Tulane University Hospital's emergency room entrance. (Marta Jewson/The Lens)

The Louisiana Department of Health has produced a draft plan for allocating the first round of coronavirus vaccines. The plan is currently under review by Gov. John Bel Edwards’ office and due to the CDC for approval by mid-October.

The CDC released guidelines for a national vaccine rollout in September, but it placed most of the planning responsibility on the states, which were directed to submit plans for distributing the vaccine and prioritizing possible recipients. So far, few states, if any, have released detailed distribution plans. 

The CDC has asked the Louisiana Department of Health to plan for a scenario in which the federal agency provides the state with thousands of doses of a vaccine by November. 

“We haven’t been given anything of specificity,” said Frank Welch, the medical director for LDH’s Bureau of Community Preparedness and Immunization. “One time we heard 34,000 [doses], another time we heard 62,000, then 24,000.”

It’s unlikely that a vaccine will be available so soon. According to reporting by Propublica, having a vaccine ready for widespread distribution by November “would take a miracle.” The furthest-along candidate, produced by BioNTech/Fosun Pharma/Pfizer, is still in late-stage clinical trials, and even if those are cut short based on strong preliminary data, the vaccine will need to go through an FDA review that could take weeks. And earlier this week, the FDA released a guidance — previously blocked by Trump administration officials — requiring two months of data for half of trial participants to assess safety. 

Louisiana’s draft plan has been developed by a group called the “Louisiana Vaccine Action Collaborative,” which includes state officials, public health experts, and healthcare industry representatives. LDH is also planning to distribute thousands of flu vaccines at public clinics in the coming weeks to test its mass vaccination system in anticipation of a coronavirus vaccine.

“If you have a limited amount of a resource,” said Welch, you’ll have to first prioritize who is going to get it.”

Guidelines for vaccine allocation released by the National Academy of Medicine on Friday aligns closely with Louisiana’s priorities, said Welch. Those guidelines outline a five step-rollout that’s intended to “maximize societal benefit by reducing morbidity and mortality caused by [COVID-19].”

The goal of the framework, said Susanne Straif-Bourgeois, a professor of epidemiology at LSU who is advising LDH’s vaccination program, is to prioritize equity. 

“We really want to make sure that [vaccine distribution] is strategic and equal, and then put the science after that.” 

What that means in practice, she said, is to consider not only who’s most likely to spread the disease — right now, young adults — or get the most sick, but who won’t have access to pharmacies and other healthcare facilities.

“It’s very important to do that at this point in time,” she said, “because you really need the public trust to go out and get the vaccine.”

The Lens did not obtain a copy of the draft before the publication of this article. But Welch described how it would work. 

In the first phase, the vaccine would be given to frontline healthcare providers, including hospital workers, first responders, and nursing home staff. After that would come people with risk factors for severe COVID-19, as well as those living in congregate settings like homeless shelters and prisons. In the second phase, teachers, anyone over 65, transit workers, and food packers would receive vaccines. The third phase would target people who are likely to spread the disease — everyone from food service workers to college students to children in school. In the fourth and final phase, the vaccine would be made available to anyone.

There are around 150,000 frontline healthcare workers in Louisiana who would be first in line, according to Straif-Bourgeois.

“You have food service workers, you have janitorial services, you have air conditioning technicians in those hospitals who would be considered frontline healthcare workers,” said Welch. Even under the rosiest predictions, there won’t be enough vaccines to cover all of them.

“Just because someone is a doctor or nurse does not mean that they would qualify for those initial doses,” Welch said. Instead, the state will work with the Louisiana Hospital Association and individual hospitals to determine which healthcare providers will be prioritized.

“You would look in your intensive care units, you would look at your emergency rooms, you would look at your urgent care clinics,” he said. “You would give those initial doses to the people you know who are coming into contact with COVID patients every single day.”

Straif-Bourgeois said that might mean giving doses to hospitals and then leaving it up to the institution to distribute internally. 

“It’s really not up to us to say, ‘He’s a brain surgeon, he might not have a high risk of being exposed to COVID.’ So I think it’s really up to the hospital to decide.”

Even so, she said, the state will still need to decide which healthcare providers receive doses, and how many they receive. 

“There might be certain regions where they see more COVID cases than other ones, and so you might need to think about that,” said Straif-Bourgeois. But, she said, that’s a moving target.

Another challenge to vaccine distribution is the nature of the drugs. All the vaccines in development require two doses, and the Pfizer vaccine must be kept at 112 degrees below zero at every stage in its transportation and storage.

That’s not as crazy as it sounds, said Welch. Up until about 12 years ago, chicken pox vaccines were stored the same way. Many universities and hospitals, which would likely receive the first doses of vaccine for internal use, already have freezers that meet those standards.

Ochsner Health has already been administering the Pfizer vaccine in clinical trials. In an emailed statement to the Lens, Katherine Baumgarten, Ochsner’s medical director of infection control and prevention, wrote, “We have established a multidisciplinary team that is planning how the vaccine will be stored, distributed and allocated among our staff and patients. … Our plan is also modeled after our influenza vaccine program.”

By the time all frontline healthcare workers have been immunized, Welch expects other vaccines with less stringent storage requirements will be available, which could be distributed to pharmacies. But the specifics will depend on the requirements of the vaccine itself.

The same holds true for follow-up injections. Welch said that the state will be tracking vaccination records using its existing immunization registry

“It has the ability to not only document who got the vaccine, but it will calculate the interval. We can then send a reminder either by text or postcard to the person saying it’s time to get your second dose,” he said.

The final component of making the rollout work will be convincing Louisianans to accept the vaccination: an NPR/PBS/Marist poll in August found that almost 38 percent of respondents who live in the South wouldn’t receive a coronavirus vaccine if offered, more than any other region. More than 60 percent of Americans would need to be vaccinated to achieve herd immunity.

Jason Halperin, the infectious disease clinician lead at CrescentCare, has also been involved in vaccination rollout plans, he said. He has already begun approaching community groups in New Orleans about enrolling in vaccine trials, which he said will be a starting point for larger vaccination efforts.

Welch said that he believes that the hesitance reflects the fact that vaccines are still in trials, and that it will fade once frontline healthcare workers begin receiving the injection. 

“Once there is an approved vaccine, we’ll be able to see that FDA review. [Right now] it’s kind of like reaching into a dark room, and whatever you feel, taking a bite of it, versus turning on the lights and seeing what it is.”

“I’m certainly proud of what we’ve done,” he said. “But there are so many things we do not know: when the vaccine will come to us, what vaccine will come first, what age range it’s appropriate for. We’re trying to plan for every scenario, and in doing that you spread yourself pretty wide.”