Michigan’s more northern and rural communities are more likely to use the new Moderna coronavirus vaccine – at least initially as vaccinations ramp up in Michigan.
In December, the FDA granted emergency approval to two vaccines, one collaboratively manufactured by Pfizer and a German company named BioNTech, the other created by Moderna. While both work similarly, the Pfizer vaccine has stricter storage requirements, that some rural communities may not be able to meet.
“Proper storage temperature would be our biggest challenge here,” said Arenac County Commissioner Bobbe Burke, who also sits on the Central Michigan Health District Board of Health, which oversees rural communities in Arenac, Clare, Gladwin, Isabella, Osceola, and Roscommon counties.
Pfizer directs its vaccine be stored at -94 degrees, which requires special “ultra-low-temperature freezers.” The freezer can cost between $5,000 and $15,000 and are not readily available at health offices or hospitals in sparsely populated areas of Michigan.
Once in a proper freezer, the Pfizer vaccine may be stored safely for up to six months.
Burke said she’s aware of only one location within her health district that has a proper freezer for Pfizer vaccine storage — it’s in Mount Pleasant — but she believes once the Moderna vaccine distribution ramps up, there will be adequate coverage for rural communities.
“The only hold-back with Pfizer was the temperature,” Burke said.
While the Michigan Department of Health and Human Services, which oversees vaccine distribution, has a working list of partners with ultra-cold freezers, they’re not sharing that information publicly.
“We are not releasing additional details about which hospitals of local health departments are receiving shipments of the vaccine, how much vaccine they will be receiving and when shipments are expected,” MDHHS spokesperson Lynn Sutfin said in response to a request for a list of locations with the freezers. “This is due to concerns about security as well as the fact this information is continually changing as we receive additional information from the federal government and additional sites are enrolled to receive the vaccine.”
As of Dec. 30, there were 578 providers, including hospitals and health departments, across Michigan enrolled in the state’s vaccine program. The state vaccine dashboard reflects 337,875 doses had been shipped and 86,626 doses administered as of Dec. 29 – the majority from Pfizer.
The majority of inoculations so far have been administered by hospitals, with nearly 13,000 of the more than 86,000 doses done by local health departments.
While special freezers are required for long-term storage of the Pfizer vaccine, there are workarounds for shorter-term storage.
Pfizer ships its vaccines in temperature-tracked refrigerated packaging filled with dry ice. Upon receipt, a hospital, health clinic or pharmacy may keep the doses in the refrigerated shipping packaging for up to 30 days, refilling the packaging with dry ice every five days.
After the 30th day, the vaccines may be refrigerated at 36 and 46 degrees for an additional five days.
The Moderna vaccine actually has a shorter shelf life, 30 days, but is easier to store. It arrives at between -13 and 5 degrees and may be refrigerated at up to 36 degrees, the CDC says.
More flexible batch sizes of the Moderna vaccine, which comes in 10-dose packs, also makes it more manageable for sparsely populated communities than the Pfizer vaccines, that come in packages with a minimum of 100 doses.
Both vaccines have proven to be effective in protecting patients from severe symptoms of the coronavirus during clinical trials. Pfizer reported a 95% efficacy rate, while Moderna’s was 94.1%.
The FDA granted Pfizer emergency approval on Dec. 11. Moderna received approval Dec. 18.
Clinics over pharmacies
Most Michigan residents are expected to be inoculated at a pharmacy, such as CVS or Walgreen’s, which both already adept at delivering mass flu vaccinations, when the supply makes its way to the general public this spring or summer.
But local health clinics are likely to take on a greater delivery role in Michigan’s rural communities, said Jeannine Taylor, a spokesperson for District Health Department 10.
Taylor’s district oversees 10 counties, including Crawford, Kalkaska, Lake, Manistee, Mason, Mecosta, Missaukee, Newaygo, Oceana, and Wexford. Most of Michigan’s 45 local health departments only oversee one county. It’s geographically the largest health district in the state.
“All of our counties are very rural,” she said on Dec. 23. “We started receiving our vaccines this week and we began vaccinating our frontline staff, our vaccine clinic staff and also we’re starting to assist with long-term care facilities that don’t have a contract with Walgreen’s or CVS. In the rural areas, there aren’t Walgreen’s and CVS pharmacies readily available.”
At the end of December, the the health office expected to begin coordinating the vaccination of EMS workers and lower priority medical first responders.
Taylor expects the health department will establish drive-through vaccination clinics potentially in parking lots at schools or county road commission sites, similar to what they provided for COVID-19 testing throughout the summer.
It’ll be a place where residents “can just pull up to a parking lot have people drive through,” Taylor said. “It’s extremely coordinated.”
The final clinic locations haven’t been identified.
Taylor said her local health department has a contract in place to obtain a deep-freezer to store Pfizer vaccines, but the initial shipments, determined by MDHHS, will be Moderna.
Spread of the coronavirus in Michigan is slowing in recent weeks.
The state is averaging 2,601 new cases and 80 new deaths per day over the last week, according to data from the Department of Health and Human Services. Both are improvements from the 4,507-case and 115-death per day averages from two weeks ago. Michigan’s seven-day average for tests coming back positive is 8.2%, though 15 counties remain at 10% or higher.
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