New Jersey healthcare officials say the state inoculation effort is operating at about 25 percent of its potential given a lack of doses. Challenges persist in penetrating communities of color and those in congregate living.
By Matt Skoufalos | January 27, 2021
In a little more than a month of distributing the novel coronavirus (COVID-19) vaccine, New Jersey health officials say the state has provided nearly 650,000 doses, of which more than 90,000 are second doses.
That leaves New Jersey about 4.61 million people short of hitting its 70-percent-of-population, theoretical benchmark for community protection, or “herd immunity,” from the virus.
All the while, the process has been marked by an intense demand for the vaccine among New Jersey residents, some 1.2 million of which pre-registered for their immunizations in the first days that the state offered the opportunity to do so through its vaccine portal.
Hours after New Jersey supplemented that online process with a staffed phone service this week, callers jammed the lines in the earliest hours of its operation.
Yet none of that intense interest has been met with a comparable level of vaccine supply, as the state, which New Jersey Health Commissioner Judy Persichilli has said could support as many as a half-million immunizations per week, is only getting one-fifth that amount in its federal allocation.
Beyond merely frustrating residents with the complications of the process, the effects of that shortfall are varied. So far, they have meant that vaccines are only reaching a limited audience, through prescribed channels, and according to a process that is bumpy, but promises to improve.
Yesterday, New Jersey public health officials offered a comprehensive briefing about the vaccination process in the state. Here are the major takeaways.
The majority of vaccines (41 percent) administered in New Jersey have been received by white, non-Hispanic residents.
That figure falls to 7.3 percent for Asian, non-Hispanic residents, to 6.1 percent for Hispanic Latinos, and to 4.2 percent for Black, non-Hispanic New Jerseyans.
Along gender lines, female vaccine recipients outpace males by about a 60-40 split, and those aged 30 to 64 comprise the majority of immunizations, with a bell curve distribution among all age groups.
“This is a really telling story of who is getting vaccinated,” said Amanda Medina-Forrester, Executive Director of the New Jersey Office of Minority and Multicultural Health.
“It goes back to public confidence, hesitancy [regarding]the vaccine, or just no access [to immunizations].”
Public health officials are “seeing some hesitancy” to embrace the vaccine among Black and Latino New Jerseyans “because of the history of systemic racism,” Medina-Forrester said. Some residents are “feeling like [they’re] part of a clinical trial,” she said, amplifying concerns rooted in the urgency with which the vaccine was developed.
To help boost confidence in the process, officials are working with community stakeholders who have been vaccinated and are willing to share their experiences publicly.
“It’s really important that we have these stories of our people of color who have the most hesitancy,” Forrester said. “We’re looking at all types of role models, from big to small, to be our ambassadors for the vaccine.”
Regardless of consumer confidence in the vaccine, the biggest hurdle in the mass immunization process remains availability of doses.
Dr. David Adinaro, Deputy Commissioner of New Jersey Public Health Services, said that although the state is receiving 100,000 to 110,000 first doses weekly, it’s nowhere near enough to inoculate the estimated 4 million New Jerseyans who are already eligible to receive it.
“We just need more vaccine,” Adinaro said.
“We’ve developed a network of vaccinators; many more want to get in on the process,” he said.
“We just don’t have enough to meet the demand.”
That supply-demand imbalance could be resolved in a number of ways, but Adinaro believes it’s most likely to come from increasing production of the currently available formulations from Pfizer and Moderna. Emergency-use authorizations from additional manufacturers, including Johnson & Johnson of New Brunswick, could help the cause; its immunization is administered in a single dose.
The state also has realized a 15-percent boost in vaccine availability “because it turns out that you can get six doses out of the Pfizer vials,” Adinaro said, but not enough for New Jersey to hit the 500,000-dose-per-week threshold it needs to have a more significant impact.
Those who get the immunization must still adhere to pandemic protocols afterwards, including wearing face coverings and social distancing.
Although the shots confer protection against the virus, it isn’t yet clear from available data whether they prevent transmission of COVID-19 to others.
“If everybody has received the vaccine and they’re no longer in danger of it, that would still be an amazing thing, even if it doesn’t prevent it from circulating in our society,” Adinaro said.
Given the dearth of available data, neither was Adinaro able to say with confidence whether, in the future, the COVID-19 immunization would be administered annually (like a flu shot) or less frequently (as a booster).
“We don’t know for how long it will provide protection,” he said. “Now that there’s a couple other strains, it may require a booster to fine-tune.”
Public health officials will continue to adapt their approaches based on what they learn going forward, he said. Beyond that, the state health department meets daily with its vaccination partners, which Adinaro said provides an opportunity for coordination of any changes in the plan.
“We have about somewhere between 150 and 200 people on the line answering questions, reminding them of their responsibilities,” he said. “It’s very collaborative. If we hear of issues that come up that are large enough that we want the group to understand, we’ll bring it to them.”
Long-term care (LTC) sites
The federal Pharmacy Partnership for Long-Term Care (LTC) Program, through which residents and staff of LTC sites across New Jersey will receive their COVID-19 vaccines, is in its fifth week of a process that Adinaro expects will continue until late February or early March.
New Jersey pharmacy partners CVS and Walgreens will visit each of those facilities three times in that span to administer the vaccine onsite, providing initial doses at the first visit, a combination of initial and booster doses at the second, and booster doses at the third.
Adinaro said nearly 100,000 people in New Jersey have been vaccinated through the program thus far, but that the partnership will not visit each of the 1,700 LTC sites in the state. Some sites have made other arrangements with local pharmacies for their vaccinations; others have not. The state has also announced a partnership with Walmart to reach those individuals with intellectual disabilities living in congregate settings across New Jersey.
Adinaro believes that home healthcare companies could provide last-mile inoculations for those residents unable to leave their homes to receive a shot, as well as primary-care physicians, eventually.
“I really do see a time period when every pharmacy and every physician’s office is going to be vaccinating,” he forecasted.
Those residents who aren’t covered in the LTC plan will schedule their vaccinations at any of 260 point-of-dispensing sites (PODs) across the state.
Of those, 240 are open exclusively to healthcare workers, a select number of the 1B group, and those with specific medical complications that put them at risk of dying from the virus.
There are 17 PODs in Camden County.
PODs include the six statewide “megasites,” acute care hospitals, chain pharmacies, those in the federal LTC partnership program, urgent care centers, federally qualified health centers (FQHCs), and local health departments.
Each must be able to register and vaccinate patients, bill their insurers (there is no copayment or out-of-pocket expense to receive the COVID-19 vaccine), manage and protect the vaccine supply, and report back to the state.
Patients may register for their vaccine appointment at PODs, through the state call center, by walking up to a site, or with the help of community healthcare workers.
Until more doses become available, however, the New Jersey vaccine call center is only capable of answering general vaccine registration questions and entering patients’ information in the health database to notify them of vaccine availability.
In addition, the New Jersey Vaccine Scheduling System (NJVSS) doesn’t yet have the level of functionality it needs to manage the nature of requests coming in, Adinaro said. That means that some vaccinators are using their own systems, which are not harmonized with one another nor with the NJVSS. In a few weeks or a month, however, those bugs could be worked out.
“The NJVSS is a great system but it is still being completed,” Adinaro said.
Three components to getting people vaccinated: having enough sites for people to go, having enough people to schedule an appointment, and having enough vaccine.
Those looking for more information about New Jersey vaccination efforts should visit Covidvaccine.nj.gov,
Covid19.nj.gov/vaccine, or sign up for Vax Matters, the weekly newsletter from the New Jersey Department of Health.
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