Minnesota readies its plan to distribute first doses of vaccine

Minnesota hospitals are readying plans to distribute the first doses of COVID-19 vaccine later this month while awaiting guidance from state health officials on which people should receive it first.

A Minnesota Department of Health panel on Friday drafted plans to adapt vaccine distribution guidelines from the federal Advisory Committee on Immunization Practices, which prioritize the first doses of COVID-19 vaccine for health care workers and residents and staff of long-term care facilities.

State infectious disease director Kris Ehresmann did not reveal details but said the panel discussed how to prioritize limited vaccine within high-priority subgroups, and whether to adjust distribution for socially and economically disadvantaged regions.

"There was robust discussion about those subgroups ... and conversation about racial disparities in disease severity," she said in an e-mail.

Projections from other states suggested that Minnesota would receive 47,000 doses in the first week of availability — with each person needing two doses — but Gov. Tim Walz on Friday said those numbers are "not solid."

He urged patience as health officials establish priority groups for vaccination that are ethical and have the most benefit against the pandemic.

Broad public vaccine distribution is more likely in the spring, he said. "We're going to be in a really good spot by the time those trees bud out and those bats are cracking."

Hope about vaccines comes as Minnesota contends with a pandemic that has caused 338,973 known infections and 3,845 deaths, including 61 reported Friday. The number of COVID-19 patients in Minnesota hospital intensive care beds has declined from 394 on Nov. 30 to 367 on Dec. 3 — but remains well above the count of 197 on Nov. 1.

While case growth may be slowing, Ehresmann said it could rebound during the holidays and that vaccines are "the end game for COVID-19."

All plans start with the assumption that the U.S. Food and Drug Administration on Dec. 11 will approve Pfizer's experimental vaccine, which was approved last month in the United Kingdom.

Vaccinating health care workers first is important, because it ensures a stable supply of doctors and nurses to treat COVID-19 and other patients, said Dr. George Morris, who is coordinating the COVID-19 response for St. Cloud-based CentraCare.

CentraCare has a volunteer and priority list, though that could be revised based on state or federal guidance. "We've already canvassed our staff to identify interested people, what roles they serve, and in essence which ones we may prioritize [for vaccination] on week one, week two, week three, week four," Morris said. "It depends on availability, because no matter how much they send us, it won't be enough."

Adding complexity is the fact that the Pfizer vaccine must be kept in ultracold storage until it is ready to use, at which point it can be kept at normal refrigerator temperature for no more than five days.

"It's use it or lose it" at that point, said Dr. Melanie Swift, who is leading COVID vaccination planning at Mayo Clinic. "The fundamental underlying principle is: Do not waste vaccine."

Swift said she is expecting the first shipment of Pfizer vaccine for the southeast Minnesota region to come in five containers, which look like thick "pizza boxes," totaling around 4,900 doses. A similar shipment should come a week after that.

Mayo's allotment will be distributed equitably throughout its hospitals and clinics to personnel deemed at greatest risk of COVID-19 exposure and at greatest need to keep the health system functioning.

"It's not just the doctors and the nurses, it's who is cleaning the COVID patients' rooms, right?" she said. "Our EMS personnel are transferring patients and getting exposed despite all the precautions we put in place. ... When you're resuscitating someone in the field, it's a pretty chaotic, uncontrolled situation."

Some have countered that national and state distribution strategies should start with mobile young adults who spread the virus, but Swift said there wouldn't be enough doses right away for that strategy to work, so the ethical choice is to vaccinate people at greatest risk of severe COVID-19.

Bloomington-based HealthPartners is similarly prioritizing initial doses for workers in its emergency, intensive care and COVID-19 units. Dr. Mark Sannes, who is coordinating that system's vaccine planning, said further decisions may be needed if the initial shipments don't stretch to all workers in those units.

"Logical sorts of prioritizations might occur around age" of workers, he said, "knowing that older people seem to be more likely to have severe outcomes if they become infected with COVID. We haven't had to go down that road yet and are hoping that our vaccine supply will make it so that isn't necessary."

Broader vaccine availability will likely come from expanded distribution by Pfizer and FDA approval of a second vaccine by Moderna, as well as other vaccines being studied.

HealthPartners has the second­-highest enrollment number in the U.S. of more than 550 volunteers to receive an experimental vaccine made by AstraZeneca that has yet to be formally submitted for FDA approval.

Minneapolis-based Allina Health entered an ongoing trial of a vaccine by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson, last month and is tops in U.S. recruitment with 188 volunteers for that trial.

It's unclear if availability of approved vaccines will slow enrollment in clinical trials — which give participants a 50:50 chance of receiving experimental vaccines or placebo injections — but Sannes said it will be important to study all of them.

Some vaccines could end up more effective in certain demographic groups, while Sannes said the AstraZeneca vaccine is easier to distribute than the Pfizer version; that ease would more readily address global supply needs.

Hospital providers are likely to receive direct shipments of vaccine to distribute to health care personnel in the top priority groups, while the federal government has tapped chain pharmacies CVS and Walgreens to help with initial distribution to long-term care facilities.

Swift said another reason for vaccinating health care providers first is the examples they will set, because their broad uptake will give the public confidence that the vaccines are safe.

These vaccines seem to produce a high rate of mild side effects, such as muscle aches and fatigue, and Swift said there is concern that this will dissuade people from going back for the second dose they need for protection from the virus.

"These minor, mild side effects resolve on their own," she said. "They're not dangerous. It's a sign your body is responding the way we want it to so that it will be able to defend you against COVID-19."

Jeremy Olson • 612-673-7744