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1/7/21 COVID-19 Brief: Strategies to Achieve Corporate (and Public) Vaccination Targets

We have been working with a number of companies that are eager to get their employees vaccinated. Based on that work, we have identified three basic strategies for companies to consider.

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

Strategies to Achieve Corporate (and Public) Vaccination Targets

Hope inspired by vaccine approvals late last year fueled the ambitious aim of vaccinating 20 million health care workers with their first dose by the end of 2020. As we know, that did not happen. The inherent logistical challenges of the effort, compounded by holiday season timing, and a post-Thanksgiving COVID-19 surge that overwhelmed hospitals put the goal far out of reach.

It was a rough start that demonstrated in real time the immensity of the challenge that public health officials have been warning us about for months. It also reinforced the need for collaboration among all vaccination stakeholders, including employers.

Below, I describe three strategies companies can use to accelerate achievement of local vaccination goals by proactively becoming involved in the vaccination value chain. But before I get to the strategies, let’s review three foundation points:

  • Companies Need to Understand and Adhere to Vaccination Priorities: The table below summarizes vaccination priorities recommended by ACIP. Under no strategy are we recommending that companies “jump the line.” But companies can help accelerate efforts to vaccinate frontline essential workers in Phases 1b, and at-risk populations and other essential workers in Phase 1c. In these phases, companies that are engaged and equipped to collaborate can have a huge impact.

Of note: ACIP definitions of frontline essential workers and other essential workers can be found in this document. Further, ACIP guidance is just that – guidance. States have been given the authority to determine vaccination priorities and to determine what jobs are considered frontline essential or other essential.

Source

  • Prepare for Success: In this recent article, I traced a high-level road map for successful corporate vaccination efforts. It is important to prioritize, plan and do the work it will take to implement a successful vaccination effort.
  • Think Big to Do Good: If you can leverage internal or contract resources to provide worksite vaccinations to your employees, that’s good. If you can figure a way to include families in that effort, that’s better. If you can further leverage your vaccination infrastructure to vaccinate contractors, key suppliers and even members of the community, that’s better still. Keep in mind: the goal is not just for your employees to get vaccinated; it is for your community to be protected.

Strategies

We have been working with a number of companies that are eager to get their employees vaccinated. Based on that work, we have identified three basic strategies for companies to consider.

1. Direct Allocation/Public Health Collaboration: This strategy focuses on establishing your company as a direct recipient of an allocation of vaccine doses. The idea may seem far-fetched, but once states get through the initial phase (health care workers and long-term care), they will be challenged to identify and vaccinate people in Phases 1b and 1c. Companies that employ essential workers and that can work with vendor partners to help target and promote vaccination among older and at-risk employees will be valuable collaborators in the vaccination effort.

The application process varies from state to state and multiple steps are involved, so you will want to consider engaging a vendor partner like WorkSTEPS to assist.

2. Buy Direct form Manufacturers (through reputable brokers): This opportunity will evolve over time. Right now, of course, supply is tight. Over time, however, brokers tell us that there will be available supplies due to manufacturing overages and supply chain gaps, even in Phases 1b and 1c. And once we get to Phase 2, direct purchase/administration will be key to driving high vaccination rates, similar to seasonal flu shot programs.

3. Connect with Pharmacy Retailer (Walgreens, CVS, Walmart): Our information on this strategy is thin. We understand Walgreens is responding to RFPs to assist employers with COVID-19 vaccination. Others may be as well. It is worth considering these retailers in your strategy mix.  

Which strategy is right for your company? It likely depends. Your locations are likely to vary in terms of workforce composition and vaccine eligibility per the above guidance. Beyond that, you may encounter differences in vaccination priorities and essential work definitions from state-to-state, and you are likely to find different needs/opportunities for collaboration among state and local public health authorities. Therefore, your company’s overall strategy should account for location-specific differences.

Each of the above strategies will have its own steep learning curve. As such, I recommend companies work with a vendor partner like WorkSTEPS to evaluate and implement options. Click here to let us know if you have questions or would like to talk about how we can be of assistance.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

For more from Dr. Hoffman, connect with him on LinkedIn.

Medical


Area Reported Cases Deaths Recovered
Global 87,446,580 1,886,843 62,939,713
United States 21,765,716 368,567 12,960,322

The global cumulative incidence surpassed 80 million cases on December 29. From the first reported COVID-19 case, it took 177 days to reach 10 million cases. From there:

10 to 20 million - 44 days

20 to 30 million - 37 days

30 to 40 million - 31 days

40 to 50 million - 21 days

50 to 60 million - 17 days

60 to 70 million - 17 days

70 to 80 million - 16 days

The global cumulative mortality surpassed 1.75 million deaths on December 27. From the first reported death, it took 115 days to reach 250,000 deaths. From there:

250k to 500k - 56 days

500k to 750k - 46 days

750k to 1 million - 45 days

1 to 1.25 million - 40 days

1.25 to 1.5 million - 26 days

1.5 to 1.75 million - 23 days

The US CDC reported 20.56 million total cases and 350,664 deaths. The US reported a new single-day record incidence of 284,554 new cases on January 3, becoming the first country to report more than 250,000 new cases in a single day. The US surpassed 20 million cumulative cases on January 2. From the first case reported in the US, it took 200 days to reach 5 million cases. From there:

5 million to 10 million- 92 days

10 million to 15 million- 29 days

15 million to 20 million- 24 days

The US surpassed 325,000 cumulative deaths on December 23 and 350,000 deaths on January 4. The 9 days to increase from 300,000 to 325,000 deaths matched the rate at the peak of the initial surge in March. Notably, the 12 days between 325,000 and 350,000 included 2 major holiday weekends, which likely delayed reporting to some extent. From the first US death, it took 55 days to reach 50,000 deaths. From there:

50k to 100k- 33 days

100k to 150k- 63 days

150k to 200k- 55 days

200k to 250k- 58 days

250k to 300k- 25 days

300k to 350k- 20 days

WHO head ‘very disappointed’ with delays in expert team being let into China to study COVID-19 origins: In a rare critique of the Chinese government, WHO Director-General Tedros Adhanom Ghebreyesus expressed disappointment that his agency’s officials hadn’t yet been allowed into China to examine the origins of the COVID-19 pandemic. Even though members of a team representing the WHO departed their respective home countries over the past day, “we learned that Chinese officials have not yet finalized the necessary permissions for the team’s arrival in China,” Tedros told reporters yesterday, adding that he was “very disappointed” since at least two team members had to cancel their trips at the last minute. Still, Tedros also said that he had been “assured” that Chinese officials were working to speed up the approval process.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020. During December 14–23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination

Study: US COVID Cases, Deaths Far Higher than Reported (CIDRAP): An estimated 14.3% of the US population had antibodies against COVID-19 by mid-November 2020, suggesting that that the virus has infected vastly more people than reported—but still not enough to come close to the proportion needed for herd immunity, according to a study published today in JAMA Network Open.

Immunological Memory to SARS-CoV-2 Assessed for up to 8 Months After Infection (Science): Understanding immune memory to SARS-CoV-2 is critical for improving diagnostics and vaccines, and for assessing the likely future course of the COVID-19 pandemic. We analyzed multiple compartments of circulating immune memory to SARS-CoV-2 in 254 samples from 188 COVID-19 cases, including 43 samples at ≥ 6 months post-infection. IgG to the Spike protein was relatively stable over 6+ months.

SARS-CoV-2 Variants: Viral mutation is a common, expected process, although genetic changes often do not result in improvements or fitness advantages for the virus. The SARS-CoV-2 variants first identified in the UK and South Africa, however, do appear to have advantageous mutations in the spike protein, which allow the virus to more efficiently enter cells to begin the viral replication process. Emerging evidence indicates that these changes at the cellular and molecular level may result in increased transmissibility for these variants. Furthermore, these variants are emerging as the dominant strains of SARS-CoV-2 in the UK and South Africa, respectively. In response to news of the emerging variants, many countries have implemented travel restrictions for the UK, but the variant has already been identified in at least 37 countries, including the US.

Increased transmissibility of the SARS-CoV-2 variants poses serious problems to pandemic control efforts, especially among already burdened healthcare facilities. Preliminary studies indicate that the SARS-CoV-2 variants do not cause increased disease severity or case fatality; however, a substantial increase in caseloads further strains hospital systems. Social distancing measures—including mask use, physical distancing, and enhanced hygiene practices—will be critical to limit the spread of these new variants. Some scientists and health authorities have expressed concern over the possibility that existing vaccines and vaccine candidates may be less effective against the new variants, but preliminary studies have not found any indication current vaccines will be less effective in protecting against the UK variant. There are fewer studies on effectiveness against the South Africa variant, but research is ongoing. Notably, if current vaccines are determined to be less effective, BioNTech scientists have stated that they could make necessary changes in approximately 6 weeks.

Mitigation / Suppression

National Social Distancing & Lockdown: As countries around the world begin to implement SARS-CoV-2 vaccination programs or look ahead to future vaccination efforts, some are recognizing the need to strengthen social distancing and other COVID-19 containment measures in response to ongoing surges in transmission. Germany, which leads the EU in terms of vaccine doses administered, is reportedly considering an extension to its national “lockdown,” which is currently scheduled to end January 10. Germany is averaging nearly 18,000 new cases per day, which corresponds to more than 200 daily cases per million population. The UK is entering another period of “lockdown” as well, following the emergence of the B.1.1.7 variant and associated increases in incidence. New national Level 4 lockdowns are now in place in England, Scotland, and Wales, and Northern Ireland increased its national restrictions on December 26. South Africa also strengthened COVID-19 restrictions nationwide to Level 3 on December 29, which orders the closure of beaches and parks in hotspot areas, the closure of bars and pubs nationwide, and prohibits all alcohol sales, among other restrictions.

The US Food and Drug Administration (FDA) has issued a safety communication about the potential for false results from a rapid COVID-19 test from Curative Inc, which is being used in Los Angeles and other large metropolitan areas in the United States.

The real-time reverse transcription polymerase chain reaction (PCR) test was developed by Menlo Park, California–based healthcare start-up Curative Inc. Results are analyzed by the company's clinical lab, KorvaLabs Inc. The test, which is authorized for prescription use only, received emergency use authorization from the FDA on April 16, 2020. By November 9, the company had processed 6 million test results, according to the company.

U.K. Vaccination Timing: In an effort to increase the number of people with some degree of protection against SARS-CoV-2, the UK government announced that it is increasing the time between the first and second dose of SARS-CoV-2 vaccines to 4 months, for both the Pfizer/BioNTech and AstraZeneca vaccines. The policy will be implemented across all 4 UK countries based on advice from the UK’s Joint Committee on Vaccination and Immunisation (JCVI). This decision increases the time before individuals can be fully vaccinated against SARS-CoV-2; however, it allows the UK government to use its available vaccine doses to provide the first dose to more people, which can provide them with a lower degree of protection.

Singapore’s Police Now Have Access to Contact Tracing Data (MIT Tech Review): Singapore’s COVID-19 contact tracing system is being used in criminal investigations, a senior official said on Monday. The announcement contradicts the privacy policy originally outlined when the government launched its TraceTogether app in March 2020 and is being criticized as a backpedal just after participation in contact tracing was made mandatory.

Corporate

STAT News: Five key milestones in the COVID-19 pandemic that we’re anticipating in 2021:

If 2020 was defined by the explosion of the SARS-CoV-2 virus, 2021 could be about its dwindling. But how many people will fall ill, and die, as that happens is dependent on our leaders, individuals, vaccine makers, and public campaigns to encourage people to get the COVID-19 shots developed with unprecedented speed.

As always when making forecasts, some of these moments could take place in different ways or at different times than predicted...

The Work From Home WorkSTEPS Medical Team:

Ben Hoffman, MD, MPH
Chief Medical Officer

Tony Nigliazzo, MD
Medical Director

Loraine Kanyare, MSN, MPH, RN
Director of Case Management

Lynda Phillips, LVN
Nurse Case Manager

Codey Church, LVN
Nurse Case Manager

Kerry Womack, LVN
Nurse Case Manager

Chuck Reynolds
Strategic Communications Consultant

This Guidance (“Guidance”) is provided for informational and educational purposes only. It is not intended as Legal Advice or Medical Advice. Adherence to any recommendations included in this Guidance will not ensure successful diagnosis or treatment in every situation. Furthermore, the recommendations contained in this Guidance should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. Similarly, this Guidance is based on current advice, comments, and guidance from the EEOC, CDC and the CMS made publicly available. The ultimate judgement regarding the propriety of any specific employment action must be made by the company and attorney in light of all of the circumstances presented by the company, state and federal rules existing at the time and the then current state of the National Pandemic. This Guidance and its conclusions and recommendations reflect the best available information at the time the Guidance was prepared. The results of future studies or changes in rules, regulations or laws may require revisions to the recommendations in this Guidance to reflect new data. WorkSTEPS does not warrant the accuracy or completeness of the Guidance and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Guidance or for any errors or omissions.

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