We are sharing this important information regarding COVID vaccines to help ensure we all have a safe and healthy 2021.

Greetings and good wishes for a safe and healthy new year!

Doctors Margan Zajdowicz and Thad Zajdowicz, Co-Chairs of the Healthcare Committee, have researched and prepared this announcement to help us all understand the efficacy of the vaccines and where we fit into the distribution plans as individuals and as a community. We are fortunate to have two physicians with a background in epidemiology heading up our Healthcare Committee. Please read their article and share it with your family and friends.

 Wishing us all the best possible outcome,

Martha Zavala, President

League of Women Voters – Pasadena Area

A Slow Roll-Out of the COVID-19 Vaccine: When Can I Get Vaccinated?

Two highly effective vaccines for Covid-19, the Pfizer and Moderna vaccines, were approved for emergency use (EUA) by the Food and Drug Administration (FDA) in December 2020. Twenty million Americans were promised their first dose by the end of December, but only 2.1 million had been vaccinated as the New Year arrived. Sadly, the original estimates have proven wildly optimistic and vaccination deployment is proceeding much too slowly.

Two concepts are critical to understanding the Covid-19 vaccine roll-out challenges. First is the role the Centers for Disease Control and Prevention (CDC) plays in setting priorities. Using available science, ethical considerations, and implementation feasibilities, the CDC recommended a phased approach, with healthcare personnel and residents at skilled nursing facilities (SNF) and long-term care facilities (LTCF) as top priorities, followed by essential workers and people 75 years of age and older. This is federal level guidance; the states are free to modify the guidance based on their local circumstances.

The second critical concept relates to the distribution of vaccine from production plants. The US Army was assigned the role of logistics tracking. Unfortunately, President Trump miscast their role. The Army was to coordinate with civilian organizations (FEDEX, UPS) to oversee the transportation of vaccine from production plants to designated sites within each state and territory. The President implied the Army would use its entire active-duty force to get the vaccine out to every person. This was false and the Trump administration made no plans for what to do with the vaccine once it reached the states. As a result, the distribution roll-out did not go well.

"Vaccines don't prevent disease, vaccinations do" is a time-honored infectious disease precept. No vaccine is effective until it is implanted in someone's arm. In the absence of a unified federal plan, each state has been on its own regarding vaccine deployment within its borders, a fact which led to a jumbled patchwork of 50 different policies. Since late fall 2020, hospitalizations, and deaths from COVID-19 have surged. In Southern California, hospitals are overwhelmed, ICUs full, and triage standards implemented. Public health departments, already underfunded, understaffed, and frazzled from months of hard work are near collapse. Now, in addition to coping with the COVID-19 disaster, these same healthcare and public health personnel are being asked to take on the job of vaccinating millions of Americans. Delays in vaccine distribution also resulted from the interposition of the holiday season in the middle of the deployment and because some states withheld vaccine doses in an attempt to ensure supply for the second dose. To date, California has received 2.69 million doses and has administered 734,000 of them. Los Angeles County has received 491,000 doses and has administered 146,000 doses.

The California plan for vaccine administration is similar to the CDC guidance. The L.A. County Public Health Department has its own guidance, and the City of Pasadena Public Health Department vaccine web page does as well. Healthcare workers and residents of LTCFs are the top priority. Persons seventy-five years of age and older are the next priority, followed by those at risk from work in education, childcare, emergency services, food, and agriculture. Others follow in descending order of risk or exposure. There is no statewide registry to sign up for the vaccine. If you are a healthcare worker, you should contact your employer. If you are an LTCF resident, you should contact your caregiver. Others should contact their healthcare providers to ascertain when the vaccine will be available. The vaccine and its administration are free. Sometime in the spring is the best estimate for when the general public will receive the vaccine.

In October 2020, the Department of Health and Human Services announced a partnership with CVS and Walgreens to provide and administer Pfizer vaccine to LTCF residents. In December 2020, this partnership become operational in Southern California with residents of LTCFs and SNFs receiving vaccine administered either by CVS or Walgreens. The Los Angeles County Public Health Department chose to enter into a public-private partnership with Curative to administer Moderna vaccine as soon as possible at SNFs; many SNF residents have already been vaccinated with at least one dose.

Plans for rapidly vaccinating all Americans have been insufficiently robust. Arresting the pandemic requires an increasingly vaccine-immune population. This would require mass immunizations similar to those in the 1950s and 1960s for polio and in New York City in 1947 for smallpox. Massive arenas and sports stadiums such as the Rose Bowl or Dodger Stadium could be used as vaccine venues with vaccinators drawn from volunteers and the military. President-elect Joe Biden has promised that 100 million Americans will receive at least their first dose of vaccine in his first 100 days as President. President-elect Biden has also promised to lobby Congress for additional funding for states.

Vaccine immunity reaching the 95% efficacy shown in the Pfizer and Moderna trials requires two doses spaced either 21 days (Pfizer) or 28 days apart (Moderna). After the second dose, 7 to 10 days must elapse for the immune system to produce antibodies protective against disease. It is not known whether the vaccine also protects against infection as opposed to only preventing disease. It might be possible to become infected with coronavirus and be an asymptomatic spreader after vaccination; hence we cannot abandon masks, physical distancing, and sheltering at home until a sufficient proportion of the population has been vaccinated and virus circulation has stopped. Most experts believe that could happen by summer 2021 with successful mass vaccination.

We urge all to be vaccinated as soon as the vaccine is available.  Everyone should complete the two-dose series. Bringing this pandemic to an end through vaccination is the only way to return to more normal interactions in our life in general and in our League in particular.

Margan Zajdowicz, MD, MPH and Thad Zajdowicz, MD, MPH

Co-Chairs, Healthcare Committee