Monty Health Department Outlines Vaccine Distribution

By Rikki N. Massand / December 15, 2020

Montgomery Township Health Officer Stephanie Carey outlined the basic vaccination distribution process for the region, to begin in the new year. She spoke during the annual Joint Boards of Health meeting, held via Zoom, on December 9 — the same day the COVID-19 American death toll surpassed 3,011, breaking the nation’s record for deaths on a single day, ominously passing September 11, 2001.

Carey tells The Montgomery News that the availability of vaccines to people in the Montgomery area still needs to be determined. A realistic timeline for administration of vaccines to a substantial percentage of the local population could take the first eight to ten months of 2021, if not longer.

Expect a Somerset County-level program announcement of when the vaccinations will be available. The New Jersey Department of Health (DOH) plan called for county health departments to be the primary source for early vaccinations. However, the Montgomery Township Health Department is accountable to the NJ DOH for a number of procedures and community-centric endeavors.

“Different protocols will need to be in place, whether we receive the Pfizer vaccine or the Moderna vaccine. It will depend how quickly each of these vaccines become available,” Carey said. The ultra-cold, 80 degrees below centigrade storage requirement will go directly to hospitals for essential staff, and no health department can accommodate that necessary low temperature.

“There’s prioritization by tiers and we’ll do things by-appointment, both to make sure that people fit into a priority tier (per CDC guidance) and to have spacing as people should not have to stand in a line. Thirdly, we (health officials) must have people logged into a data system because we need to follow up. The vaccinations from Pfizer, Moderna, and AstraZeneca are all talking about AT LEAST two doses (shots) so we’d have to find people three to four weeks later for their second shot,” Carey explained in a December 11 interview with The Montgomery News.

The rollout of vaccinations — shifting from pandemic response to mitigation — will not be similar to a flu-shot clinic, in which the Montgomery Health Department is well-versed. For a flu shot, a multi-dose vial is drawn, “stick it in someone’s arm and they’re done,” Carey noted.

The Pfizer vaccine has arrived in New Jersey and the first dose was administered to a nurse in Newark today, December 15. It will be some time before most Montgomery residents will have access to it, though, for a variety of reasons. For one, the Pfizer vaccine must be held at a “super cold” temperature, and requires storage likely using dry ice. Then it must be defrosted, gradually — and after that it needs to be mixed with a saline solution prior to being administered, according to Carey.

During the meeting, Carey introduced the Montgomery Township Board of Health and their counterparts in the three nearby municipalities serviced by Montgomery’s Health Department: Hopewell Borough, Pennington Borough and Rocky Hill. Montgomery Committeewoman Catherine Gural, liaison to the township Board of Health, also joined in the discussion as Carey introduced the topic of mass vaccinations that county-level and healthcare officials are strategizing for, with guidance from the New Jersey Department of Health and federal-level officials.

As reported late last week, the FDA made an emergency approval of the Pfizer COVID-19 vaccine, with the FDA Advisory Panel’s vote in favor of emergency authorization to approve the Pfizer COVID-19 vaccine on December 10. That vaccine was determined to be 95 percent effective in recent clinical trials, and is approved for people 16 and older. In addition, the FDA is expected to approve the Moderna vaccine this week. Moderna stated in a press release that it expects to produce 500 million to 1 billion total doses of its vaccine in 2021.

Health officials statewide have commented that some other manufacturers could be providing vaccines that only require refrigerated temperatures, and one shot, such as the Johnson & Johnson vaccine that is currently in clinical trails worldwide, including a trial at Rutgers University in New Brunswick.

The Pfizer vaccine, “once defrosted and prepared, can be drawn into a syringe and put in someone’s arm, but once it’s defrosted and mixed your clock is ticking as there’s a window of hours to administer the vaccine," Carey says. "That becomes very tough outside of a hospital setting.

"Hospitals serving as vaccination ‘clinics’ — for both practical and logistical reasons — would be ideal," Carey adds, "However, people working the clinic, including the essential healthcare workers, must be protected (and vaccinated) first."

Carey said the vaccines will save lives, but not instantaneously. “If somebody gets the shot next week, they could be (50 percent) immune to COVID-19 in six to eight weeks. It takes time for the body to build those antibodies,” she said.

Mass vaccinations’ planning by Montgomery Health Department, which is one of America’s smallest nationally-accredited health departments with certification conferred on March 31, comes without full funding.

No level of public health — not local, state, or national — is fully funded right now. Carey tells The Montgomery News that this exacerbates the public health challenge everywhere, as federal dollars stop at providing for costs associated with getting the vaccines to her office and the other points of distribution. At the township committee’s meeting via Zoom on December 3, a revised memorandum of understanding with the Montgomery School District Board of Education for use of facilities for COVID-19 vaccinations was approved.

The Montgomery Health Department has reported about ten COVID cases or more per day in Montgomery Township in the past two weeks, Carey said at the December 9 meeting. In the three boroughs represented, there were a few cases every day but not more than five reported daily in any location. She notes the costs, both physical and financial, as certain local businesses had to close over a period.

At the December 7 Rocky Hill Borough Council meeting, Mayor Bob Uhrik, who is the senior registered environmental health specialist for the South Brunswick Health Department, provided a ‘big picture’ and said people should keep in mind the long-term impacts to the healthcare system and protection of hospital workers, first responders and others as hospital beds filling up as COVID-19 numbers spike means a hazardous situation for everyone.

New Social Worker and Outreach

Messaging and community outreach on vaccinations will take place through The Montgomery News, on the municipalities’ websites, on social media, and from efforts of a new social worker named Amanda Pulgarin.

Pulgarin began her job in the Montgomery Health Department on December 7. The state is funding each health department in the state to create a position “to help identify the most vulnerable people” in each community. Pulgarin is also designated as Montgomery Health’s Vulnerable Populations Outreach coordinator.

Carey told the boards of health that the emphasis on outreach is drawn from data clearly indicating that people of color, people non-native English speakers, those who live in crowded housing situations, and people with preexisting health issues are experiencing both higher rates of COVID-19 illness, higher severe illness due to the virus, and a higher death rate.

“Initially, the social worker is specifically tasked to try and identify the vulnerable populations in communities we serve. She will also reach out to church and faith-based leaders, nonprofits, and those who work with senior citizens and populations that are not native English speakers," Carey says.

"The hire comes as part of a statewide initiative to make sure that people at highest risks in our communities get access to COVID testing and access to the vaccine, and support to be able to safely quarantine. Our municipal administration and the Montgomery Township Committee are extremely supportive of our health department, and our Committee has been very forward-thinking, and I am so grateful to them for their support,” she said.

During the December 9 meeting, Montgomery Deputy Health Officer Devangi Patel said the department’s contact tracers are dealing with COVID-19 case clusters and outbreaks among people who “may work in our community but live in another town.”

“The way the systems are set up, it’s difficult to trace and therefore provide the right guidance. We are lucky to be able to build our contact-tracing team, and thankfully we've done everything to get them trained and on-boarded,” Patel commented. She praised department intern and Rutgers’ student for his help before presenting the Boards of Health an analysis of Optimal Contact Tracing, identifying needs for better accountability for COVID-testing facilities, “standardized policies and procedures” and more communications channels for health officials.

Last week, Council President Irene Battaglia said Rocky Hill’s website “COVID-19 Updates” contains info on COVID-positive cases, all tallied and linked directly from the Township Health Department. Carey expressed confidence that residents will remain well-informed through proactive measures.

As vaccine supply increases, more vaccination sites and clinics will be added. Your local CVS and Walgreens are likely to have COVID-19 vaccinations to supplement healthcare and government-organized locations. Carey is optimistic that availability can happen fast with vaccine shots at local pharmacies for the public by mid-year, depending on supply.

“The private store brands like Walgreens and CVS took a leading role with the CDC through the Pharmacy Partnership for Long-Term Care (LTC) program. They are actually going to be administering the vaccines to all nursing homes (Tier 1A) as part of a nationwide initiative,” Carey noted. The CDC states this program “will facilitate safe vaccination of this critical patient population, while reducing the burden on LTC facilities and health departments.”

The involvement of partners at the local level, from Boards of Health members to the private sector this winter as the pandemic nears its one-year mark, would be timely, welcome, and much safer than any “shot in the dark.”

TIERS of Who Gets Vaccinated Set by CDC

The CDC has provided a tiered system for who should get vaccinated first because the supply of vaccines will start out very constrained and then will increase over the next two quarters.

“Hospital workers and people who live and work in any nursing homes are first in line, Tier 1A. Nursing homes have driven so much hospitalization and death, that needs to get under control quickly to take stress off our medical system. Seniors in nursing homes are first in line; healthy seniors or any seniors living at home or elsewhere come after them,” Montgomery Health Officer Stephanie Carey explains.

Following the nursing home population and all hospitals’ staff, the next tier of target populations are the other members of the healthcare community as well as the first responder community with Fire, EMS, Police and OEM squads, as Carey noted “people putting themselves at the frontline of the pandemic and trying to protect the public.”

The next category for vaccination are people with chronic conditions including diabetes, heart disease and “other immune system-compromising symptoms.”

Montgomery Township’s Health Department has received funding during the pandemic for its contact-tracing process as well as outreach to ‘vulnerable populations.”

The Third Tier, per CDC, includes seniors of any condition, ages 65 and up, in Tier 2 and this will include essential workers such as teachers, utilities’ workers; people who prepare food and work in food service from restaurant workers to supermarket employees.

“We’ve seen a lot of COVID-19 among people who are responsible for getting our food to us, not just restaurants but among those in food manufacturing, retail and wholesale -- and this is critical infrastructure so they need to go to work safely so the rest of us can have a food supply,” Carey said. She says people generally healthy and under 65 years old are in line well after the segments noted.