Before Catherine Troisi’s book club began discussing the finer point of “Becoming Duchess Goldblatt,” her fellow readers only wanted to know one thing. And it had nothing to do with the memorial of an 81-year-old social media personality.
Their main question was: When could they get the COVID-19 vaccine?
The infectious disease epidemiologist at UTHealth School of Public Health in Houston offered her friends a sober assessment: Their first shot at being inoculated wouldn’t be next week — but next year.
Based on federal guidelines, hospital workers will get the first doses along with elderly Americans in long-term care facilities, she told them.
“We don’t know after that,” she recalled saying. “We will find that developing the vaccine was easy compared to getting it into the arms of people.”
The unprecedented push to develop vaccines to stave off the coronavirus is entering a new phase that raises all sorts of questions and conundrums that can’t be answered in a laboratory.
Who is an essential worker? How should race, which has proven to have an outsized effect on how badly COVID-19 afflicts a person, be considered? What happens if no one — or everyone — shows up at the same time?
Just as the federal and state governments are leading the charge, Dallas-area public health and elected officials, business leaders and bureaucrats are working to create the infrastructure needed to vaccinate millions of North Texans, assuming the inoculations are approved on the federal level. They’re also busy conceiving information campaigns to ensure an orderly process.
It will be a “logistics nightmare,” Troisi said, adding that there are already worries of needle shortages. And personal protective equipment appears to be running low again. Each vaccine will have its own storage requirements and different doses.
But more is unknown than known. Among the problems left to be solved: finalizing the pecking list for the vaccine, creating systems that ensure folks don’t skip the line, and establishing a message that conveys both hope and a stern warning that mask wearing and physical distancing must continue.
As many as 500 Dallas County providers — including hospitals, local pharmacies and doctors’ offices — have signed up to vaccinate people. And yet, it’s still unclear when there will be enough vials to go around.
Dallas County and Parkland Health & Hospital System have also not ruled out massive vaccination efforts akin to drive-through testing. But they are taking a wait-and-see approach. They will defer to the private providers and pharmacies for the initial rollout, only setting up drive-through options if the demand is great enough, officials said.
“We have a model that we take pride in and that has worked,” said Vivian Johnson, Parkland’s senior vice president of clinical support services, who is helping organize the hospital’s vaccine plans. “If that opportunity exists, to help get access quicker, we’ll be able to set up.”
Dallas County’s health authority, Dr. Philip Huang, said he anticipates most people will be vaccinated through their primary care physician or a commercial pharmacy such as Kroger and Walgreens. CVS, which is also expected to be a distribution point, has announced a hiring spree to help vaccinate.
Jeff Loesch, director of pharmacy from Kroger Health Dallas, said he anticipates his chain of pharmacies to begin vaccinating people by the end of the year.
However, only a tiny fraction of North Texans are likely to be eligible for the limited supply of shots before 2021, he said. Texas is expected to receive about 1.4 million doses of the vaccines this month. But the very first allocation is expected to be 224,250 doses, which will be shipped to 109 hospitals in 34 counties.
Communicating who may receive the vaccine and when will be one of the biggest challenges, he said.
“One of the things we have to do as health care providers, working in conjunction with the state and county, is communicate exactly where we are in each of the phases,” he said.
The federal government will be driving a lot of these decisions, but both state and local governments will have some discretion on who qualifies. One such example of local decision making is defining who is an “essential worker.”
Huang said the county — which in the past has prioritized essential workers, including teachers, grocery store workers, and restaurant employees for free COVID-19 tests — will also work to ensure Black and Latino populations have early access.
“Our interest is to make sure it is distributed in a way that is equitable,” he said, noting that there can be broad overlap between Black and Latino communities and essential workers. “They are our priority populations.”
Loesch said Kroger will do its best to abide by government guidelines, even as public health officials have acknowledged there is little they can do to prevent people from skipping the line. Health care workers at commercial pharmacies will screen patients to ensure eligibility, much like at a private doctor’s office, Loesch said.
All the while, health officials are wary the vaccine’s arrival will send a signal to people living with pandemic fatigue that they can back off other safety precautions such as physical distancing and mask-wearing when the opposite is true.
Dallas County’s health department and other agencies will be able to monitor who gets the vaccine, Huang said, since each person inoculated must be entered into the state’s immunization registry system, which is more commonly used for logging child vaccinations.
Between now and spring, when Loesch assumes Kroger will be able to vaccinate the majority of the public, the company is setting up plans for North Texans to reserve a shot online and walk in. It’s also anticipating public events where hundreds can be vaccinated at the same time.
Loesch recommended North Texans regularly check vaccinefinder.org, a website run by Boston Children’s Hospital and promoted by the Centers for Disease Control and Prevention, to monitor availability as the vaccines become widely accessible.
Parkland’s No. 1 priority with its first doses will be to vaccinate its health care workers who are taking care of the sickest COVID-19 patients. After that, the public hospital charged with caring for North Texas’ poorest and most vulnerable will work with the city and county of Dallas in various capacities.
“We’re going to do our best to make it accessible to everyone,” Johnson said.
That includes its 12 community health clinics throughout the county that count more than 104,000 residents as patients. Parkland hopes to use regularly scheduled appointments at its clinics to vaccinate people.
Like other public health officials, Johnson is aware there are residents who will not take the voluntary vaccine.
A November Pew Research Center poll found that two out of every 10 Americans will abstain from being vaccinated. What’s more, fewer than half of all Black adults surveyed said they’d skip the vaccine, a troubling number given how COVID-19 has disproportionately killed Black people.
Johnson, who is Black, said she is educating her neighbors on the science of the vaccines — that despite the historic speed in which they were developed, no procedural steps were cut.
“This is something I would strongly encourage my neighbors, my families to accept,” she said.
But it will take time, Johnson said, which means physical distancing, mask wearing and good hygiene practices will be necessary for the foreseeable future.
“We need 70 percent of the community” to be vaccinated to reach a point that some of those practices can begin to fade away, she said. “We need a lot of people to make an impact.”