COVID-19 vaccine rollout begins in Tampa Bay Area, around Florida

The COVID-19 vaccination distribution program has begun to roll out quickly in parts of the Tampa Bay Area with much-deserved fanfare, given the speed at which the vaccine has been produced as part of Operation Warp-Speed, the U.S. national vaccination effort.

Florida’s receipt of 179,000 doses of the Pfizer-BioNTech COVID-19 vaccine this week was described by Dr. Charles Lockwood, USF Health Senior VP and Dean of the USF College of Medicine, as “our magical Neil Armstrong moment.”  A rapidly evolving process, here’s what we know about Florida’s distribution of vaccines so far:

The state’s five medical centers, including Tampa General Hospital, all facilities with ultra-cold freezer capacity, have been allocated 100,000 doses and have begun vaccinating healthcare personnel this week.  

Tampa General initially is serving as a hub for distribution in the Bay Area and will work with other community partners, including support for 21 local locations to serve as general immunization sites. The timeline for this stage is not known at this point. TGH will be working with other partner hospitals, including AdventHealth, BayCare, Bayfront, HCA, and Moffitt, and sharing vaccine distribution for allocation with their healthcare workers.

Another 60,000 doses of the Pfizer vaccine will be distributed beginning Monday, Dec. 21, to long-term care facilities through two pharmacy chains CVS and Walmart, according to a nationwide federal contract.  

Earlier this week, on Wednesday, (Dec. 16), Florida Gov. Ron DeSantis announced that in advance of the pharmacy-based distribution plan that is to start Monday, an additional 21,450 doses of the vaccine were shipped this week by National Guard “strike teams” assisted by Emergency Medical Services personnel to long-term care facilities in Pinellas and Broward counties to speed the delivery process in these two counties with disproportionately higher numbers of older citizens.
 
These “strike force” vaccinations began with the intent to reach all 112 facilities within a week. The “strike teams” will act as a bridge for about the next two weeks in supplying vaccines until CVS and Walgreens are “up and running” in the Tampa Bay region as well as the rest of the state. An additional six long-term care facilities in Miami-Dade will also receive the vaccine by a separate allocation.

Florida was scheduled to receive a second batch of the Pfizer vaccine, an additional 500,000 doses, over the next two weeks, but shipments are on hold due to production delays in Pfizer’s manufacturing and logistics systems. DeSantis has announced the next allocation being set up will come not from Pfizer but Moderna with 367,000 doses expected to become available soon, pending its Emergency Use Authorization, possibly beginning Friday, Dec. 18. 

Moderna, unlike the Pfizer vaccine, does not require ultra-cold storage -- making distribution easier -- and is potentially scheduled for distribution to 173 hospital locations in Florida, including 43 counties that have not yet received the earlier Pfizer vaccine. The Governor says he wants all long-term care residents in Florida to be vaccinated by the end of the year, a potentially daunting task. Moderna vaccinations could begin as early as next week.

Planning the logistics of distribution on the local level

At a Wednesday (Dec. 16) Town Hall sponsored by the Hillsborough County Medical Association, Hillsborough County Health Department leaders, including Director Dr. Douglas Holt and Director of Public Health Preparedness Ryan Pedigo, said their offices have been engaged for weeks in planning with the local leaders and an Emergency Task Force.

Dr. Holt noted that county health departments while having the resources to focus on the communities they serve, will be seeking partners, “large groups to help take the lead” to assist in distribution. Admittedly, the panel acknowledged, there have been recent changes from Tallahassee in what has become a rapidly evolving distribution plan. Pedigo added “we’re not getting a lot of vaccine in Florida right now,” emphasizing the need for patience despite the recent news of the first tranche this week of vaccine arrival in the Tampa Bay Area.
  
Pedigo outlined the timeline and priorities for vaccine distribution laid out recently by the state and which he emphasized follow guidelines from CDC and the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that advise it routinely.

There are three priority groups, with Priority 1 subdivided into three subcategories:
  • 1A -- Long-Term Care Residents,
  • 1B -- Health Care Workers (High-Risk and High-Contact), and
  • 1C -- People ages 65+ and those with underlying health conditions.
Currently, only groups 1A and 1B are receiving the vaccine in Florida. These include high-risk workers such as those working in hospital E.R.s, ICUs, and COVID floors, or in long-term care facilities. It is not anticipated that groups other than 1A and 1B will have access to a vaccination before January.

Priority 2 includes workers in critical Infrastructure services, such as transportation, utilities, and education -- entities that Pedigo emphasized “keep us moving, keep the power on, and (keep classrooms open)” -- as well as vulnerable populations, including racially at-risk populations. Priority 2’s timeline would start in late February or early March.

Priority 3 includes the general public and will likely begin in April and, hopefully, conclude by mid-year. Private providers can expect the availability of the vaccine for their offices probably in March but they will first have to enroll with the Health Department through a program called Florida SHOTS, a centralized immunization information system. The Health Department will be surveying county health providers for guidance in developing an efficient system to get vaccines to enrolled providers.

Pedigo referred to an entity called “PODS” (points of dispensing) which will be central to the distribution process in our area. These will be “closed points of dispensing”  for which “our community partners will play a huge role in setting up,” he noted. 

In addition, the Raymond James Stadium on Dale Mabry Highway is being considered for a major vaccination site, as well. He added the distribution process will “have many moving parts and involve many groups in coordination to get the vaccine out.” 

Workgroups are being set up now to make the process as efficient as possible to work with various target populations. In Hillsborough County alone, Pedigo explained, “three of the largest groups include long-term care residents and staff (23,000 individuals), hospital residents and staff (30,000 individuals), and seniors over 65 years of age (206,000 individuals).”

The HCMA panel heard a discussion comparing the Pfizer and Moderna vaccines. Both act in a similar way with similar mRNA technology that does not use a live virus, enter the cell’s nucleus or interact with a person’s DNA. Both have similar efficacy after the second dose (given three to four weeks after the first, depending on the manufacturer) of around 95% effectiveness.

“The handling of Moderna is much easier in not requiring that ultra-cold freezer,” Pedigo said, which many but not all hospitals have and most physician offices do not. “So it’s more difficult to use the Pfizer vaccine on a widespread basis,” he added.

More details about vaccination protocols
 
Additional COVID-19 vaccination protocol information is consistent with current CDC guidelines:

SAFETY -- Both vaccines have met stringent safeguards in Phase III testing with side effects reported as limited to localized discomfort and occasionally fatigue or fever. None of these side effects after a first dose is a contraindication to the second dose. The most notable precautions or possible reasons to avoid these vaccines are acute illness or a personal (not family) history of a severe allergic reaction (e.g., anaphylaxis) to any previous vaccine or medication. However, other allergies to foods (shellfish, peanuts, eggs, etc.) are not contraindications.

PERSONS WITH UNDERLYING MEDICAL CONDITIONS -- The Phase III trials included similar safety and efficacy in such patients and the vaccine may be given including to those, for example, with cardiovascular disease, diabetes, auto-immune disorders, or on biologics. Such patients may in fact be at higher risk for severe COVID-19.

PREGNANCY AND BREASTFEEDING -- While no data on safety in pregnant or breastfeeding women is available, the vaccine can be given in such instances after first discussing with the patient’s obstetrician because pregnancy may increase the risk of severe COVID-19 illness and may increase fetal risks, including pre-term labor. These vaccines are not thought to be a risk to the breastfeeding infant.

PERSONS WITH CURRENT COVID-19 INFECTION -- Vaccination should be deferred until recovery. Current information indicates reinfection is uncommon within 90 days of COVID-19 infection, so that vaccination may be performed after an interval of 2-3 months.

PERSONS WITH A HISTORY OF COVID-19 INFECTION -- Vaccination should be offered regardless of history of COVID-19 with or without symptoms and does not require testing prior to vaccination.

IMMUNOCOMPROMISED PERSONS -- Patients with HIV or other immunocompromising conditions or who take immunosuppressive medications may be at increased risk for severe COVID-19 infection. While safety and efficacy information is not available in these groups, the vaccine may be considered after a discussion with their physician.
 
A member of the HCMA panel, Dr. John Sinnott, Chairman of the Department of Internal Medicine at USF Morsani College of Medicine, stressed the importance of taking a wide perspective in viewing vaccines for COVID-19. He reminded the audience that “no pandemic has ever been stopped by a vaccine -- only by vaccine programs.”

This means that following vaccination (which becomes effective about 1-2 weeks after the second shot is given), vaccinated persons should continue to follow all current guidelines to protect themselves and others, including wearing a mask, social distancing, avoiding crowds, and following quarantine guidance following exposure to someone with COVID-19.

This piece is a composite of the latest COVID-19 vaccine information drawn from two CDC webinars, recent local news reports, and an HCMA-sponsored Town Hall on vaccines.
 

Read more articles by Dr. Bruce Shephard.

Dr. Bruce D. Shephard, a retired Obstetrician-Gynecologist and Affiliate Associate Professor, Department of Obstetrics and Gynecology, USF Morsani College of Medicine, is best known locally for delivering more than 7,350 babies. He now occasionally teaches and always practices good health, dabbles in writing, and raises monarch butterflies. He and his wife, Coleen, live in Tampa.
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