem, envisioning a future where the virus remains a manageable threat, if hopefully not the crisis it is today.
The White House announced Wednesday that people who received Pfizer or Moderna shots will be eligible this fall for boosters eight months after receiving their second dose. The additional doses will reinforce the vaccines’ protections against hospitalization and death. Boosters are expected to eventually be recommended for the Johnson & Johnson vaccine, but officials are still gathering data about its effectiveness.
The boosters are also a signal that the vaccines may be on the way to becoming a regular part of life.
Missouri’s state health department, or DHSS, has contracted with the Missouri Immunization Coalition, a new group led by health leaders from across the state, to assist with vaccination efforts over the next 15 months. During that period, the federal government will almost certainly authorize shots for children and will likely confront the question of additional boosters.
“I think Missouri, it was a good thing they did because as you are now figuring out, COVID-19 vaccination is not going to go away,” said L.J. Tan, chief strategy officer for the national Immunization Action Coalition. “This disease, at least in the foreseeable future, is not going to leave us quite yet.”
The coalition’s contract, valued at $2.5 million, requires the group to implement strategies to prevent the virus’s spread in high-risk populations and hold immunization trainings for staff at small rural hospitals and federally-qualified health centers, which typically serve low-income patients.
By March 1, 2022, the coalition must establish “mobile immunization efforts,” according to the contract.
‘Rapidly changing landscape’
Many states, and even some localities, have long had coalitions with health organizations making up their membership.
DHSS spokeswoman Lisa Cox said the agency has ”had several campaigns and partnerships over the years related to other public health issues and immunization programs.”
The Missouri Immunization Coalition’s board of directors includes the director of the Missouri Academy of Family Physicians, the medical director at the University of Missouri Student Health Center and other prominent health leaders.
“Our focus is on the immunization providers and what they need to be successful with the COVID vaccination program. It is an evolving, rapidly changing landscape,” said Lynelle Phillips, the president of the board.
Those changes are likely to include boosters, vaccination of children under 12 and approval of new vaccines. The coalition will be able to reinforce state agencies stretched thin by the crisis, she said.
“We can sort of intensify those efforts and be nimble,” Phillips said. “One of the challenges of COVID is just when you figure it out, some new science becomes available or whatever and you’ve got to pivot quickly.”
One of those major pivots will soon be underway as booster shots become available for much of the vaccinated population over the next few months.
Just a week ago, the Food and Drug Administration authorized an additional dose for immunocompromised individuals. On Wednesday, President Joe Biden made clear he wants to move forward with boosters for the general public.
Under a plan from the U.S. Department of Health and Human Services, booster shots will become available beginning the week of Sept. 20 for people who have gone eight months since receiving their last dose. Health care workers and seniors will be the first ones eligible, given that they were the first to be vaccinated.
By late fall and early winter, demand for boosters may surge as those who lined up for shots in March, April and May — when vaccination rates peaked — reach their 8-month mark.
Those who work with low-income and vaccine hesitant individuals are already wondering what boosters will mean for continuing efforts to reach the unvaccinated population. Missouri has administered at least one dose to roughly 51% of the population; Kansas has administered at least one dose to 56%, according to data from the Centers for Disease Control and Prevention.
“I think the influx of dollars and other grants that are helping to support our emphasis on the vaccine and the fight against the COVID-19 virus is probably close to over with and so the set of resources is likely going to have provider organizations … pick and choose where to best put those resources that we currently have,” said Jeron Ravin, president and CEO of Swope Health in Kansas City.
Ravin said in his view the immediate priority should be to focus on the unvaccinated and getting shots to them as quickly as possible.
“We’ve got to choose here. We’ve got to prioritize,” he said.
Bringing back mass clinics?
Johnson County Department of Health and Environment Director Sanmi Areola said his agency is constantly preparing for changes. Plans are in place for what he called “surge capacity” to expand the department’s ability to administer shots.
But compared to the early rollout, far more providers are administering shots now. Doses are widely available at pharmacies, grocery stores and pop-up clinics at schools and other locations. It’s a far cry from the first few months of 2021, when supply was limited.
“This is going to be a different scenario and some of those limitations will not be there,” Areola said.
The White House has said the federal government has secured enough doses to cover the anticipated booster demand. “It will be just as easy and convenient to get a booster shot as it is to get a first shot today,” White House COVID-19 response coordinator Jeff Zients told reporters Wednesday.
Kansas Department of Health and Environment spokesman Matthew Lara said the agency is meeting weekly with entities administering doses. He added that “playbooks” have been developed to help guide multiple kinds of vaccination efforts.
“Kansas has inventory on hand currently and additional doses have already been ordered” and more will be ordered each week, Lara wrote in an email.
Cox said Missouri only orders doses on behalf of providers — meaning that requests for more shots will be made by the groups administering them.
“Some states order, stockpile and distribute, but this is not how our operation works. The State doesn’t have custody of any vaccine,” Cox wrote in an email.
In Lawrence, public health leaders are weighing bringing back mass clinics once demand rises. Dan Partridge, director of the Lawrence-Douglas County Health Department said the agency has begun meeting with hospital and emergency management officials to discuss what elements of the county’s vaccination apparatus should be reactivated.
The last mass clinic in Douglas County, held in late April at the county fairgrounds, was staffed almost entirely by volunteers. Officials have begun contacting them to gauge their availability and are scouting possible sites.
The mass clinic model is a very efficient way to administer vaccines and is the best method if there’s enough demand to warrant it, he said.
Partridge is hopeful that eventually COVID vaccination will become as routine as the flu shot. The annual flu shot is widely available in the fall.
“My hope is that down the road that it just becomes part of our flu campaign,” he said.
This story was originally published August 19, 2021 at 12:51 PM.
