As the coronavirus vaccine continues to roll out in the North Country, regional health care leaders detailed the timeline for the region, how the vaccine will be administered to the general population, how residents could be informed of its availability, and what communities could expect to see in the coming months.

Although the schedule is a work in progress and depends on the availability of the vaccine, Gov. Chris Sununu on Tuesday outlined the six population tiers based on those at highest risk who will receive the vaccine first.

Underway now is Phase 1a, which will last through January and includes long-term care home residents and staff members, high-risk health care workers, and first responders.

From January through March will be Phase 1b, which includes anyone 75 and older, those with medical conditions that put them at severe risk, corrections officers, and adults with developmental or intellectual disabilities.

From March through May will be Phase 2a, which includes those 65 to 74, childcare workers, K-12 teachers and school staff.

Also running from March through May is Phase 2b, which includes those ages 50 to 65.

Beginning in May will be Phase 3a, which includes vulnerable residents age 50 and younger at moderate risk because of medical conditions.

Phase 3b is also scheduled to begin in May and will include everyone else who hasn’t been vaccinated.

Local Plan

In general, the local vaccine timeline will mirror that of the state, said Kris van Bergen, senior program manager with the North Country Health Consortium, a private nonprofit that works with the state on various efforts, including vaccine distribution for the designated North Country Public Health Network, one of 13 health networks in New Hampshire.

“Part of the reason that’s the case is there’s been a lot of collaboration statewide with the public health regions to make sure we stay on the same page,” she said. “And part of that is because this is such a massive undertaking, this mass vaccination effort, that each stage is being built while the previous stage is being worked … Until guidance is released by the state, we’re staying in the tier we have guidance for.”

Guidance is nearly complete for Phase 1b.

Doses of vaccines - currently from Pfizer and Moderna, though more will be given federal emergency use authorization - are coming in waves and the region must be careful about the use of that supply and ensure that those most at risk of exposure and risk of complications receive it first, as the tiers were established for a reason, she said.

Both Pfizer and Moderna require two shots - the former 21 days apart and the latter 28 days, with a four-day window on either side - and tiers are based on vaccine availability, said Jim Richardson, NCHC’s public health emergency preparedness coordinator.

In the North Country, not everyone in Phase 1a will have their second dose by the end of January, he said.

The two vaccines are being deployed to different parts of the 1a effort.

Pzifer is primarily being administered at North Country hospitals to vaccinate hospital workers and is also going to the pharmacies vaccinating those in long-term care facilities, said van Bergen.

The public health networks and the fixed sites that are being staffed by the New Hampshire Army National Guard are receiving the Moderna presentation, which helps with smaller populations as storage and handling is a little more flexible with Moderna, she said.

“I think it’s been going great,” Richardson said of the overall effort. “Our partners have really stepped up. Our closed PODs [points of dispending] are all operational at this time throughout the entire North Country. We have five of those that are working to vaccine the 1a population.”

van Bergen spoke of the particular challenges of vaccinating those in the North Country, a region different from southern New Hampshire.

“The North Country is unique in terms of how we’re coordinating that infrastructure,” she said. “We know that the North Country is big, but sparsely populated, and one of the challenges that exist in this vaccine allocation strategy is that resources are being deployed on a per capita basis. Our region, the North Country Public Health Region, covers just over 30 percent of New Hampshire’s geography, about 3,000 square miles, but we only hold 3.8 percent of New Hampshire’s population. When resources are deployed from the federal and state level, it’s done on a per capita basis.”

The way residents access those resources is complicated by geography, with Coos County, for example, having no interstate and only secondary and tertiary roads, said van Bergen.

“From the beginning, Jim has been working very closely with our municipal partners, our EMS partners, and our community health centers to build a plan for making sure that North Country residents from Pittsburg south don’t have to travel the same fixed site that’s been allocated to our region, the [National Guard] armory in Littleton,” she said. “That is a big drive for people, especially in January. Months ago, we started the process of making sure that we had clinics in the sub-regions of the North Country so that people didn’t have to travel far.”

The clinics are placed in locations where people generally travel.

In addition to the fixed government-run site at the Littleton armory, closed POD locations are in Gorham, Colebrook, Lancaster, Woodsville, and Littleton.

“As a set amount of vaccine is allocated for the North Country region as a whole, the work that we’ve been doing at the consortium, and Jim especially, has been to coordinate with those other clinics around the region to make sure those supplies get distributed across not just one fixed site, but one fixed site and five points of distribution sub-regionally,” said van Bergen.

As the vaccine rolls out to the general public later in the spring, Richardson said the region is prepared to implement both drive-up clinics and fixed sites, depending on what the state asks the North Country to do, and has the capacity to have mobile clinics.

“When we get into those deeper tiers, when we’re talking about the general population, they are really anticipating that about 75 percent of New Hampshire’s residents will receive their vaccines in their medical homes, at the primary care provider offices as part of a regular appointment process visit,” said van Bergen. “Across the state, our primary care clinics are signing on as providers of the vaccine and preparing storage capacities to be able to deliver the COVID vaccines in their clinics to their patients.”

The work that the consortium does for the public health network part of the government side of the vaccination distribution effort will cover about 25 percent of the North Country population or about 10,000 to 12,000 residents of the 52,000 in the region’s network, she said.

Getting The Vaccine

It still hasn’t been fully determined how residents in each tier will be informed that the vaccine is available to them.

It will likely be a hybrid approach, with residents who might have medical conditions that put them at higher risk actively inquiring about where they can receive it, and physicians and health care providers, after going through medical records to find those at greatest risk, contacting patients who have medical conditions that put them at that risk, said van Bergen.

The AstraZeneca vaccine is moving ahead, and, unlike Pfizer and Moderna, has a better shelf life at room temperature, she said.

Johnson and Johnson also has a vaccine in the works that requires just one shot and not two, although its efficacy rating is currently undetermined.

(Pzifer and Moderna are about 95 percent effective, high for any vaccine).

Because each vaccine is a little different, the region and nation, as more testing data in larger populations emerges, might begin to see that some vaccines work better in certain populations, said van Bergen.

There has been a smaller number of people who have had significant allergic reactions to the two vaccines on the market right now, but that might not be solely attributable to the vaccines themselves, and as more data comes forth it might be determined that someone of a certain medical profile might be a better candidate for a certain vaccine, she said.

Studies still need to be done on vaccines and the population under 18, said Richardson.

And the threshold for herd immunity by vaccination is still an open question, said van Bergen.

“The two presentations of the vaccine currently in use are created to prevent symptomatic illness,” she said. “So if you receive the vaccine and you’re exposed to the virus, you’re less likely to develop symptoms of the illness. What’s less clear in the data right now is whether you can then transmit the virus. With traditional vaccines, we know that it prevents transmission … That prevention of transmission is less clear with these two presentations. We’re still cautioning folks that it’s important to get the vaccine because if you’re exposed the symptoms will not be as bad or you may not even experience symptoms. But we’re not sure if you’re still able to transmit it to others in your community.”

As the data is compiled, that question will get closer to an answer, she said.

And as the COVID-19 variant in the United Kingdom makes its way to the U.S., communities with high rates of vaccinations that don’t show transmission might be a good indicator that the vaccine is working against transmission, she said.

van Bergen also spoke of “vaccine hesitancy.”

“We are confident these vaccines are safe and effective and were very pleased that across the region our partners are being very public, not just organizations, but individual employees being public about showing themselves getting the vaccine and really helping to demonstrate to our community members that these are safe, that they are an important part of the process of getting back to something that feels a little more like normal,” she said. “We are trying to encourage folks that there is good science behind vaccines, that they are safe, that they are effective and there are reliable places to go for information if they have questions, including the consortium web site, which provides some information and also directs them to reliable resources.”

Francine Morgan, director of community relations director for NCHC, said, “Having a safe source of information is critical. We are trying to position ourselves to provide that information.”

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