The coming weeks will also be a trial period for the computer systems states plan to use to track and schedule immunizations. Ideally, people presenting for vaccinations will be informed of their eligibility and register in advance through systems linked to national immunization registries. This would mean less paper forms on site and less manual labor for local staff who were asked to report updated immunization figures daily. This will allow states and the Centers for Disease Control and Prevention to track the progress of dose allocation. In addition to the electronic notifications, those vaccinated will also receive a physical card with the date of their vaccination and a reminder to return for a second dose in three or four weeks, depending on the vaccine they received.
These notification and tracking features are a major improvement over those in place in previous immunization campaigns, such as H1N1 in 2009, says Rebecca Coyle, executive director of the American Immunization Registry Association, which advocates for the improvement of computer systems for vaccines. But new systems are bound to have problems, especially on a large scale. The next few weeks will be a test for these systems, starting with hospital systems that have extensive experience in vaccine record keeping. “Easy data capture will come first,” Coyle says. “I guess there will be opportunities for improvement.”
One downside to not sending people to their regular doctor for injections may be to follow these people long-term, well beyond the second dose, says Hemi Tewarson, senior researcher at the Duke-Margolis Center for Health Policy who has reviewed state immunization plans. This long-term surveillance is necessary to build confidence in a vaccine. “There’s so much focus on hugging people that the states haven’t had time to think about this piece,” Tewarson says.
In Teton County, Wyoming, home to 23,000 people spread over an area of 4,200 square miles, the regional hospital received an initial plateau with 975 doses of the Pfizer vaccine, according to the state health department. Earlier this year, hospital staff ignored CDC guidelines to purchase a freezer capable of storing the vaccine. “Fortunately, they did, and we’re very happy they did,” says Jodie Pond, county health director. As a result, the hospital is now a Pfizer vaccine storage point for much of the western half of the state.
The vaccine is “coming in small pieces” for now, she said, but the county is set for a larger campaign across the sprawling territory, where it makes sense to move. Earlier this fall, officials used the annual flu shot as a road test. They rented a campervan and made the vaccination effort in the area. The RV kitchen table, Pond thought, would be good for people when the Covid-19 vaccines were given in the middle of a winter in Wyoming. They will record the immunization data upon their return to the office, due to limited internet access in the field.
Pond also considered another need: the support of the police. Security has been tight around air and truck shipments, and for local distribution this will also be true, especially if the vaccine supply is limited or uneven. In Teton County, some nurses recalled pushing and pushing lines for the H1N1 vaccine when production issues led to shortages. “It’s human nature when there is a shortage. People want what they can’t have, ”she says. The county health department has received calls from people asking how to queue. She assures them that they will be notified when it is their turn, once the pecking order has been settled – and no, calling will not increase their priority. But she’s happy to see the interest. For now, her main concern is to communicate that these vaccines are safe and well tested. When the time comes, she wants everyone to get vaccinated.
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