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A Message From Mark E. Wilson, MD Jefferson County Health Officer

1b is One Big Group; COVID-19 Vaccination Challenges Ahead

Currently all Alabama counties are offering the COVID-19 vaccine to everyone age 65-74 and people in Phase 1b in the Alabama COVID-19 Vaccination Allocation Plan. The expansion from 1a to include 1b happened on February 8, 2021. This includes:

- Food and agriculture workers

- U.S. Postal Service workers

- Manufacturing workers

- Grocery store workers

- Public transit workers

- People in education and childcare (teachers and support staff)

- Judiciary, including judges and district attorneys

- Persons working or living in congregate living settings

- Clergy/ministers

- People deemed essential for continuity of state government

According to the Alabama Department of Public Health (ADPH), this adds more than 1 million more Alabamians to the 326,000 people working in health care (Phase 1a) and 350,000 people age 75 and older who are already eligible to receive the vaccine.

Jefferson County has numerous health care organizations and pharmacies able to vaccinate large numbers of people, in addition to the Jefferson County Department of Health (JCDH). Therefore, vaccine supply is our main rate-limiting factor, not the capacity to administer it. At the rate supply is becoming available, along with the requirement for second doses with the currently available vaccines, it will likely take several weeks to meet the demand in Phase 1b. Additionally, we still have some unmet demand among people age 75 and older who became eligible on January 18.

The good news is that highly effective and safe vaccines were approved in record time, and a large number of people do want to be vaccinated. The bad news is that the demand is far greater than the supply, so a lot of people are going to have to wait. It will be frustrating for many. Vaccine requests to the Jefferson County Vaccine Call Center far exceed available doses, and the same is true for other vaccine providers in the area. Nonetheless, people are encouraged to keep signing up so we know about their intent to get the vaccine when it does become available. Eligible people should take whatever first opportunity they get to be vaccinated.

Other challenges lie ahead. One is making sure vaccine access and uptake are equitable across geography, income level, race, and ethnicity. Alabama is receiving its fair share of vaccines based on population, and ADPH is making an effort to be equitable in its allocation to all the counties in the state. However, it can appear that there is inequitable distribution within a county, especially a large and diverse one like Jefferson County. Early on, vaccines mostly went to hospitals to prioritize front-line health care workers. Some vaccine providers, such as UAB, received large allotments of the Pfizer vaccine because they were among the few that had the ultra-cold freezer storage required. The Moderna vaccine, which is easier to store, is being requested and distributed to a greater number of sites. This means there is less vaccine available at each site. For example, JCDH, which is designated as a Moderna site, is being provided enough vaccine to give second doses only throughout February, with very little left for first doses. ADPH has approved other sites in Jefferson County that have not yet received their first shipment.

Health equity is a major priority for JCDH, and we are fortunate to have other partners in the community who share this priority. According to the Centers for Disease Control and Prevention, Black people in the United States, on average, are 3.7 times more likely to be hospitalized and 2.8 times more likely to die from COVID-19 than White people. Latinos are 4.1 times more likely to be hospitalized and 2.8 times to die than Whites. Data so far indicate that we are beating the odds for racial disparities in COVID-19 deaths in Jefferson County, but we could see greater disparities emerge if an insufficient number of black and brown people are not vaccinated. Preliminary data show that disparities in vaccination rates are already emerging, as they have in other states. There are multiple reasons why this tends to occur, but we must make a special effort to overcome this tendency. Even before the vaccines became available, JCDH began efforts to reach Black and Latino communities with vaccine information, and we will continue to do so.

Another challenge is the pandemic of misinformation, rumors, and myths. We urge everyone to use reliable sources such as the CDC for information about COVID-19 vaccines.

Until we reach the ultimate goal of herd immunity with vaccination, we must remain vigilant to prevent the spread of the virus. While new cases and hospitalizations due to COVID-19 have been going down from the disastrous holiday surge, there is still a risk of another surge as the more contagious variant strains emerge. We all know the drill: Wear a mask, watch your distance, wash your hands, and avoid large gatherings.