Wisconsin hospitals work to finalize vaccine distribution plans as Gov. Evers calls for federal prioritization

MADISON, Wis. — Hospital systems in Wisconsin are working to finalize vaccine distribution plans for their health care workers as expected emergency authorizations from the Food and Drug Administration for Pfizer and Moderna loom.

The vaccines themselves could potentially begin arriving in the state as soon as mid-December; the FDA is set to meet Dec. 10 to discuss authorizing the Pfizer vaccine in the United States–a dose already approved by the U.K.

A state in crisis

Gov. Evers issued a letter to the U.S. Department of Health and Human Services on Thursday, asking for Wisconsin to be prioritized ahead of other states in vaccine distribution due to political inaction and an ongoing surge in cases.

“A significant contributor to the crisis we are facing is that most of our statewide mitigation efforts have been struck down, enjoined, or are currently the subject of ongoing litigation—including even a public health emergency declaration and order requiring face coverings in public places—and a legislature that has not convened in more than 230 days,” he wrote. “Consequently, while other states are experiencing similar surges, Wisconsin uniquely faces substantial barriers to implementing statewide mitigation strategies supported by public health experts and science currently utilized by other states.”

Earlier this week after more than seven months of inaction, Assembly Speaker Robin Vos (R) introduced a package of COVID-19 bills that Democrats decried as placing too much power with politicians rather than science. The GOP-controlled state senate, however, has indicated they have no plans to convene before the end of the year, when CARES Act funding is set to expire.

Thursday in a press conference with reporters, Gov. Evers said Wisconsin would need $10 million to distribute the vaccine in the first quarter of 2021 alone, and another $2 million to fund education efforts surrounding COVID-19 vaccination. That’s part of an overall budget of $466 million needed to continue combatting the virus from January through March, he said.

“From testing to contact tracing to helping folks make ends meet, our federal CARES funding is critically important to our state’s response to this pandemic,” Evers said.

Hospital distribution plans 

Wisconsin’s roughly 450,000 health care workers will come first on the list under the DHS vaccine distribution plan, to be followed by people over 65, individuals in long term care facilities, and potentially other essential workers.

One important component to hospital distribution plans is the equipment needed to store and safely transport the vaccines between facilities in the health care system. The ultra cold freezers needed to store them–the Pfizer vaccine has to be stored at -70C–have been in short supply nationwide.

“Finding storage freezers with surge capacity around a health system has been a challenge,” SSM Health’s Regional VP of Pharmacy Services Mo Kharbat said. Currently, SSM Health St. Mary’s Hospital in Madison has been able to procure one, and two more are expected to arrive at facilities in the SSM Health system around Wisconsin soon, a spokesperson said. UnityPoint Health-Meriter Hospital in Madison also now has the needed freezers, according to a spokesperson.

“But then to distribute the vaccine to smaller sites is another issue,” Kharbat explained. “Packing the vaccine correctly and appropriately, sending it to the appropriate location. Once we get it out of the freezer, the vaccine is also good for a shorter period of time, five days for the Pfizer vaccine, for example. So we will want to make sure that our vaccination sites are ready as the vaccine arrives, because the clock is ticking.”

Those more detailed plans are expected to be completed by mid-December in readiness for vaccine availability, he noted.

Part of the process has involved developing a method to inform employees about vaccination logistics and determine how many staff need one and are willing to get it. UnityPoint Health has developed an educational module for staff with information about vaccine development, safety information, and any potential side effects.

“At this time, we encourage, but will not require team members to receive the COVID-19 vaccine,” a spokesperson said.

More than 10,000 employees in patient care at hospitals and clinics across the SSM Health system in Wisconsin would be eligible, and part of their distribution process involves determining how many of them will want the vaccine wants it’s available, Kharbat said. Both health care systems say employees with higher levels of exposure to the virus will be prioritized among their staff once the vaccine is available. While the capabilities to get everyone vaccinated in a few days’ time would be there, Kharbat said the likelihood based on vaccine availability will probably stretch into a four to six week period before everyone who wants a vaccine has one.

“It’s going to be quite an operation here, to try to vaccinate all employees within a short period of time,” he said. For comparison, SSM Health employees are required to get flu vaccines, a process that normally lasts for two months.

Timeline uncertainty

The state is responsible for receiving and passing on the vaccinations from the federal government to the health care providers and other organizations signing up to be vaccine providers. Set to receive about 50,000 in an initial shipment according to the most recent guidance from the Centers for Disease Control and Prevention, DHS Secretary-designee Andrea Palm said Thursday that it’s unknown how many vaccines will become available in what’s expected to be weekly shipments thereafter.

“It will be different every week depending on how much is coming off the manufacturing line,” Palm said. “It’s hard for us to say at this point how the number and that allocation will grow over time based on the manufacturing capacity.”

Part of that will be based on how quickly (and if) the Moderna vaccine is authorized for emergency use by the FDA, which has been scheduled for discussion after their meeting on the Pfizer vaccine emergency authorization next week. Changes in availability as well as the potential to add the Moderna vaccine into the manufacturing lineup could result in greater fluctuations to weekly shipments, Palm explained.

The vaccine isn’t expected to be available to the general public until much later in 2021, according to CDC guidance, and a vaccine for young children could have delays as well until more studies on its impact on children must still be completed before their authorization for use.

Vaccine requirements

The state has no plans to make vaccines mandatory, Palm told reporters on Thursday. Wisconsin law does allow employers to require employees to get vaccines, with exemptions for religion and under the Americans with Disabilities Act–a measure that Vos’ legislative proposals to prevent employers from requiring a vaccine could throw into question. Until now, employment law experts say the two provisions for religion and disabilities have been narrowly interpreted by the courts.

“In most instances, an employer could require that vaccine as a condition of employment,” Erik Eisenmann, a Milwaukee-based labor attorney and the chair of labor and unemployment practice at Husch Blackwell, said of current state laws. Most federal guidelines and court decisions currently relate to flu vaccine decisions; in a pandemic, however, he says exemptions could become even more unlikely.

“What we’re more likely to see is people who have ethical or other objections to it, or say that ‘I just don’t think it’s safe,'” Eisenmann said. “Right now, those people are not protected in [the religious or disability] categories.”

Eisenmann says he’s hearing from his business clients across Wisconsin that the likelihood is many industries will encourage rather than require a COVID-19 vaccine. Even in health care, some hospital leaders say that the vaccine won’t be required–at least under FDA emergency authorization.

“At some point in the future when the studies are completed, the FDA will review the vaccine for formal approval,” Kharbat with SSM Health explained. “Once the vaccine is approved by the FDA–just like the flu vaccine is for example–at that point we will revisit this topic and we could potentially at that point make it mandatory.”

UnityPoint Health also indicated that “at this time”, employees would be encouraged but not required to get a vaccine.

A sigh of relief

For Wisconsin health care leaders, the coming vaccine represents a glimmer of hope in an otherwise long, discouraging timeline of surging cases and deaths in the state. While it’s too soon to stop practicing COVID-19 safety measures and the general public is likely to need to continue social distancing and mask wearing for months to come, the vaccine represents hope.

“This is the light at the end of the tunnel that many across the world have been waiting for,” UnityPoint Health spokesperson Leah Huibregtse told News 3 Now in an email. “We are optimistic that scores of lives will be saved thanks to medical science.”