‘It has been something on everyone’s mind’: A public health planner on preparations, challenges in COVID vaccine rollout

The race is on to create a COVID-19 vaccine — and when one is finally available, local health officials will be on the front lines of a long chain of logistical challenges as they work to protect the public.

Christopher M. Goshea, the Pioneer Valley Planning Commission’s Public Health Emergency Preparedness Planner for Hampden County, says a main concern involves the preparations needed to immunize local populations against the virus once vaccines are approved for distribution.

The National Governors Association has issued a memo advising governors on how to prepare for immunization against COVID-19 on a mass scale. Massachusetts Health and Human Services Secretary Marylou Sudders, who noted the state through the Massachusetts Department of Public Health distributes about 3.2 million vaccine doses every year, said the DPH “has had an internal working group to ensure that we have the infrastructure in place” when a vaccine is ready for distribution.

This week, meanwhile, Gov. Charlie Baker announced a vaccine advisory group to “advise the administration, including the Massachusetts Department of Public Health and the COVID-19 Command Center, on communication, distribution and equity issues relating to a COVID-19 vaccine,” officials said. The board will include medical professionals, public health experts, elected officials, community leaders and infectious disease specialists.

“It has been something on everyone’s mind, and municipalities have been improving their plans,” Goshea said of a potential COVID-19 immunization effort. “There is a lot of potential change with the way anything can be manufactured and shipped so we are all prepared for last minute changes and adaptations to make it work at the local level.”

Some reports indicate COVID-19 vaccines in development may require special refrigeration units for storage. While some vaccines don’t require cold storage, Goshea said, “There has always been a capacity to store large volumes of supplies needing a secure location with and without the need for refrigeration.”

Goshea noted the role of the federal government in providing additional medical supplies to states during emergencies, and how concerns around immunization helped expand this role.

Vaccines in federal storage include one that can be used, along with antibiotics, for people exposed to the bacterium that causes the potentially deadly anthrax disease. Traces of the cultivated germ were sent through the U.S. Postal System to two U.S. Senators and news organizations in 2001, killing five and sickening 17 others.

Following those attacks, Goshea said work was done to help in the evolution of what is now known as the Strategic National Stockpile. Now, he said, plans are in place for dispensing vaccines and medical supplies that come through the stockpile.

“Upon declared emergencies states can request federal assets through the SNS as they did with personal protective equipment this past spring,” he said. “These supplies come from various locations or from vendors and come into the state under Massachusetts Department of Public Health control and then are dispersed through a priority system to the local communities.”

Cities and towns have “Emergency Dispensing Site” plans for distribution.

“Some municipalities have individual plans while other towns may share EDS locations, hence having one plan,” he said.

Goshea said a survey on storage capacity for vaccines needing refrigeration was conducted about a year and a half ago through planners in each of the Western Massachusetts counties.

“The purpose of the survey was to see what current boards of health had for refrigerator storage capacity and partnerships,” Goshea said, adding that the survey was used “to identify gaps and work towards building additional capacity and partnerships.”

“Since then equipment was purchased through various means and other agreements were formed between private partnerships,” he said.

Most of the time, he said — such as in the case of anthrax — there’s enough vaccine to distribute it to all residents. He believes the supply for a COVID-19 vaccine may be more limited as it is rolled out, so vaccination could take place over several cycles.

“In such cases there are resources, such as the Centers for Disease Control and Prevention’s tier schedule to prioritize distribution so that essential services will be maintained,” he said. The CDC guidelines prioritize vaccination for “critical healthcare” workers, public health workers and first responders, including police and firefighters, among other groups.

Goshea said much of his work during the pandemic has involved coordinating with partners in Hampden and Hampshire counties regarding COVID-19 needs, and questions around guidance and enforcement. Those working in local emergency preparedness, he believes, are doing what is needed to prepare for the availability of a COVID-19 vaccine and its distribution.

“Care is not much different from anthrax, seasonal flu, or measles with the exception of a potential limited vaccine initially,” he said. “In such cases we have recommended various non-pharmaceutical interventions such as masks and hand washing that have been effective against limiting transmission.”

Goshea, who has a background in fire and emergency medical services, has held his present job since December 2018, “working with the various Hampden County municipalities to plan and prepare for public health disasters and other emergency planning and preparedness activities they need.”

He also serves as director of the Medical Reserve Corps, helping to coordinate medical and non-medical volunteers in the county, and teaches public education classes on topics including emergency preparedness, hands-only cardiopulmonary resuscitation, and Narcan and overdose education.

Goshea said the pandemic is “certainly the longest challenge” he has faced as a public health emergency planner — and exactly what those in his profession work toward planning for.

“Not all public health emergencies have vaccines and they all have somewhat similar challenges,” he said. “The biggest challenge I would say is prior to COVID, as not many people knew about the work that was constantly being done on their behalf and there were challenges getting buy-in from partners and limited funding support.”

He added, “Each disaster better prepares us for the next one.”

There are always lessons learned, and improvements to technology and logistics.

“These improvements are incorporated into plans constantly when gaps are identified,” he said. “Planners, communities, and emergency management work incredibly hard to build the best systems.”

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