What will it take to vaccinate Oregon?

This week, Kaiser Permanente launched a COVID-19 vaccination clinic at the Oregon Convention Center in partnership with three other large health systems: Providence, Legacy Health and OHSU.

It’s the first mass vaccination site in the Portland area and a key step in the state’s effort to build a system that can eventually scale up to inoculate more than 3 million adult Oregonians.

The convention center clinic will be by appointment only and will start out vaccinating around 2,000 people a day. As more doses become available, Kaiser and its partners say the site should have the capacity to vaccinate up to 7,500 people daily.

“We are setting this up as a sustainable operation that we will run until we no longer need it,” said Wendy Watson, chief operating officer of Kaiser Permanente Northwest. “Our ultimate goal is to have it open 7 days a week, extended hours.”

The new site is an example of how Oregon, after a slow start, is doing a better job of getting vaccine doses out of the freezer and into people’s arms: last week, vaccinators repeatedly exceeded Gov. Kate Brown’s target of 12,000 doses administered daily.

But the pace of vaccination still needs to increase for Oregon to achieve herd immunity and stop the spread of the virus: Just over 6% of the adult population has received at least one dose of the COVID-19 vaccine so far.

Getting there is complicated and requires more than just large spaces in which to give our vaccines. Here’s what else experts say the state needs to successfully scale up distribution:

More vaccines

Each week, Oregon is receiving roughly 100,000 vaccines total, including first and second doses of the Pfizer COVID-19 vaccine and the Moderna COVID-19 vaccine. If that sounds like a lot, consider that there are roughly 3.3 million adults in Oregon, and each needs two doses.

It would take roughly double the current supply to fully vaccinate every adult Oregonian by the end of fall.

Patrick Allen, director of the Oregon Health Authority, said a lack of supply is the key obstacle the state faces.

“We’re now at a place where we can administer virtually as much vaccine as the federal government can provide us,” Allen said at a press conference launch for the convention center clinic.

Across the state, hospital systems and other partners have ramped up the effort to administer shots -- and now they’re begging for more doses. But the supply coming from the manufacturers remains limited.

“Until we see a new vaccine approved, or see production go up significantly, everybody in the state, including this operation at the convention center, will be capable of vaccinating more people than we have vaccines for,” Allen said.

In fact, the approval of a new vaccine could soon help alleviate the supply shortage in Oregon and other states.

A third vaccine candidate, from Johnson & Johnson, is nearing the end of clinical trials. Depending on what the data shows, it could go to federal regulators for emergency approval in February.

An army of volunteers

Oregon needs more trained vaccinators and more staff to support them.

Before a person can get vaccinated, they may need help figuring out where to park. They need to sign a consent form and undergo screening for factors that could complicate vaccination. After receiving the shot, patients must be observed for 15 to 30 minutes in a clinical setting in case of an allergic reaction.

All that takes additional volunteers.

Health systems are tapping retired nurses and doctors to help staff vaccination sites, so their regular clinicians can focus on treating COVID-19 patients and everyone else who needs care.

Another source of support: the Oregon Air National Guard and Oregon Army National Guard.

Oregon has approximately 8,300 Army and Air guardsmen. Several hundred have medical qualifications and can administer the shots, but the guard’s greater role will likely be in providing logistical support and non-medical volunteers for vaccination sites.

Vaccines at the pharmacy

Pharmacies are currently playing a key role in getting the vaccine to residents in long-term care and memory care, by bringing them directly into facilities.

And the state and the CDC have the potential to activate a much more extensive pharmacy partnership that could deliver the vaccine directly to retail pharmacies across the state -- potentially allowing eligible members of the public to get vaccinated at their local pharmacy for free.

The pharmacies participating in the federal program include many familiar names, including CVS, Walgreens, Fred Meyer and Costco.

The governor said earlier this month the state was expecting shipments for pharmacies to arrive shortly.

Now it’s unclear if that happened, or if the federal government is sending Oregon enough vaccine to activate the pharmacy program. A week after Brown said the state was in the process of launching it, she and other governors accused outgoing Health and Human Services Secretary Alex Azar of promising more doses than the federal government could actually deliver.

The Oregon Health Authority didn’t respond to a request for an update on when retail pharmacies in Oregon will start receiving the vaccine.

A plan for essential workers

COVID-19 hasn’t impacted all Oregonians equally. Case rates are more than twice as high for Black and Native American Oregonians as for whites. For Pacific Islanders and Latinos, the disparity is even greater: they are more than three times as likely to get COVID-19 than a white Oregonian.

National research has found that a key reason for these disparities is that specific racial and ethnic communities are over-represented in low-wage jobs that cannot be done remotely, and they’re more likely to be exposed to the virus at work.

“I’d like to bring that to the forefront of the conversation,” said Daniel Lopez-Cevallos, a professor of health equity and ethnic studies at Oregon State University. “We have essential workers who are out there, being exposed, day in and day out.”

Lopez says that at a minimum, the governor needs to make it clear when essential workers will be prioritized for vaccination. The state’s vaccine advisory committee has put them in the broader group - IB -that will get priority some time after teachers and adults 65 and over, but before the general population.

Lopez-Cevallos would like to see the state planning a specific vaccination strategy for essential workers.

Melissa Unger, director of the the SEIU Local 530, shares Lopez-Celvallos’ concern: the state doesn’t yet have a targeted plan for how to reach the very essential workers who have been most harmed by the virus.

Unger believes essential workers are at risk of getting left behind if the state relies too heavily on mass vaccination sites, because they won’t have time to wait in line, or to lurk online looking for new appointments to be released.

“They have to go to work. We have to make sure we’re making this process work for the very people who have been asked to keep our economy going during this pandemic,” Unger said.

Unger’s suggestions include a dedicated appointment line that allows essential workers to schedule their vaccinations, and better outreach - over text and in people’s native languages.

More, and better, public health communication

Unger and Lopez both say the state needs a more aggressive public health messaging campaign to reassure people and answer their questions about the vaccine.

Unger says not all the health care and hospital workers currently eligible for the vaccine feel comfortable receiving it. They’re a heterogeneous group that includes people with varying degrees of health literacy: certified nurses’ assistants, people cleaning hospitals and providing food service, and home health aides, for example.

Unger says many of them are trying to decide whether to get vaccinated and need more help getting their questions answered.

“What are we doing as a community and a state to make sure they have the answers they need to feel secure?” Unger said.

Unger also thinks the state needs to do a better job reassuring the public that there is a plan to get everyone the vaccine -- it’s just going to take time.

“The element of scarcity in a pandemic is very dangerous,” she said. “‘Everyone is trying to figure out how to feel safe and secure for their families right now, and I think the role for government is to be able to communicate that we’re going to get there, and there is hope.”