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Five weeks after the arrival of the first COVID-19 vaccines in Puerto Rico, the number of doses shipped has failed to meet the high demand for this product on the island.
Since the arrival of the first shipment on December 14, it was expected that this inequality could arise, as the 350,000 Pfizer (205,725) and Moderna (147,400) vaccines that were due to arrive in the country at that time have not been received.
The director of the COVID-19 vaccination program Health Department, Iris Cardona, has insisted that the root of the problem – and what remains a major challenge – is the low supply of vaccines that has reached the country.
“I am very happy and calm that people want to be vaccinated. The limiting factor is the number (doses available). The biggest challenge was the adjustments (that had to be made) in the distribution (of the vaccines). The 300,000 doses assigned to Puerto Rico were cut. We have received a third of what was expected. We knew it (the dilemmas that would arise with the supply and demand of the product) since December, ”said Cardona.
In an interview with The new daythe pediatric infectologist acknowledged that they had to juggle with the distribution of the vaccine, for which they have the support of the National Guard.
“Although there are fewer doses (than expected), a regular cadence of 40,000 doses per week is guaranteed,” he stressed.
However, he explained that 11,300 of them go straight to Walgreens and CVS, pharmacy chains that have a contract with the federal government to vaccinate older adults living in long-term care facilities.
The vaccination of older adults who gathered in these facilities, which is part of Phase 1-A set up by the government to prioritize populations at high risk of infection or complications related to the virus, began January 4 and should continue until mid-February, the official estimated, emphasizing that this also includes staff at these centers interested in vaccination.
According to Cardona, 4,000 people had been vaccinated in 127 of these facilities by January 12.
Meanwhile, of the nearly 40,000 vaccines arriving in the country every week, the National Guard is stockpiling 10,000 to administer at its regional vaccination centers and for other initiatives. The remaining 20,000 will be distributed to healthcare providers who are authorized to administer them. On Friday, there were about 300 certified suppliers to administer the vaccine in Puerto Rico, although only 175 had received the product, according to data from the Department of Health.
Phase 1-A, Cardona recalls, also involves approximately 150,000 health professionals and employees. It is expected, he said, that the vaccination of this population, which began on December 15, will be extended to the end of the month or early February, with the two doses required.
Huge challenge phase 1-B
The current challenge, he emphasized, is Phase 1-B because of its magnitude, as it includes about 600,000 people over the age of 65, in addition to about 60,000 first responders, including police, firefighters and medical responders. . They began to be vaccinated last week in a gradual integration process that should give precedence to adults over the age of 75, but for which, due to the high demand for the product, it was decided to implant it in people over the age of 65.
And within the challenge of vaccinating such a large population with limited amounts of the product, it is added that this week the vaccination of teaching and non-teaching staff will begin, both at the public and private levels. According to Cardona, this sector should be vaccinated in about four to five weeks, while everything that includes Phase 1-B is expected to take between eight and 12 weeks. He expected that, between weeks 8 and 10 of phase 1-B, 1-C could be integrated.
The designated Education Minister, Elba Aponte, reported that Tuesday will begin operation of the first three vaccination centers for public system personnel and private schools across the island. The first three centers will open in Bayamón (Rubén Rodríguez Coliseum), Mayagüez (Recreation and Sports Palace) and San Juan (Federico Asenjo Pre-technical School). The goal is to open more vaccination centers to vaccinate about 55,000 people in this sector.
“Education is an interest group (in vaccination), but we must also allow the (continuity of) vaccination for first responders and the elderly. The question is: how do I do that with 30,000 doses (per week)? Asked Cardona, who pointed out that they are also starting to vaccinate some 63,000 residents and employees of homes of people with intellectual disabilities this week.
Care for the bedridden population
The challenge of continuing and ensuring the vaccination of a growing population includes coordination to immunize bedridden older adults. For this, the official said, they have the support of staff from the College of Surgeons and the College of Practical Nursing of Puerto Rico.
Julio Irson, spokesman for the College of Practical Nursing, reported that the Housekeepers Corporation and the Hospice and Home Care Association will participate in the vaccination of this population.
Víctor Ramos, president of the College of Physicians, said this process started last week and also includes the vaccination of the main caregiver. Those interested in vaccinating a bedridden person, it was reported, should write [email protected].
During the interview, Cardona insisted that given the limited number of vaccines that have come in, they be distributed using concepts of “science, logistics and justice” to ensure coverage throughout the island. However, he acknowledged complaints about the lack of vaccines in certain places and geographic areas, such as the mountains and the west of the country.
“The number of vaccines that arrive every week is finite and they don’t all arrive on the same day. For example, they told us that on Monday, which is a holiday (today, Martin Luther King’s day), nothing (of vaccines) will be delivered, ”he said, pointing out that this is causing delays in distribution, as happened over the Christmas holidays .
He warned that if only limited numbers come in, the vaccination could be extended longer than expected. “If it remains finite (the arrival of vaccines), I will stay with these groups (1-A and 1-B) until May. If more arrive now, the process will speed up, ”he said.
The hope, he added, is that in February production of doses will increase and more will come, in addition to other vaccines against COVID-19 that are approved by the federal government and more are available. As one of the next to approve, he cited that of Johnson & Johnson, which he said only needed one dose, which would increase coverage in less time.
“If more (doses) arrive, the priority will be the elderly,” he stressed.
In the meantime, he noted that the facilities and certified suppliers to store and administer the vaccine must have the capacity to handle the rigorous cold chain required. And, despite the dose restriction, he felt the process was orderly, especially now that there are more vaccination sites.
However, he reported that in one of the facilities, which he did not identify, 40 vials of the vaccine were kept in a freezer instead of a refrigerator, resulting in 200 doses of the vaccine being lost. This is because, after consultation with the manufacturer, he indicated that he would not use these doses. It did not specify what measures, if any, had been taken in relation to that supplier.
Regarding complaints that in some clinics people not included in the current vaccination phase have been immunized, Cardona stressed that this action is “not wrong” if the doses are in danger of being damaged, as they last only six hours after preparation.
Of the 68 vaccine adverse reactions reported through Jan. 1, he reported that one was an anaphylaxis or severe allergic reaction that required the person to be hospitalized for two days. All of these reactions, he said, were reported after the first dose and 25 required emergency room visits.