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Health and Medicine

Why Oregon Still Can’t Say When You’ll Get The COVID-19 Vaccine

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Kristyna Wentz-Graff / OPB
CVS Pharmacist Jordan Tran prepares a shot as he helps give Pfizer COVID-19 vaccine on Monday, Dec. 21, 2020, at Rose Villa in Portland. Despite big headlines when inoculation efforts launched in mid-December, Oregon has fallen behind its goals for vaccinations.

People want to know: when are my parents gonna get vaccinated? Teachers? Me? Apologies, but it gets really complicated.

Every week, it seems, we find ourselves wrestling with the latest existential “COVID-19 and Me” question. Early on, it was, “Should I wipe down my Amazon boxes?” And then, “How do I get my kindergartener to join a Zoom call with his teacher?”

These days, the Big Coronavirus Question being put to OPB reporters is this: “When will I get the vaccine?”

The short answer is: we really can’t say. The Oregon Health Authority’s Vaccine Advisory Committee, a diverse group of public health experts and community representatives selected from 400 applicants across Oregon, met for the first time Thursday to decide who will be vaccinated next, and in what order. So far, no decisions have been made.

The longer answer for Oregonians is: Distribution problems at the federal level and logistical challenges at the local level have slowed the state’s rollout and delayed further planning. Oregon was supposed to vaccinate 100,000 people by the end of Dec. 31. As of Friday, Jan. 8, Oregon was just two-thirds of the way to that goal. And with over 300,000 healthcare workers in the state, there’s a long way to go.

But it’s a lot more complicated than that. And being told “we don’t know” doesn’t help much. So we’re answering all of your questions with what we do know, and why there’s so much still up in the air. Is most of it kind of wonky, nitty-gritty inside baseball? Yeah, kind of.

Is Oregon vaccinating slower than other states?

The Oregon Health Authority says that Oregon is in the middle of the pack when it comes to states’ vaccination efforts. At the end of last week, 1.5% of the total population of Oregon had been vaccinated. Forty states and Washington, D.C., the District of Columbia have vaccinated a higher percentage of the population than Oregon.

The number of vaccines a state gets, and when they arrive, rests primarily on the federal government. But that alone can’t explain the reasons for Oregon’s slow rollout.

Another metric is to look at the percentage of delivered vaccines that have been administered. On Friday, Oregon was ranked 36th. So far, Oregon has used just under a quarter of the vaccine doses that it’s received.

How do I know when I'll get vaccinated?

First, you need to figure out what phase of the rollout you might be vaccinated in. It’s broken up into four phases and several sub-phases.

Who came up with the phases?

The vaccine rollout phases were designed by the CDC’s Advisory Committee on Immunization Practices. This advisory panel is made up of virologists, outbreak specialists and medical ethicists. They have been issuing recommendations for states to follow in each stage of the vaccine rollout.

Here is who the CDC’s advisory panel recommends the state vaccinates in each phase:

  • Phase 1: Frontline workers and people who are at high risk.
  • Phase 2, 3, and 4: Not yet determined. The Advisory Committee on Immunization Practices has yet to issue any recommendations. It’s safe to say that if you aren’t included in phase 1, it will be several months before you receive the vaccine.

Phase 1 is divided into several sub-phases, and those are the groups of people being vaccinated right now.
Who decides who's in what phase?

ACIP issues recommendations for who gets the vaccine when, but ultimately, the states have the authority to determine who gets vaccinated when. Just to make it even more confusing, individual hospital systems and county health programs may have additional priorities and strategies for administering the vaccine.

That means that no two states are vaccinating people the same way. There are similarities -- all of the states are following CDC’s Advisory Committee on Immunization Practices recommendations to some extent, but each state can choose to define “frontline workers” and “people with pre-existing conditions” however they choose. The committee also issued guidance on how to sub-prioritize people in each phase.

Oregon has a vaccine advisory committee that will meet regularly to decide how to best follow federal recommendations in Oregon. Who does the CDC’s advisory committee recommend be vaccinated in Phase 1, and when?

It breaks Phase 1 into three groups. Phases 1a, 1b, 1c.

Phase 1a is health care professionals and residents and staff of long-term care facilities. States can define those terms however they choose.

Phase 1b includes frontline workers (defined differently from essential workers), as well as people over the age of 75. The federal government advises prioritizing the elderly because people over the age of 65 make up about 15% of the population in the US, but 80% of all COVID-19 deaths. By prioritizing the elderly, many deaths can be avoided.

Phase 1c includes “essential workers”, people ages 16-64 with high-risk medical conditions, and people over the age of 65.

The Advisory Committee on Immunization Practices recommends everyone else be vaccinated in a different group.

The committee defines “essential workers” as workers whose jobs are necessary to keep the state and country running. Frontline workers are a subgroup of essential workers who have close contact with other people. So, for example, a utility maintenance specialist is considered essential, while a grocery store cashier is both essential and frontline. The cashier would get vaccinated first because they are the most likely to get sick.

How is Oregon's plan different from the federal recommendations?

Oregon has adopted some big variations from federal recommendations compared to other states.

Phase 1a includes health practitioners who have direct contact with patients. Unlike some states, Oregon has prioritized non-medical hospital staff like orderlies, janitors, and cafeteria workers in Phase 1a, along with doctors and nurses. Hospital office staff and administrators should not be vaccinated in Phase 1a, but that hasn’t stopped local hospitals with excess vaccine from providing them. Oregon also includes home healthcare workers in Group 1a.

Controversially, workers at correctional facilities are included in Phase 1a, but incarcerated people are not. To avoid a lawsuit, Oregon will now allow incarcerated peoples to receive the vaccine in Phase 1b.

Phase 1b in Oregon includes frontline essential workers and people over the age of 75. Oregon was one of the first states to emphasize vaccinating teachers in Phase 1b, when Oregon Gov. Kate Brown requested that teachers be “first in line” to help aid school reopening.

In a press conference Friday, Brown confirmed that teachers would get first priority in the next round of vaccinations: even ahead of people over the age of 75.

Who are we vaccinating right now?

We’re vaccinating Phase 1a. Initially, Oregon tried to prioritize groups within Phase 1a, so emergency staff and staff working with high-risk patients were vaccinated first. But triage proved to be a challenge and slowed rollout. Now all members of Phase 1a are being vaccinated.

There are over 300,000 people in Phase 1a, and Oregon is only through a fraction of them. Initially, Oregon planned to begin vaccinating people in Phase 1b by mid-January, but now it seems unlikely that 1b will begin here before February.

Oregon Health Authority officials have been reluctant to set firm dates for the next wave of vaccinations, citing unpredictable deliveries of vaccines and conflicting information from federal agencies.

Are other states still stuck in Phase 1a?

Many other states, including Washington and Arizona, are either about to start vaccinating people in Phase 1b or have already begun. Some are on track to finish that phase before Oregon even gets started.

What is Oregon doing to speed up vaccine rollout?

Anyone in Phase 1a — so that’s all healthcare workers and long-term care facility workers — are now able to get the COVID-19 vaccine. On Monday, three-quarters of Oregon’s COVID-19 vaccines hadn’t been administered. By widening the pool of eligible people, the Oregon Health Authority hopes to speed the process.

OHA also says it will also be expanding the pharmacy program and partnering with unions and other organizations to get the vaccine into more arms.

How will Oregon prioritize people in Phase 1b? Who gets vaccinated first? Teachers? Or the elderly?

At least for now, we’re still not quite sure.

Oregon Governor Kate Brown has asked the Oregon Health Authority to put teachers first in line when Phase 1b begins. That would be a direct contradiction to ACIP’s recommendations, which suggest prioritizing those over 75 over frontline workers.

It was initially unclear if teachers would be vaccinated at the same time as elderly, high-risk individuals. Controversially, that no longer seems to be the case. Gov. Brown stated unequivocally Friday that teachers would be vaccinated before any other group.

Oregon’s Vaccine Advisory Committee met Thursday to decide how to prioritize people within each group. They were told to consider the best ways to quickly slow the virus’ spread while ensuring distribution is equitable and meets the needs of the communities they represent.

Many members raised concerns about the speed of the vaccine rollout, and about balancing the urgency of the situation with a desire to execute the next phases correctly.

Muriel DeLaVergne-Brown, director of the Crook County Health Department, encouraged members to give health officials in rural counties the flexibility to vaccinate out of order, particularly if there are unused vaccines. Representatives from other smaller communities said this flexibility would help them vaccinate faster and waste fewer doses.

Still, no decisions were made, and the committee did not make it through their full agenda before the meeting ended. The group planned to meet every Thursday, but because there is so much to do and so little time, they hope to schedule additional meetings sooner. During Friday’s press conference, OHA Director Patrick Allen said he expects the Vaccine Advisory Committee to finish work on Phase 1b by the end of the month.

The bottom line:

The vaccine rollout is going to look different in every community, and every health care system. Depending on how much vaccine is available locally, some areas might move a lot faster than others. Rural areas will probably move a lot faster than urban ones, too.

The vaccine rollout plans are fluid. As Tuesday’s decision to open up vaccinations to everyone in Phase 1a showed, even once decisions are made, they aren’t set in stone.

So when will you get a vaccine? Unless you work in health care, the most straight-forward answer remains: “not yet.”

Copyright 2021 Oregon Public Broadcasting