Dr. Richard Williams, director of Three Rivers Health District, delivered good news and bad news and called for cooperation from local leaders during a presentation at Richmond County’s Board of Supervisor meeting.

Starting with the positives, Williams said that the number of positive cases and deaths are declining across the U.S. Virginia is among the states on the downward, and the Three Rivers Health District is also following that trend with an average of only about 60 new cases a day across the 10 counties served.

“It’s unclear what’s driving the improvement but as more people are getting vaccinated, it’s possible that the declines could be early indications of herd immunity,” he said.

The number of vaccines administered per capita across the bulk of Three Rivers is in line with surrounding jurisdictions, suggesting that despite the challenges of being rural, the health district hasn’t fallen behind.

Three Rivers has established “a system” for vaccine distribution that includes the health department, hospitals, physician practices, pharmacies and free clinics. The health district also has a partnership with Richmond County EMS that includes using its facility and getting support from EMS providers to administer the vaccine.

When all participants are fully engaged, the Three Rivers system has the native capability to administer between 9,000 and 10,000 doses of COVID-19 vaccine per week. 

The bad news

Unfortunately, Three Rivers has not evaded the nationwide trend of vaccine shortages. The district is receiving less than 25 percent of what the system is capable of administering weekly.

There are about 20,000 people already on the waiting list. Those individuals waiting for a second dose are factored into the vaccine allocations based on the date of their first dose, so “it may be weeks or even months” before everyone who is waiting gets appointments. 

The mass vaccination clinics at Richmond County’s EMS are no longer a possibility. Due to uncertainty surrounding the supply, Williams said health authorities cannot schedule any COVID-19 related vaccination events for months out.  

Although Virginia health authorities are being told that the vaccine shortages are likely to last four to eight weeks, “I honestly think the national stockpile is very, very low and we’re actually living on the real time manufacturing throughput of Moderna and Pfizer,” he said.

Johnson & Johnson’s vaccine could be available as soon as the first week in March. But Williams isn’t expecting it to have a significant impact on local availability because the initial delivery is expected to be 6 million doses, which won’t go far when divvied up across 50 states. “And after that the market will likely also be living off that company’s actual production capacity,” he said.

CVS is the major retail pharmacy partner for vaccine distribution, and it gets the vaccine directly from the federal government separate from what’s allotted to state health officials, adding to supply in some places, but not locally. 

CVS locations in cities including Richmond, Newport News and Fredericksburg will get vaccines but Williams said he’s aware of one CVS across the Three Rivers District, and it wasn’t picked to be a vaccination point.

“Ultimately, the ability to increase vaccine availability across this region will depend not only on Pfizer, Moderna and Johnson & Johnson’s manufacturing capability but also their willingness to designate vaccines for the U.S. because it must be remembered that there is a global market for these products,” said Williams.

Furthermore, Virginia required health districts to stop pre-registering people for vaccination at the local level and direct everyone to a statewide system. But late last week, when local participants tried, the state’s system flopped and left people unable to get on the list, creating additional challenges for the health district to work through. 

The call for cooperation

The U.S. is now contending with three additional variations of COVID-19, commonly referred to as the UK, Brazil and South African variants. The UK variant is expected to become the dominant strain in March. It has similarities with the initial variant of COVID-19, so it appears the current vaccines are effective against it. 

“However, the South African and Brazil strains are quite different so the effectiveness of the vaccines for those isn’t clear yet,” said Williams.  

Meanwhile, people are getting reinfected including those who had the virus and those who were vaccinated. “The virus is evolving and we need to stop it now before it becomes something worse than it is,” he added, explaining that health authorities need local support.

He called on governments to listen to health authorities’ recommendations and promote them to constituents.

As it stands, Three Rivers and Richmond County EMS can only administer about 15 percent of the system’s vaccine capability, so health authorities need the rest of its partners and are working to develop and strengthen those relationships. 

The health district is also trying to hammer out agreements to use the EMS facilities and get support from EMS staff in each county it serves. Williams called on governments to support all of its vaccination implementation efforts.

COVID-19  is a huge problem. “Nobody has planned or trained for anything like this,” said Williams. And the public health system has been gutted for the last 30 years and “is nowhere near anything adequate to engage successfully and quickly against a pathogen of this strength and adaptability.”