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New Jersey has big plans for a potential coronavirus vaccine. State health officials said they hope to get 70% of residents inoculated within six months, have identified most of the funding needed and are crafting a strategy to prioritize distribution to those most at risk.
“Our goal, if I may, is pretty high,” Department of Health Commissioner Judy Persichilli told lawmakers last month during a hearing on the new state budget, which took effect Oct. 1.
But many challenges remain. Persichilli and others warned there could be vaccine shortages, especially at first, and note additional dollars may be needed to pay clinicians to administer the injection. They said they are also working out details on storage, as the inoculations may require refrigeration, and ways to effectively track who gets immunized.
“We do not believe we’ll have enough vaccines in the very beginning to inoculate everyone who is identified as a priority population. So a lot of decision-making will be made around that allocation as well,” Persichilli testified before the Assembly Budget Committee. “We have the funding up to the point where you actually get the shot in the arm,” she added.
Persichilli told lawmakers the DOH has budgeted $6 million to hire additional staff to “manage and oversee” the COVID-19 response, including a “large-scale vaccination program” when the time comes. An internal task force, with nine subcommittees, meets regularly to discuss the plan, she said, and the department has identified potential distribution partners, including local and county-level public health agencies, pediatricians and pharmacies.
Clinical trials this fall
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a prominent White House adviser, told Gov. Phil Murphy during a recent Facebook Live conversation that he expects six drug companies — including New Jersey-based Johnson & Johnson — to conduct advanced clinical trials this fall on vaccines they have developed. Fauci said the “best-case scenario” would be to have federal officials approve a product by the end of 2020, and he urged Americans to trust the scientific review involved.
If that timeline works, Fauci said, a COVID-19 vaccine could be available to limited groups — starting with health care workers and then other vulnerable populations — at the beginning of 2021. But it is unlikely to reach “the masses” until much later in the year, he said. If 75% to 80% of Americans were inoculated by late 2021, he said it would be a “really good accomplishment.”
Murphy has said repeatedly that New Jersey will also apply its own “rigorous” review process to any vaccine approved by federal officials, but state officials have declined to explain how that separate state-level screening would work.
“We don’t know yet what it will look like or when it will come, but that does not mean that the preparations on the ground are not being laid,” Murphy said of the vaccine on Sept. 23.
The DOH has also resisted sharing details publicly on its efforts for planning the distribution. Officials declined to say who was involved in the internal discussions or how the $6 million allocated for new staffing would be spent. A department representative said Friday that staff is reviewing an “interim playbook” on vaccines it recently received from the federal Centers of Disease Control and Prevention and would share information on the state plan when there is a clear timeline for a product to be released.
The CDC’s playbook — a 57-page document issued in mid-September and posted online — is designed to help government agencies prepare to distribute the doses they will get from the federal government. Among other things, it urges officials to create an internal planning team, identify public and private partners, and develop flexible scenarios that can be scaled based on availability. It also urges officials to consider past experience with seasonal flu or other outbreaks but warns that COVID-19 requires a much larger response.
‘Many unknowns, unanswered questions’
“There are many unknowns and unanswered questions at this time. For example, it is not yet known which vaccines will be available, in what volumes, at what time, with what efficacy, and with what storage and handling requirements,” the playbook notes.
Dr. Ed Lifshitz, medical director of the DOH’s communicable disease service, agreed last month that there are “so many unknowns it’s very hard to make predictions about exactly what’s going to happen” with a vaccine. It must still be produced and distributed, he said, and full protection may require two doses. There are also questions about how much protection it will offer at first, he said.
“All of those things are going on at the same time, so it is going to be a process,” Lifshitz said at a media briefing Sept. 23. “It’s not going to be like, ‘Oh, OK, Dec. 1 or whatever date there’s a vaccine available, we’re done’” with other protection strategies. Fauci and Murphy also cautioned that traditional infection control measures — like wearing masks, washing hands and staying distant — will still be necessary for some time after a vaccine is available.
Murphy and Persichilli have indicated that for New Jersey, in addition to health care workers, priority groups for vaccination are likely to include elderly individuals and those with underlying medical conditions. They have also suggested communities of color may be an early focus, as data shows Black and Hispanic residents are more likely to be impacted by COVID-19 than their white neighbors. In all, close to 207,000 New Jerseyans have tested positive for the virus since March, including more than 14,300 confirmed deaths.
Persichilli told the Assembly panel that, to reach the goal of inoculating 70% of the population, the state must set up a system to administer, distribute and deliver enough shots to vaccinate between 5,000 and 6,000 people daily. However, if health officials worked seven days a week to inoculate 6,000 people daily they would cover fewer than 1.1 million people in six months — or roughly 12% of the state’s total population.
State epidemiologist Dr. Christina Tan called the state’s vaccine preparations “an evolving work in progress,” at a media briefing late last month.
“There are a lot of assumptions about what will be available early on, versus what might be available subsequently,” she said Sept. 23. “With different planning assumptions, as far as recognizing that there might be limited amounts at the very beginning, that we have to be very mindful of priority groups where we can really make a huge difference for the public health impact of those vaccines.”