WRAL Investigates

Distributing coronavirus vaccine presents challenges, concerns in NC

Posted October 22, 2020 6:00 p.m. EDT
Updated October 22, 2020 6:53 p.m. EDT

— Nine of the 213 potential coronavirus vaccines in development globally are in Phase III clinical trials, which means they could be a couple of months from approval. But that is only part of the process in moving past the pandemic.

"How fast are we going to be able to make enough vaccine?" asked Pia MacDonald, an epidemiologist with Research Triangle Park-based RTI International. "How are we going to assure accessibility for everyone? What are we going to do about all the people who don’t believe in vaccination?"

North Carolina health officials have been planning since the pandemic began about how to distribute a vaccine. Last week, they submitted a 163-page draft plan to federal officials, outlining who gets the vaccine first, how they’ll get it and how to track their progress.

"This is the largest mass immunization campaign in the history of this country," said Dr. Leah Devlin, a former state health director who now is one of three main advisers for North Carolina’s Vaccine Advisory Committee.

Devlin, a professor in the Department of Health Policy and Management in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, said the vaccine committee’s work is a moving target since no one knows when North Carolina will get any vaccine or how many doses.

But she said figuring out who would be first in line was easy: "When you only have the opportunity to vaccinize 150,000 out of 10.5 million North Carolinians, you’ve got to start with who might die."

The state has a multi-phase plan for now:

  • Phase 1A includes health care workers in high-risk settings and workers in long-term care facilities.
  • Phase 1B includes, among others, long-term care residents, at-risk prisoners and migrant workers, jail staff and other individuals with two or more chronic health conditions that put them at higher risk from the virus.
  • Phase 2 rolls in educators, adults with one chronic condition and the elderly with no chronic conditions.
  • Phase 3 includes students and people with a higher-risk job, such as grocery store employees.
  • Phase 4 is for everyone else.

"We absolutely anticipate that it will change as we move forward," said State Health Director Dr. Betsey Tilson, who said she believes the plan must remain flexible as circumstances change.

State officials estimate 7 million doses will be needed to vaccinate everyone in North Carolina who wants it.

"If we were to have an approved vaccine by the end of this year, it might take until April or so to have enough vaccine for everybody," Tilson said.

The number of doses needed is also in flux, with concerns that some people will question the safety of the vaccine because of the speed of the approval process.

"Yeah, we do worry about vaccine hesitancy," Tilson said. "We expect there may be more hesitancy with this vaccine than with other vaccines."

Flu vaccination rates in North Carolina show the reason for the concern. The most recent Centers for Disease Control and Prevention report shows only 57% of whites, 55% of Blacks and 53% of Latinos statewide got flu shots last year.

Worries go deeper for a new coronavirus vaccine, according to Tilson.

"There was one study that said only 7% of Black North Carolinians will get the vaccine when it first comes out," she said.

Geography is also a concern. Medicare data shows nine counties in North Carolina with flu vaccination rates at 40% or lower. Four of those are clumped together to the Triangle’s south: Bladen County at 30%, Robeson County at 38%, Cumberland County at 39% and Hoke County at 40%.

Four of the other five are in the North Carolina mountains: Graham and Yancey counties at 37% each and McDowell and Mitchell at 40% each. Tyrrell County in eastern North Carolina also has a 40% flu vaccination rate.

The flu vaccination rates in the Triangle are closer to 60%, but MacDonald said the fight against coronavirus is only as strong as the weakest link.

"If we have major pockets where there’s low vaccine uptake, that’s also going to be a vulnerable place for all of us," she said.

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