PERSPECTIVE FROM THE 19^TH HOLE:  This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf.  Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon (Les AuCoin), as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist.  This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.  I could have called this blog “Middle Ground,” for that is what I long for in both politics and golf.  The middle ground is often where the best public policy decisions lie.  And it is where you want to be on a golf course.

It’s not a brilliant thought, but for the last year as all of us have endured the unprecedented pandemic, the clear-cut reality for me is this:  Vaccines that work are the key to our future.

Pharmaceutical companies, aided by federal government agencies such as the Centers for Disease Control and the Food and Drug Administration, have moved far more quickly than ever before to bring vaccines to market. 

Was there a profit motive?  Frankly, I hope so because, if there was, it is an example of what the private sector can do to solve major puboic policy problems in this country, if not around the world.  Not alone.  With government help – but that just, help.

To answer questions about the availability of vaccines in Oregon, I turned to a client I used to represent when I worked as a lobbyist – Oregon Public Broadcasting (OPB), which remains to this day a shining example of solid journalism and public affairs reporting.  It was a privilege to represent OPB for 10 years or so.

This summary illustrates that credential.

Oregon officials anticipate seeing the first shipments of the COVID-19 vaccine arrive in just a couple of weeks. The deliveries are expected to be enough to provide the first of a two-dose vaccination for just over 100,000 people.

The speed at which vaccines for COVID-19 have been developed and soon distributed has been unprecedented.

How many vaccine doses are we getting and when?

The Oregon Health Authority (OHA) says it expects to get 35,100 doses of the Pfizer COVID-19 vaccine around December 15 and then another 40,950 from Pfizer and 71,900 doses from drug-developer Moderna around December 22.

Both vaccines require two doses to achieve the 95 per cent effectiveness rate the developers are touting, and the doses have to be spaced out by three to four weeks, depending on the vaccine. This means that those early shipments of about 147,000 doses will serve as the first dose, and then additional shipments of an estimated 120,000 more at the end of the month will provide the second dose for those early recipients.

These first doses are enough to provide vaccine to Oregon’s health care workers — nurses, doctors and other support staff — who are in direct or indirect contact with COVID-19 patients

The vaccines are coming from the federal government, which says it will distribute them to states based on the adult population. Oregon has roughly 1.3 per cent of adults in the U.S. and consequently should get 1.3 per cent of the available vaccine.

Who gets the vaccine?

Understanding that there won’t be enough vaccine available for everyone for many months, Oregon is developing a phased hierarchy to determine who gets vaccinated first. The state is taking its cues from the Advisory Committee on Immunization Practices, which is part of the Centers for Disease Control and Prevention.

The groups are broken into three phases of vaccine availability. The specifics of who gets vaccinated and when are being finalized and will govern how these early vaccines are distributed. The priorities for the first shipments are:

· Front-line health care workers and support staff

· Emergency medical service providers

· Residents and workers in long term and communal care settings

Does the plan account for health disparities for people of color when prioritizing distribution?

State officials say they are placing a high priority on equity and addressing traditional health disparities when deciding where to prioritize vaccines, but the details of how that will look have not been figured out.

In Oregon, the number of cases per thousand for Black, Indigenous and people of color is far higher than for the white population. Pacific Islanders have five times as many cases per thousand, Hispanic people have four times as many and Native Americans and African Americans have around three times the cases. Nationally these groups are nearly three times more likely to die of COVID-19 than are their white counterparts.

Does Oregon have a plan for the physical distribution COVID-19 vaccine?

Yes. The state currently is working on the logistics of how to get the vaccine to where it’s needed in the state. The first shipments will be sent to hospitals, which will administer the vaccine to frontline medical and support staff.

Oregon is also taking advantage of a federal program that is contracting with pharmacies such as Walgreens and CVS. The companies will receive vaccine doses from the state and then provide on-site vaccine clinics at long term care facilities across the state.

For populations of people that are more scattered and difficult to reach — such as people experiencing homelessness, migrant agriculture communities, and dispersed rural communities — the state is planning to contract with local Emergency Service providers to deliver vaccines in the field.

Is the state ready to store ultra-cold vaccines?

Not yet.

“That, I will tell you, is the biggest headache at OHA in trying to plan this rollout of these vaccines,” according to an OHA official.

“It requires us to set up a cold chain, the ability to keep this vaccine protected and safe at a minus 70 C from the manufacturer, out to the place where it’s going to be provided,”

The University of Oregon is working with the state to get 15 smaller, more portable ultra-low temperature freezer units to send to remote areas that don’t have sufficient storage.

Only the Pfizer vaccine needs to be stored at ultra-low temperatures. The Moderna vaccine and others in the development pipeline have much higher temperature storage requirements

What are the benefits of having different kinds of vaccines?

When the pandemic broke out, dozens of companies and institutions turned their focus to creating a vaccine for COVID-19. It was unknown if any of the vaccines being developed would work, and the more shots on goal there were, the better the chance we’d have of finding success.

Now, nearly a year later, there are several vaccines that are showing great promise. They’ve gone through or are close to completing sufficient testing to apply for Emergency Use Authorization from the FDA. Two companies have applied and another small group is expected to apply within the next few months.

But even now, with so much early vaccine-development success, there’s still a great advantage in having several vaccines available. One is related to manufacturing:  If several companies are making vaccines, the chance they’ll be able to make enough doses to inoculate a global population increases.

When is federal emergency use authorization (EAU) expected to come through?

Both Pfizer and Moderna have applied for EAU for their vaccines. The FDA is expected to hold off on its decision until the scientific and human vaccine trial data is analyzed by the agency’s Vaccines and Related Biological Products Advisory Committee.

The committee will meet on December 10 to evaluate the Pfizer vaccine. Moderna’s vaccine will be considered on December 17.

AstraZeneca is expected to apply for a EUA soon. The company is already seeking similar approval in the United Kingdom.’

Are the vaccines safe?

The FDA requires all vaccines to be extensively tested in three phases of human trials before approving them for wider use. Each trial seeks to answer different questions, with the first two focusing heavily on safety — specifically short-term side effects. During phase three testing, which can last several years, researchers are looking for longer-term safety concerns.

Because of the dire need for a COVID-19 vaccine, the FDA is considering emergency approval before the Phase 3 trials are completed. Officials won’t yet have full information about long-term effects of the vaccine, but the United States is experiencing a record number of COVID-19 deaths. The federal process is designed to determine if the vaccines are safe and effective enough that the immediate benefits of slowing an out-of-control pandemic outweigh the unknowns.

In addition to the federal process underway, Oregon has joined Washington, Nevada and California to conduct an independent safety review of the vaccines. Two physicians from Oregon are part of that working group, which will examine the data from the vaccine trials before recommending their use.