COVID-19 Vaccination What's happening? - January 2021 - Monash Health
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COVID-19 Vaccination What’s happening? January 2021
Twelve Months of COVID-19 19/01/2021 2
Why Vaccinations?
• Vaccines save lives
• Estimated 5 lives a minute are saved
• Smallpox vaccine – eradicated the disease - saves 5 million lives annually
• Measles vaccine – prior to vaccination availability – caused 2.6 million deaths annually
Vaccines only save lives if people are vaccinated
• Why COVID-19 vaccination?
• COVID-19 is a serious disease
• Physical distancing, mask-wearing and isolating have slowed the disease – but….
• We now have safe and effective vaccines available
• Vaccines have been tested on millions of people
• Risk of COVID-19 far outweighs any risks associated with the vaccines
19/01/2021 3
19/01/2021 4
Vaccination
Vaccines prime your
immune system to
recognize and fight off
an infection
They don’t actually
cause the disease
New Platforms
Years of research
behind them
19/01/2021 6
Vaccine characteristics and approvals
Vaccine Temperature
Trial Phase Safety Results Efficacy Results TGA Approval
Details Requirements
Frozen for 95% efficacy
storage/transport: - (consistent across
mRNA vaccine
Pfizer 70°C ± 10°C for up to 10 Phase 3 results Administration well age, gender, race
from the Provisional
days unopened to be published tolerated; no serious safety and ethnicity
US/Germany Determination
Thawed: three -five days concerns observed. demographics with
at refrigerated 2-8°C over 94% in adults
conditions over 65 years old)
Half dose/Full Dose
Phase 3 interim
Viral vector regimen = 90%
AstraZeneca Routine refrigerated cold results published Administration well Provisional
vaccine from Full dose/Full dose
chain at 2-8°C in The Lancet tolerated; no serious safety Determination
the UK regimen = 64%
(08DEC2020) concerns observed
Pooled efficacy =
70.4% across
Protein vaccine
Novavax Phase 3 trials
from the US Administration well
ongoing in US
(clinical trial in N/A tolerated; no serious safety TBA N/A
and Mexico,
Australia) concerns observed
complete in UK
Doses, deliveries, requirements
Purchase Agreement Weekly deliveries Weekly Deliveries Minimum Delivery
(Australia) (Victoria)
Approximately 1000
Pfizer 10 million doses spread 100-200,000 per week doses (one tray) for use in
Max. 50,000 per week
across year from February 3 days once thawed, has
maximum freeze times
once left the factory
30 million doses across
AstraZeneca Up to 1 million per week Approx. 250,000 per
the year (local TBA
from March week
manufacturing)
Novavax 40 million doses spread
across the year
Overall Victorian model
Local
General Practice Pharmacy
AstraZeneca
Government
Health Community GP Respiratory
Services ACCHOs Base capacity
Health Clinics
Targeted populations, health care workers, high risk industries, general population
Health Services
Pfizer (1a)
Pfizer-Hubs Targeted
V HUB
(6-8) Outreach Rapid and early roll out
in highest risk cohorts
• Health Care Workers (highest risk) • Hotel Quarantine Workers
• Public Sector Residential Aged Care • Ports of Entry Workers
staff and residents
PPhase 1a vaccine program
Coverage
Anticipated
Vaccine Recipient Cohorts Projection for Delivery Model
recipient numbers
Phase 1a
Staff involved in the Vaccination Small vaccination site 500-1000
Full coverage
Program (potentially coupled w ith dry run site practice) initial
Hotel Quarantine Staff
(and staff associated w ith the Hotel Full coverage A combination of small vaccination sites 5,000
Quarantine Program) (proximal to locations) or mobile clinics
Health Care Workers at Victorian A combination of large vaccine
5,000
Prioritisation
COVID19 Testing Sites Full coverage administration sites at health services or
(all staff including administrative staff) mobile clinics to some sites
A combination of large vaccine
High risk staff at Victorian Airports Prioritisation administration sites
(International & Domestic) according to (Tullamarine/Avalon/Port Melbourne) and 16,500
- including airline staff w here necessary; and exposure risk small or mobile clinics (Tullamarine & Avalon/
high-risk staff at Victoria's Sea Ports of entry.
Port Melbourne)
Prioritised Hospital Staff Prioritisation
Hospital staff administered within hospital Unknown (should be a
(ER; ICU; COVID w ards - all staff physically according to
or mobile clinic delivering it to the hospital proportion of 386,000).
associated w ith these w ork areas) exposure risk
Prioritised health care workers (other) Partial coverage
Under consideration. Unknown
e.g. General Practice, Paramedics acceptableDetailed planning for Phase 1a
Coverage
Anticipated recipient
Vaccine Recipient Cohorts Projection for Delivery Model
numbers
Phase 1a
Health and disability
care workers:
(should be a proportion
Partial A combination of small vaccination sites of ~386,000)
Health, aged care and disability coverage (proximal to locations) or mobile clinics
Prioritisation care workers acceptable Aged care workers:
~56,800
Total: ~442,800
Residents in residential Partial A combination of small vaccination sites
disability, permanent residential coverage (proximal to locations) or mobile clinics and ~50,000 TBC
and respite care acceptable coordination with local council servicesThe Pfizer vaccine will be the first available in Australia Australian capacity • 10 million doses of the Pfizer mRNA available in first half of 2021 • TGA approval expected by end of January 2021 Victorian capacity • 450k to be vaccinated (900k doses ordered) Dosage • 2 dose administration, administered 21 days apart (+/- 2 days) Supplier cold chain procedure • Pfizer boxes contain 1,000 doses per batch, 5 doses/vial (195 vials) • If a box is opened for longer than a few minutes, the vials need to be refrigerated and then used within three days Cold chain storage • Freezer storage: -70°C • Refrigerator storage: 2-8°C • 3 day shelf life from time left freezer • 6-hour shelf life once vial is opened Australian Immunization Register (AIR) • COVID-19 vaccination is currently voluntary • Provider reporting on AIR will become mandatory in 2021
mRNA Vaccines
• mRNA
• Instructs our cells on what proteins to produce Easy design
• In vaccine is in a nano-lipid layer
• COVID vaccine is toward the viral spikes Rapid manufacture
• Enters cells Robust response
• Cell makes the “viral” proteins
• Viral proteins released
• Immune response triggered
• mRNA digested by enzymes
• Immunity
• To viruses entering the body that have these
spike proteins
19/01/2021 13Pfizer / BioNTech • mRNA Vaccine • Trial:> 43,500 participants: 2 doses @ 0 and 3 weeks • Preliminary data indicating vaccine is > 90% percent effective. • 7 days after second dose • Logistics for this vaccine require vaccine “hubs” • Effective after dose 1 • 2nd dose for durability • Unclear duration of effect • Prevents severe disease • Ongoing studies on if it prevents transmission
Safety
• mRNA vaccines are quite safe
• Importantly no vaccine is ever 100% safe but greatly outweigh risks
• Safety will be assessed ongoing
• New vaccines for a new disease
• Very Rare events are likely to appear in media, amplify attention and increase worry that is
disproportionate to risk
• These vaccines are classified as “reactogenic”
• Will cause some small side effects in most people who receive than as a marker of the brisk
immune response they generate
• Most important side effects
• Pain at injection site, fatigue and headache – all resolve in first few days
• Younger > older and second dose > first dose
19/01/2021 15Anaphylaxis
• Likely not due to mRNA itself
• Polyethylene glycols/polysorbate 20
• also in other medications, moisturisers etc.
• Now known to be rare but observation for 15
minutes warranted
• Rate ~ 1 in 100,000
• Penicillin rate ~ 1 in 5000
• All vaccines ~ 1 in 1000,000
19/01/2021 17Who can have the vaccine?
• Very few contraindications
• Not if you are allergic to any components of the vaccine
Separate by 7 days
• Age > 16 years Influenza vaccine
• Pregnancy program
• Immunosuppressed
• Past-history of COVID
• Yes – wait ~ 90 days
• Acute illness
• Defer until better
• History of anaphylaxis to other medications/foods
• Watch for 30 minutes post vaccination
19/01/2021 18Monash COVID-19 Vaccination Program
• Gradual role out dependent on vaccine availability
• Commonwealth led
• High risk HCWs first
• Aged care HCWs and residents next
• Other patient facing staff
• Pfizer vaccine will be delivered from clinics
• 5 sites – 3 to begin with
• HCWs must come to the clinic
• Specific preregistered appointments
• End to end IT system
• Closely working with managers to ensure easy process that impacts least on health service
delivery
19/01/2021 19Monash HCW Vaccination Program
Vaccine delivery is driven by clinical sub-working groups with support from the
Project Team What we are planning for
Monash Health as one of the first Pfizer Hubs
• Hub and spoke model between MMC and:
Operations • Casey
• Dandenong
• Peninsula Health
Rhonda Stuart • Private Hospitals
Sarah Hirschi • Alfred Health
Project Team Tom McLaughlin
Fiona Sherwin • Scaled vaccine delivery to identified HCW priority groups
Eliisa Fok
What we are working on
Clinical Workforce Systems Workforce
Advisory Advisory Advisory • Who is allowed to deliver the vaccine (e.g. Nurse Immunisers)
• Training requirements
Vaccine delivery by Monash Health
• Priority populations to be advised by DHHS
Sub-Working Sub-Working Sub-Working • Number of vaccines clinically delivered
Groups Groups Groups • Number of vaccines to be stored
Systems
• DHHS and Federal go live dates and reporting requirements
TGA administration advice
• Including clinical delivery and SOP’s across S&TsApprox 4,000 HCWs are identified as first priority across
all Monash Health sites (similar to fit testing schedule)
Proportion
Priority HCW Nursing/ of
Medical Allied Health Pharmacy Others Total
groups Midwifery anticipated
(Vic)5 Key takeaways
Immunisation • Approx. 4,000 Monash Health are
97 0 0 9 12 118 12% identified for Phase 1a
Clinic1
vaccinations
COVID-19
30 1 10 0 152 193 4% • Vaccine clinic sites planned for:
testing sites1 • MMC
• Casey
Priority Hospital
Staff – ICU and 1493 1028 192 119 45 2,877Cohorted dosing for HCW
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
• Cohort 1 • Cohort 2 • Cohort 3 • Cohort 1 • Cohort 2 • Cohort 3
Monash • Dose 1 • Dose 1 • Dose 1 • Dose 2 • Dose 2 • Dose 2
Health HCWs
(3 MH sites) Non-pt
facing &
mop-up
~4000 Doses ~4000 Doses
Vaccine doses to be delivered in a 6 week period
Spread out HCWs over a 3 week periodAfter the vaccine….
• The virus will still be circulating
• Until herd immunity is established worldwide
• COVID-19 is with us for a long time
• Masks and distancing will still be required until we know a bit more
• Until immunity develops
• 7 days or more after second dose
• Until we know more around the ability of the vaccine to stop transmission
• Likely to be so – as this is the case for other vaccines
• Decreases disease severity
• Likely decreases viral load
19/01/2021 25Summary
On track for Australian vaccine delivery 2021
Pfizer vaccine to role out at Monash Health
First doses to high-risk employees in February
Monash Staff
Vaccination of everyone who can be immunized
Protect yourself and those around you
DHHS/Commonwealth to decide on mandates
19/01/2021 26You can also read
