COVID-19 Update 1/20: Vaccines, Variants, and Immunity

On this week's COVID-19 update, Dr. Steven Bishop provides an update on the status of vaccines at PartnerMD, how the entire vaccination proccess might improve, the U.K. variant, immunity after vaccination, and more. Watch the video below and read on for a full recap. 

Vaccines at PartnerMD

Our practices here at PartnerMD in Virginia, we were given the approval and the ability to place an order for some vaccines for COVID, which we hope to receive next week. Again, we were given approval to put in an order, so we essentially have made a request for vaccines. We do not know for sure still whether we will get it.

(Editor's Update: On Thursday, Jan. 21, the VDH informed all community providers (including PartnerMD) that no vaccine shipments will arrive next week and there will be an extremely limited supply for the next 6-8 weeks due to national supply chain issues.

Obviously, we are disappointed. We spent the last several months planning and preparing for this opportunity. We know many of you are looking forward to receiving the vaccine. And our team was ready to provide them to you. Unfortunately, this remains out of our control until the national supply chain issues are rectified. 

We are in constant communication with the VDH and will do everything we can to obtain vaccines once there is a change in supply. We also continue to develop our plans so we can vaccinate as many members as possible, as quickly as possible, once we do have access to vaccines.

Please continue to check our COVID-19 vaccine resource pages for updates from all of our states.)

We don't know whether we will get what we ordered, how much we will get of what we ordered, and we don't even know if they will actually show up. But we are hopeful that we will get at least a small supply of vaccine next week. And in Virginia, we will be allowed to start vaccinating those 75 and up first.

I really want to be clear about kind of the language around this and help people understand, the state government, as we've been kind of telling you guys off and on over the months, the state government is completely in control of vaccine distribution, of vaccine shipments, of all this stuff to practices. We have no control other than being as ready as we can be and then requesting vaccines.

We've done everything possible for the last several months to make sure our paperwork is in order. Make sure our staff is trained, that we have the freezers and all the materials in place to actually deliver the vaccine in a safe and effective manner.

But when it comes to actually receiving it, we are totally at the mercy of the Virginia Department of Health, the Maryland Department of Health, the Georgia Department of Health (editor's note: and the South Carolina Department of Health), the state governments in each of our districts.

With that in mind, we still have not heard back from Maryland or Georgia (editor's note: or South Carolina) in terms of when we may be allowed to order vaccine in our offices at those places, but we are preparing and we will be ready to order vaccines as soon as we are allowed to do that. Just want to let everyone know that and make sure everybody understands that we're working as diligently and quickly as possible.

I know people want the vaccine. I know they want it yesterday, last week. We want it for you, too. We're doing everything we can to get the vaccine available to our patients as quickly as possible. So I know all of our members got, at least in the Richmond area, got a newsletter about some of this information.

What Will Happen When Vaccines Are Available at Your PartnerMD Office

So be on the lookout for updates from that. What will happen when the vaccine is available at your practice, where you're a member, we will begin calling you and reaching out and scheduling your appointments to get the first and the second doses of the vaccine. It may be during the day. We may be having evening or weekend hours to get this done. We are still finalizing the details and all that.

But just know this is going to change day to day as we get this information in and could change very drastically, very quickly, depending on whether we actually, in the Richmond area, get the shipments we've requested or not in the next week or so. Again, we're working as fast as we can. Please know that. We wish it were faster.

If you have questions about vaccine rollout or comments, or you want to contact people, I would strongly encourage you to email the commissioner of health, to email the secretary of health in your state, to email the governor's offices in your states, because they are the ones in control of the vaccine supply and the vaccine distribution in their respective states.

We've been in contact with many of these folks as well, and that's how we've been very proactive about it, and that's the only reason we're even allowed to order vaccine as of now. So if you have things you'd like to share with those folks, I strongly encourage you to do so frequently and as soon as you like. I think that's going to be helpful.

There's lots of concerns about whether there is stockpile available, a lot of back and forth about how many doses are available at the national level to give to states and that sort of thing. I know we just heard from the health department a little while ago that Virginia ordered 300,000 vaccines last week, but we only got a 100,000.

There are supply chain problems all along, but once the vaccines arrive in the states, it's up to the state governments and to health departments to decide who gets the vaccine when, in terms of practices and where they're shipped and distributed to. So call your congressman, call your state delegates, call the governor's office, call the health departments and let them know that they need to do a better job of getting these vaccines distributed as quickly as possible.

Continue to Monitor Other Places to Get Vaccinated

We're continuing to monitor other places you can get vaccinated even outside our practices. The best thing that you can do right now is, what we have been told from our health department here in Virginia and I think it's going to be the same in other places, is to find one of these interest forms that you can fill out and put your name down, and they say they will contact you and let you know when you're eligible.

And if any other vaccination opportunities come about in your district, I would strongly encourage everybody to do that. I know that Bon Secours also has started doing some vaccinations for anyone who is a member, or has been taken care of at a Bon Secours facility, and they have put out a hotline for that, that you can try to call. I know also that VCU has been calling some of their patients who are 75 and up as well.

Things are moving forward, but they're moving forward very slowly, much more slowly than we would like to see. That is definitely for sure, but they are moving forward. So be on the lookout for all of that, be on the lookout for other opportunities to get vaccinated outside of our practices, if you're either not a PartnerMD member or if you want to see if you can get vaccinated sooner than what we might be able to do.

But do know that most of the private practices and small offices in the area are pretty much in the same boat, or they're much further behind the eight ball than we are.

Again, we just got off a call with the health department and we are as out in front of the game as you can possibly be having the freezers, having the processes, having our staff trained and ready to go. So again, we're trying to move this along as quickly as we can. I know it's still frustrating but please hang in there with us. We're trying to get these vaccines out to you as soon as possible.

Increasing Rate of Vaccinations?

"Currently, Maryland has 1.5 million eligible to be vaccinated under stage 1B of the state's plan, but the state is only receiving 10,000 doses per day. At that rate, it would take until the end of June to get through just this stage. When do you expect vaccine production to increase and what has to happen to make that possible?"

Yeah, so excellent questions. At this rate of vaccine distribution, it's going to take an unacceptably long time to get everyone vaccinated. I think, you know, June is unacceptable.

What I'm expecting, hoping, that President Biden, I know a lot of people probably watched the inauguration today, President Biden will likely, I hope, use the Defense Production Act to direct more resources to producing vaccines at a more rapid manner so we can get more of these doses delivered to states. And so that the states can deliver more doses to private practices and hospital systems.

I think that's the only thing that's going to make this go any faster at this point in the short, short term. At some point, you know, Pfizer, Moderna, and then whatever other vaccines may come on board, they will ramp up their production over time, but it does take time. And they are just a couple of companies.

I think that, I do think that President Biden should use the Defense Production Act to specifically direct more resources to the vaccine production effort at this point. Otherwise it's going to take forever to vaccinate everybody. That's my hope right now. We will see what the president does over the next few weeks here, but I'm hopeful that will be the case. Good question.

Timeline for AstraZeneca Vaccine? 

"Is there a timeline for the AstraZeneca vaccine approval?"

No, I do know that there is going to be an emergency meeting of one of the vaccine committees, the FDA vaccine committees, next Wednesday, I believe on the 27th to talk about sort of a data safety review of the vaccines already out there. And I think they're going to have some discussion about the AstraZeneca vaccine at that point.

We may know more after next Wednesday after that committee meets again. But I have not seen or heard anything further about the AstraZeneca vaccine in terms of being approved here in the US to date. I know they're using it over in the UK at this point as well with some, I haven't heard any problems with it, so I assume with some success, so that's good.

Value of a One-Shot Vaccine?

"How valuable would an effective one dose like Johnson, Johnson vaccine be?"

Very valuable because it's much simpler to give. I hope at some point we'll be able to find that a one dose of a vaccine is extremely effective.

And I've seen some interim data from Moderna and such that the FDA had reviewed and the efficacy after one dose of Moderna was about 80% or so, which is pretty good for any vaccine to be, to be honest. Then it goes up to 95 after the second dose, which is great.

But if we can get a one dose vaccine that's more than 80% effective, I think that would be fantastic. It would be hugely valuable. It would simplify a lot of our supply chain issues because that's part of the problem, right? For every person that needs to be vaccinated, we've got to produce two doses rather than one. So it would cut our production needs in half, so it would be extremely valuable.

New Info on Variants

"Anything new on the variants?"

Oh yes. Actually there is something new on the variants that I was reading about earlier today.

Pfizer had been doing some further testing and interim analysis on the UK variant that's more transmissible and they continue to say, they do not believe that there will be any problem with the Pfizer vaccine in terms of continuing to protect against the new variant. So that's good.

I didn't read details and how they sorted all that out. My guess is they used genetic sequencing to compare the new variants with the old one that they developed the mRNA against and I suspect they found that they were similar enough that there's not going to be a problem. So hopefully that will continue to be true.

The only other things I've heard about the variant is that the UK variant has made its way pretty significantly to China. A lot of cities in China are now back under total lockdown, unfortunately, including parts of the capital. And I know they're vaccinating people as well with different vaccines. They, the Chinese and the Russians, have developed their own vaccine that they're using. So they are using that there in their countries, but the UK variant has made its way there, unfortunately. And so they've seen a big uptick in cases of late as well, them and Japan.

New Info on Immunity? 

"Anything new on immunity?"

No, not just yet. I think the big question, immunity, I guess it's sort of tangentially related to immunity, is the issue of transmissibility after vaccination. And I think that's still very much up in the air.

Can people still transmit the virus even though they've been vaccinated and are protected themselves from a severe disease or disease in general? Might they still transmit it to other people?

And I think we're just not going to know that for sure. I've seen some prominent infectious disease experts saying that they think that it will be effective at preventing transmission. but it's going to take some months before we really know the answer to that question. Probably another year from now before we really know for sure.