The COVID-19 vaccination rollout is in full swing across the Granite State. Despite ongoing progress, residents and health workers still have major concerns. This week, Concord Monitor’s Health Reporter and Report for America Corps member Teddy Rosenbluth as well as Dr. Staci Hermann, Chief Pharmacy Officer at Dartmouth-Hitchcock, dug into some of those concerns.
Watch the full interview below
Melanie Plenda: What are some of the biggest issues you’ve seen in your reporting with the vaccine rollout so far?
Teddy Rosenbluth: I think there have been several technical issues with the vaccine rollout. I’ve spoken to several people who logged on to the state website the very first day at 8:00 AM; this is supposed to be a first come, first served system. These people signed up and then didn’t get the second email back which allows them to register for their site, and the time and the date until maybe a week later. By that point, even people who were older than 75 couldn’t get an appointment slot until mid-March.
The other thing I think people are very frustrated by is the 2-1-1 hotline, which is supposed to provide help to people who are struggling with the signup. I would say almost everyone I’ve talked to has been on a continuous holds loop with 2-1-1. When they do happen to talk to a real person, the advice isn’t very helpful or they just tell them to contact their primary care provider. I’ve had people contact me, not because they think I have any information that they don’t already have, but just because they want a real person to listen to their frustrations.
Melanie Plenda: Has the state addressed that at all? Has anything gotten a little bit better since those first few days, or is it still complicated and with some troubles?
Teddy Rosenbluth: I would say it’s still complicated. I think the state is doing their best, but this is a huge group of people that are trying to register; there’s about 300,000 people in phase one B, which is the phase we’re in right now. They’re actually working on rolling out a more streamlined registration process. Right now, how it works is you log on to the state vaccine portal, you put in your information, and then you get an email back from the CDCs registration system called FAMs. From there, you do the final steps of registering and picking your appointment. The hope is that with this new state-run registration system, you can do all of that at one time. I believe the expected date for that rollout was supposed to be February 4th. I haven’t heard any updates on whether or not that’s still being rolled out this week or how the state plans on going forward with that.
Melanie Plenda: You had mentioned the frustrations people felt with 2-1-1 and being told to call their primary care physicians, is there somewhere else people should call or can find out information that you know of?
Teddy Rosenbluth: I’m slightly biased on this, but I’m a big proponent of reading your local newspaper. I think this is such a great time to be investing in local news. There’s not a whole ton of clear information coming out of the state right now, and I’ve seen really, really great guides coming out of newspapers across New Hampshire that try to troubleshoot the vaccination registration process.
Melanie Plenda: What are some of the common misconceptions you’ve seen about the vaccination program?
Teddy Rosenbluth: I think the primary misconception I’m seeing right now is there is a lot of concern and panic about second doses. People are really scared that they’re not getting their second dose appointment within that 21 or 28 day window, and they’re worried that they’re going to have to start the vaccination process over again, or the vaccine is going to be less effective somehow. That’s actually not true. The CDC has recently updated their guidelines to allow for a six week gap if it’s necessary between the initial shot and the booster shot. I spoke to an immunologist yesterday who studies this time window between the first and second shot and he said even if you got your vaccination beyond that six week period, it’s really not going to affect the efficacy of the vaccine. The most important thing is that these doses aren’t too close together.
Melanie Plenda: When it comes to pharmacies, are there any issues with pharmacies issuing the vaccines?
Teddy Rosenbluth: Right now, shots are primarily being distributed to the state fixed sites for the public; the federal government partnered with CVS and Walgreens to distribute vaccines to nursing homes and assisted living facilities. These pharmacies have been broadly criticized on a national level for being slow to get these vaccines in the arms of older adults in New Hampshire. I found that it’s primarily slow because of bureaucratic lag: there’s lots of paperwork, they have to go through the federal government before they can go through the state government, so there’s lot of miscommunication that can happen between those steps. I will say that since I’ve reported this lag, Walgreens and CVS have finished giving the first dose to nursing homes they’re partnered with and are nearly done vaccinating assisted living facilities.
Melanie Plenda: Concord Monitor’s Teddy Rosenbluth, thank you so much for being here today and for talking to us. Now we turn to Dr. Staci Hermann, Chief Pharmacy Officer at Dartmouth-Hitchcock Medical Center about lingering questions and fears surrounding the vaccine. How is the vaccine rollout going at Dartmouth Hitchcock?
Dr. Staci Hermann: We have had a very successful rollout in terms of our employee vaccinations. You may be familiar with the fact that early in December, the FDA approved through emergency use authorization both the Pfizer and the Moderna vaccines. We have been actively vaccinating our workforce and are at the final stages of the second dose for our workforce here at Dartmouth. Earlier this month the state started to roll out phase one B, the high-risk population that is within the state of New Hampshire, so we are partnering actively to support the state in those efforts right now.
Melanie Plenda: Talk to us about what makes an MRNA vaccine different from, say, a flu vaccine or some other kind of vaccine that a person might get.
Dr. Staci Hermann: The MRNA is a newer technology – although it has been in development for a number of years now – and is helping the body to produce the spike proteins so that our immune system recognizes it, which is different from other vaccines. Some of our vaccines are what we call live vaccines, so they actually contain part of the virus itself. Others are not live vaccines, and it really just depends on the vaccine in question in terms of how it’s made; some of the flu vaccines are derived from eggs, so people with egg allergies may have issues with a number of the flu vaccines, but there is an egg-free version. It’s a little complicated in terms of how each of them are made but suffice to say, we would ensure that the patient gets the right presentation of the vaccine in question that they need based on their allergy profile.
Melanie Plenda: Some people report feeling ill after receiving the vaccine. What side effects should be expected, particularly after the second dose, and how long will they typically last?
Dr. Staci Hermann: I’ll start with the easier part of that question, which is how long do they typically last; we’re seeing anywhere from 24 to 48 hours. Some of my colleagues have already gotten their second doses and what they’ve told me is it’s almost like a veil lifting in terms of them getting back to normal. During those 24 to 48 hours, one of the biggest side effects really is fatigue. I would say the fatigue is just a symptom of the body’s immune system thinking it has seen the COVID virus and is fighting it off and building that immune system. Similar to when you may get a cold, your body tends to get fatigued a little bit because you’re fighting off that cold virus.
There will also be some arm soreness at the site of injection, and we would anticipate that just like we would with any other vaccine on the market. We are also seeing some people get nausea with these vaccines, but not everybody. With Moderna – and this is where the two differ a little bit in terms of side effect profile – there may be some arm swelling, but nothing that is severe in terms of side effect profile. They all resolve themselves within 24 to 48 hours.
Melanie Plenda: There seems to be some questions still as to once you get the vaccine, if you have COVID, can you still give it to somebody else? What do we know right now about that?
Dr. Staci Hermann: Both the Medina and Pfizer studies did show about a 95% efficacy rate, meaning you are protected from getting COVID. There was 5% of the study population that did still get COVID post-vaccination. Even though there’s a 5% chance that you may still get COVID, I would still encourage people to get the vaccines because what we did find in those studies is when they got COVID the symptoms, the severity of the COVID disease was significantly less than when individuals got COVID without the vaccine protection; that means you reduce your chances of ending up in the hospital or in an ICU and on a ventilator.
Unfortunately in those studies, what they did not study was asymptomatic transmission of the COVID virus. Knowing that the way the COVID virus is spreading most rapidly is through asymptomatic transmission, you still could be passing on COVID to other people that are in your sphere or family members who may be living at home with you. We still encourage folks to continue to mask and socially distance even after the vaccine because of the uncertainty around asymptomatic transmission. Again, knowing that 5% of the PA study populations did end up getting COVID, we do suspect that there likely is some asymptomatic transmission that was occurring in the studies. We just don’t know if that is true and at what percent, so my understanding is there are ongoing studies actually looking at asymptomatic spread for people who are vaccinated.
Melanie Plenda: What’s one message that you have for people who are undecided or concerned about getting the vaccine?
Dr. Staci Hermann: I would encourage everybody to get the vaccine. I know there’s a lot of unknowns in terms of, is Pfizer or Moderna the right vaccine for you? It really comes down to a risk-benefit decision; we know there is great protection offered by getting the vaccines. There are also a number of vaccines in trial right now that have not been approved, such as the Johnson and Johnson vaccine, which from all reports is slated to come before the FDA sooner rather than later. AstraZenica and Oxford are wrapping up some of their trials which should also land before the FDA fairly soon. Each of those presentations is a different type of vaccine in terms of how it’s manufactured. If there are concerns about a particular vaccine, such as the fact that Madrona and Pfizer are MRNA, there may be other options in the future.
Given how COVID is mutating, there could be a need for future boosters or vaccines even beyond what we’re seeing right now in terms of getting the population vaccinated. If you’re seeing your health provider, certainly they are able to have those in-depth, risk-benefit conversations with you. If you’re seeing your local pharmacist, they can have that conversation with you as well, knowing your medication profile and some of the disease states that the general public may have.
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