FILE PHOTO: A woman holds a small bottle labeled with a "Vaccine COVID-19" sticker and a medical syringe in this illustration

A woman holds a small bottle labeled with a “Vaccine COVID-19” sticker and a medical syringe in this illustration taken April 10.

More than 60,000 health-care workers, 15,000 residents of nursing homes and assisted-living facilities, and 13,000 first responders will be among the first Granite Staters to receive a COVID-19 vaccine, according to state plans.

Last week, two companies, Pfizer and Moderna, announced promising results from ongoing vaccine trials. With COVID-19 cases sharply rising across the country, states are getting ready to distribute the vaccines as soon as they are available.

New Hampshire officials say the first vaccines could arrive as soon as next month. The Department of Health and Human Services’ Coronavirus Disease 2019 Vaccination Plan outlines a phased approach to distributing vaccines to state residents, with the most vulnerable and those who care for them at the top of the list. A draft of the 40-page document is available on the DHHS website.

Once COVID-19 vaccines are available to the general public, most people will get them from their health-care providers or local pharmacies, according to Elizabeth Daly, chief of the infectious disease control bureau at DHHS, who is overseeing vaccination preparations for the agency. The vaccines are expected to be available at no cost.

Elizabeth Daly

Elizabeth Daly is chief of Bureau of Infectious Disease Control at the state Department of Health and Human Services.

Daly said Pfizer expects to seek Emergency Use Authorization for its vaccine in the next week or so, and it will likely take another couple of weeks for the Food and Drug Administration to give its approval.

“The timeline we’ve been working with is early December,” Daly said. “It could all happen faster. There’s a will to get this stuff out to the public.”

DHHS plans to set up vaccination sites through the state’s 13 Regional Public Health Networks, with those sites providing around 100 vaccinations an hour.

“We’re actually trying to leverage drive-through models quite a bit,” Daly said. “They might look a lot like what we are doing for (COVID-19) testing.”

DHHS developed its plan based on guidance from the Centers for Disease Control and Prevention, experience with outbreaks here in New Hampshire, and work done by the National Academies for Science, Engineering and Medicine. The executive summary notes that the COVID-19 pandemic “has caused substantial morbidity and mortality, and significant economic and social disruption.”

There are five groupings in the planned rollout:

Phase 1a: Because more than 80% of New Hampshire’s deaths from COVID-19 have been related to long-term care settings, residents of those facilities will get the first shots, along with health-care workers and first responders.

Phase 1b: The second group will include older adults in other group living settings, such as senior complexes, and people of all ages who have other conditions that put them at “significantly” higher risk.

Phase 2: Vaccines will be offered to school teachers and staff, child-care workers, critical workers in other high-risk settings, people with conditions that put them at moderately higher risk, those in homeless shelters or group homes, prisoners and prison staff, and all other seniors.

Phase 3: This group includes young adults, children and workers in occupations “important to the functioning of society and at increased risk of exposure” who were not included in the earlier phases.

Phase 4: The final group is everyone else.

Daly said DHHS will probably not receive the 100,000 doses it would need to get everyone in Phase 1a vaccinated right away, but shipments will continue to come into the state weekly. “It’s going to ramp up quickly, but our initial allotment is going to be limited probably,” she said.

Two pharmacy chains — CVS and Walgreen’s — have federal contracts with the CDC to provide vaccinations at long-term care facilities, Daly said, and many New Hampshire nursing homes have already signed up to participate. Facilities also can opt to work with their local public health networks, Daly said.

Hospitals will vaccinate their own staffs, and they could offer vaccination clinics for the public later on, Daly said.

For vulnerable populations without access to regular medical care, the state plans to offer mobile clinics “or even go meet people where they’re at,” such as homeless shelters, she said.

How it will work

State Sen. Tom Sherman, a Seacoast gastroenterologist, serves on the state Disaster Medical Advisory Committee. He also is co-founder and chief medical officer for the COVID-19 Policy Alliance’s Senior Support Team, which works with long-term care facilities in New Hampshire to make sure they are getting what they need to protect their residents.

Dr. Tom Sherman

State Senator Tom Sherman, D-Rye, is also a physician who serves on the state Disaster Medical Advisory Committee.

Not everyone will be able to receive the COVID-19 vaccines, Sherman said, because of underlying medical conditions. But if enough people get vaccinated, he said, those who are vulnerable will be protected because the virus won’t be spread in the community the way it is now.

“You want to vaccinate as much of the population as possible, but at a certain point … you start seeing the impact on everybody based on the number of people who have been vaccinated,” Sherman said.

That’s the best way to get to “herd immunity” — and the opposite approach to what some have suggested, Sherman said.

“The whole concept of allowing nature to take its course and letting all these people get sick so you develop herd immunity is a ridiculous idea, because of the number of people who would have to get sick and the percentage of people that would die,” he said.

The vaccines in development so far require two doses, given a couple of weeks apart. A new state registry will track which vaccines people receive, to ensure that they get the correct second dose. The state plans to use “shot cards” that will be given out with the first doses, as well as text messaging, to remind people to get their second doses.

Daly said New Hampshire has one advantage over most states: It’s a “universal vaccine purchase state,” meaning that DHHS purchases all vaccines for children through contracts with the CDC.

As a result, the state has around 300 health-care providers who already meet the training requirements for vaccine storage and handling to administer the COVID-19 vaccines, she said. The state plans to enroll other providers, who will have to go through the training first, she said.

One challenge is that the vaccines that have shown the most promise so far will need “ultra-cold” storage, but Daly said she’s not worried. DHHS has the right freezers to safeguard the vaccine lots, as do some health-care facilities in the state.

To get vaccines out to providers who don’t have such capabilities, Daly said, “We can also deal with it with dry ice and coolers.”

“It’s a complexity, but it’s not a concern,” she said.

What to do in the interim

Until the vaccines are widely available here, which likely won’t be until next spring, Sherman said New Hampshire residents need to keep their guard up.

“All you have to do is talk to somebody who’s been through COVID,” he said. “They talk about drowning. That’s what it feels like.”

As winter descends on the Granite State, “The two things we need to really think about are personal responsibility and compassion for our friends, our neighbors, our families,” he said. “Because that is the argument for a mask.”

Science has shown that wearing a mask, social distancing and hand-washing can prevent the spread of the highly contagious virus, Sherman said. New evidence suggests that a mask also can protect the wearer.

“A mask is a sign of our love for each other,” he said. “Love for our family, love for our neighbors, love for our community.

“And if we were all doing this, we would see a sharp drop in the incidence of this disease,” he said.

For those who are still dubious about wearing masks, Sherman has a suggestion: “If you don’t trust the CDC or the WHO, ask your doc what’s the best way to prevent getting COVID.”

Sherman said it’s stunning to see how quickly scientists have developed promising vaccines for a disease that was unknown a year ago. It took 30 years, he said, to come up with a treatment for hepatitis C.

“So to think that we have identified a virus, and within a year have an effective vaccine is beyond remarkable,” he said. “It’s just revolutionary.

“It is unheard of in the history of medicine.”

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Wednesday, December 02, 2020