Health Care

Vermont sticks to its two-dose approach for administering vaccine

Dr. Mark Levine, state health commissioner, discusses Vermont’s first Covid-19 patient at a press conference at the State Emergency Operations Center in Waterbury on March 8, 2020. Face masks quickly followed. Photo by Glenn Russell/VTDigger

Vermont is doubling down on its vaccination approach, even as the federal government changes tack. 

The Trump administration has announced plans to release more doses of the vaccine all at once, so states can give more people first doses of the vaccine while delaying the second, conceding to scientists who see that as a strategy to deal with high case rates and a slow vaccine rollout. 

But Vermont officials say they will keep their promise that anyone who gets vaccinated gets fully vaccinated. 

“We had committed to Vermonters that we’re going to have a second dose ready for them at 21 or 20 days,” Gov. Phil Scott said Tuesday. “And I believe we should follow through on that promise and the strategy that we rolled out to begin with.”

Vermont officials say the data show their plans have succeeded. About 4% of Vermonters age 16 and older have been vaccinated so far, the sixth-highest state in the nation.

Some states have announced they will follow the new federal plan. Gov. Andrew Cuomo of New York says that, with the new doses, the state will allow anyone 65 and older to be vaccinated — about 7 million New Yorkers — although he expressed concern that the federal government may not be able to keep up with demand. 

Dr. Mark Levine, commissioner of the Vermont Department of Health, thinks that vaccination strategy will only cause more trouble. 

“I hate when people advocate getting into vaccination schemes that can only disappoint everybody, instead of please most people,” he said. “When you have too broad a band of age, or conditions … all you have to do is disappoint people because they all think, ‘Oh, my turn has come up,’ and then you find out that the amount of vaccine coming in a given week is only going to take care of a very small percentage of all those people.

“So I think the way we’re doing it is simpler, and it makes sense.”

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The CDC issued guidance this week prioritizing people 65 and older after health care and long term care workers.

Vermont’s next phase of vaccination will be for Vermonters 75 and older, followed by 70 and older, then 65 and older. The Vermont vaccination advisory panel has recommended they be followed by younger Vermonters with high-risk conditions, and frontline essential workers.

49,000 are 75 and older

The state estimates 49,000 Vermonters are 75 and older. State officials have said primary care doctors, pharmacies, local health departments and Covid testing sites are likely to be the main locations for vaccinations.

“If we start with the oldest age and work our way back, we will be letting people know when their age has risen to the front of the line, and they won’t be disappointed for three months, feeling like they’re competing with the world to get their vaccines,” Levine said.

Levine also pointed to chaos in Florida — where some counties decided to register people for vaccines through Eventbrite, leading to issues with high demand and fraud — as a reason for Vermont’s method of distribution.

“We want to get it done in a way where we don’t see what happened in Florida, where people in walkers are lined up for seven hours waiting to get into a vaccine center or, God forbid, arriving overnight, waiting to get into a vaccine center,” he said. 

Vermont is working on its registration system and plans to announce on Friday how people can register for the vaccine, Levine said.

A major reason for vaccinating people by age bands — starting with the oldest group — is the overwhelming number of deaths among older Vermonters, Levine said. 

“The older you are, the more vulnerable you are to severe risks and death from Covid,” Scott said Tuesday. “Saving lives must be our priority.”

As of Wednesday, 90 of the 158 deaths in the state were people 80 and older; fewer than 10 deaths were people under 60 years old.

There is one confounding factor, though: 60% of deaths in Vermont have been patients in long-term care facilities, where vaccinations will be completed this month. It’s unclear what percentage of deaths in the general community are older Vermonters. 

Glove, syringes and hand sanitizer
Syringes of Covid-19 vaccine are prepared for injection at Gifford Medical Center in Randolph in December. Photo by Mike Dougherty/VTDigger

The first dose

Experts believe the initial dose of the vaccine provides 90% protection after the person develops immunity, while the second dose ensures 95% protection. Those in favor of providing more first doses argue that it will give some level of protection to a broader swath of the population.

But Pfizer and Moderna’s clinical trials focused on the efficacy of administering two doses per person, and it’s unclear exactly what level of protection one dose provides or how long it lasts. 

Levine has described delaying the second dose of the vaccine as an “off-label” use.

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“If we’re going to believe in the efficacy of the vaccine, we should use it the way it was used in the studies that we’re using to use it in the first place, and not be experimenting on Vermont’s population,” Levine said.

But he said he would be “delighted” if the federal government began to ship Vermont more doses of the vaccine — even though the state hasn’t distributed the vaccine as fast as it has been getting it.

Estimates of what percentage of shipped vaccines have been used vary, and officials have warned there may be reporting lags in those numbers. CDC data shows that about 40% of vaccines sent to Vermont have been used, above the national average of 34%.

Levine said the slow rollout of the vaccine so far is the result of the state’s current phase of the vaccine and who it’s targeting. 

“These are special clinics being set up by hospitals for the health care workers in their region,” Levine said. Some people have minor side effects after receiving the vaccine, and hospitals are staggering their workers’ vaccinations “so that health care workers don’t get them all at once and then all get sick and can’t come to work.”

Vaccine allocation uncertain

Levine expects the vaccination pace to pick up.

“The next phase will involve a lot of community vaccination sites, a lot of health department district office sites, a lot of pharmacies and primary care sites,” he said. “And so, you will find that the vaccine will go much more quickly.”

He said he couldn’t estimate how many vaccine doses will be distributed per week in the next phase, because Vermont still doesn’t know how much it will get from the federal government. 

“Right now we don’t even know what next week’s vaccine allocation is; we won’t know until Wednesday or Thursday this week,” he said. “And it’s been going down, not up. So it’s really hard to make an estimate when the vaccine amounts are so changing.”

It also may be many months before the vaccine begins to have an effect on Covid data. The older people getting priority for the vaccine “may not be the people who are mixing with others in society; they’re trying to stay safe — that’s going to take a long time,” he said.

As vaccinations occur, Covid cases in Vermont are reaching record-breaking levels. But since the majority of deaths have been in long-term care facilities, that may be where the vaccines are most immediately beneficial, Levine said. 

For now, the Department of Health is trying to reach Vermonters to remind them: Don’t slow down on the measures you’re taking to prevent the spread of the virus, Levine said. 

“We want to have the dual pathways,” he said. “One pathway: getting people vaccinated as quickly as possible; The other pathway being to make sure everybody knows it’s going to be many, many months before you stop wearing masks, and [continue] keeping distance and avoiding crowds.”

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Erin Petenko

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