NEWS

A dose of the Moderna COVID-19 vaccine is administered at the Spokane Fire Department Training Center. YOUNG KWAK PHOTO

HEALTH SLOW-MOTION SHOTS

Why is it taking so long to give out lifesaving vaccines in Washington state?

On average, 3,000 Americans are dying from the coronavirus every day. A new COVID strain first identified in the United Kingdom has added to California’s woes. Hospitals in Los Angeles County have been so overwhelmed that ambulances can’t take some heart attack victims to the emergency room.

Washington state, however, has been one of the most successful states in slowing down the spread of the coronavirus. It went from the first state to be hit with the outbreak last March to the state with the fifth-lowest total number of cases today.

Yet, when it comes to the drugs that could end the thing, restart our economy and restore our way of life, Washington has been slow out of the gates.

By Friday, the Seattle Times reported, nearly 468,000 doses had been distributed in Washington, but only a third of those had actually been injected. Despite recent improvements, on Monday Bloomberg’s “vaccine tracker” ranked Washington state’s ability to get COVID shots into arms among the bottom third of the country.

8 INLANDER JANUARY 14, 2021

BY DANIEL WALTERS

And while some heap blame upon federal failures of “I was worried there wasn’t a sense of urgency,” Billig the Trump administration, state House Minority Leader says. “Once I communicated with the Department of J.T. Wilcox (R-Yelm) notes that Gov. Jay Inslee had nine Health, there was absolutely a sense of urgency.” months to plan for efficiently distributing COVID vac- He says he emphasized that the Legislature would cines. provide the department any funding necessary to com-

“We should have a top 10 United States plan, not plete the task. bottom 20,” Wilcox says. “We are one of the slowest states rolling this vital thing out at the same time as we are squeezing down “We are one of the slowest states rolling parts of the economy.” The stakes, after all, couldn’t be more this vital thing out, at the same time as we clearly a matter of life and death. “How would you feel if it was your are squeezing down parts of the economy.” grandmother who contracted COVID this week because she should have been vaccinated two or “Our Senate budget team has met with the Departthree weeks ago?” Wilcox asks. ment of Health and conveyed the message that we do not want a lack of resources to be in any way a hindrance for

The frustration has been bipartisan. Sen. Majority vaccine distribution,” Billig says. “This is too important to Leader Andy Billig (D-Spokane) indicated that he have us delay in any way that’s preventable.” initially had some of the same concerns as Wilcox. ...continued on page 10

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NEWS | HEALTH “SLOW-MOTION SHOTS,” CONTINUED...

Inslee’s administration has rolled out a plan with a series of phases, subphases and tiers within those subphases to determine who gets the vaccine first. Most residents under 70 who aren’t working in a high-risk setting likely won’t get vaccinated until at least May.

But even the first tier of the very first phase — focused on hospital workers, first responders and nursing home residents — has been rife with delays.

Rep. Joe Schmick, a Republican who represents southeast Washington including the southern tip of Spokane County, set up meetings last week to try to identify the roadblocks.

One problem, he says, was that the distribution was interrupted by the Christmas and New Year’s holidays. There were also misunderstandings: While each vaccine recipient is supposed to get another shot a few weeks later, some hospitals and clinics incorrectly thought that they were supposed to reserve that second dose themselves, instead of trusting it would be delivered.

Though serious side effects are rare, Schmick says that enough of those who received vaccines didn’t feel well a few days after being vaccinated that it “precluded hospitals from going in and saying we’re only doing this floor or this whole wing.”

“Hospitals were staggering vaccinations,” Schmick says.

Some health care workers didn’t want to get vaccinated at all.

“There are health care workers who are on the front lines who are hesitating getting vaccines. That is a significant issue as well,” state Secretary of Health Umair Shah says.

Yet, there are millions of people in the state who do want to get vaccinated. But state rules require certain high-risk groups to get vaccinated first before others.

While the state has tweaked the rules to allow for a bit more flexibility, the process of vetting everyone can create a bottleneck, says Kayla Myers, lead of the Spokane Regional Health District COVID-19 Vaccination Task Force.

“We all are trying to make sure we’re vaccinating the right people, but we also need to determine if it’s time to move on to the next group,” Myers says.

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Paramedic Nikko Humphry administers a dose of the Moderna vaccine to dispatcher Sara Thomas at the Spokane Fire Department Training Center. YOUNG KWAK PHOTO

The Trump administration hasn’t helped. On Monday, Democratic senators sent a letter, co-authored by U.S. Sen. Patty Murray (D-Washington), to Trump’s Health and Human Services secretary, scolding the administration for failing to develop a comprehensive national vaccine plan.

“Jurisdictions and health care providers are not the only ones in the dark,” the letter reads. “Members of the public do not know when, where, or how they will be able to be vaccinated.”

Confusion has reigned. Last month, Washington state abruptly learned from the federal government that their first batch of COVID vaccines would be cut by 40 percent. Idaho, which has similarly struggled with effective vaccine distribution, saw their first batch cut by 44 percent.

States don’t know how many vaccine doses they’ll receive

until a week beforehand, giving local hospitals and clinics even less time to schedule patients.

At a single clinic, says Brent Albertson, director of pharmacy at Providence’s hospitals, it’s only possible to deliver a limited number of vaccinations a day. Not only is there all the paperwork to fill out, but each vaccinated person has to be monitored for 15 to 30 minutes to ensure they don’t have an allergic reaction.

“I wouldn’t call that a limiting factor,” Albertson says. “I just call it, ‘That’s kind of the way it is.’”

But there’s a solution to that, too: Add more vaccination sites.

Last week, the Spokane Regional Health District launched a large-scale drive-through vaccination clinic at the Fire Training Center for first responders and health care workers. While that clinic will only last 10 days, the health department plans to create smaller vaccination sites at fire stations throughout the county in the future.

In the meantime, thousands of clinics, pharmacies and doctor’s offices throughout the state are lining up to become vaccination sites.

“Members of the public do not know when, where, or how they will be able to be vaccinated.”

Yet before receiving their first vaccine shipment, each health care provider has to get the greenlight from the Department of Health, a process that involves providing everything from the schedule of employees available to receive shipments to extensive documentation about refrigeration and temperature monitoring devices for vaccine storage.

For some, like Providence’s hospital pharmacies, the approval from the state came relatively quickly.

But for others, Schmick says, “it’s an agonizingly slow process.”

Only four providers had been approved to give out vaccines in his district. One of them started the process in October, he says, but it still took four weeks to get approved. A lot of others, he says, are still waiting.

“I’ve got hospitals in my district, and they’ve not been approved,” Schmick says. “As of last Monday, [the Department of Health] had 2,000 applications sitting on their desk.”

Spokane County has been having the same issue.

“We had a local large health care organization that hadn’t been approved yet. They’re going to become extremely needed in the community once we move through later phases,” Myers says. “I reached out to DOH and gave them a list of the names of their clinics, and just said, ‘Can we expedite these people?’”

At least 160 providers in Spokane County have notified the Department of Health of their desire to administer vaccines, and as of Monday, less than a third of them had been approved. While most applicants were still working through the application process, 33 providers had completed all their paperwork and were waiting to hear back from the state.

The Washington state Department of Health declined a phone interview request from the Inlander. In an email exchange, a department spokeswoman acknowledged that there were “many providers who have submitted enrollment applications and aren’t approved yet,” but that it was “hard to determine an exact count because there are many duplicate or accidental applications” and stressed that “staff are working with providers on completing applications and we add new enrollees every day.”

Still, Wilcox says even he’s been directly contacted by facilities in Eastern Washington who’ve been frustrated.

“For crying out loud, why the hell can’t we approve them. … I grew up in an industry where I put in a lot of all-nighters,” says Wilcox, who’d worked on his family’s dairy farms. “For god’s sake, that was to get milk out. This is to get lifesaving vaccines out.” n danielw@inlander.com

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Dr. Jonathan Staben is the principal investigator leading a clinical trial of a new COVID-19 vaccine developed by Novavax. YOUNG KWAK PHOTO

Testing COVID Solutions

Cheney clinic will test new coronavirus vaccine on hundreds of Inland Northwest volunteers

BY SAMANTHA WOHLFEIL

Under a new clinical trial, another COVID-19 vaccine is closer to becoming a reality, and hundreds of Inland Northwest volunteers can help researchers by volunteering to take the shots.

A MultiCare researcher in Cheney has been selected to lead the only phase three COVID vaccine trial in the region as part of the nationwide testing of a vaccine developed by Novavax.

Since 2007, Dr. Jonathan Staben has helped lead research on multiple vaccine trials at MultiCare Rockwood Cheney Clinic. When MultiCare acquired Rockwood Health System in 2017, Staben and others partnered with MultiCare’s Institute for Research & Innovation based in the Puget Sound area to continue their research. That experience is partly how his clinic was selected as the only site apart from the University of Washington to test out the Novavax vaccine.

Up to 300 people can participate in the trial, and unlike most placebo trials where you have a 50/50 chance of getting the actual vaccine or a placebo of saline fluid, two-thirds of participants will receive the actual vaccine for this trial.

HOW THE VACCINES WORK The vaccines being developed and those already being distributed are designed to help the body target the spike protein on COVID-19 virus cells.

The spike protein helps the virus break into and enter your body’s healthy cells so it can then take over and use your cells to replicate itself.

“All of these vaccines are trying to train your body, for the most part especially with the ones we’ve all seen, to recognize the spike protein,” Staben says.

The two vaccines that have already been approved for emergency use by the Food and Drug Administration, produced by Pfizer and Moderna, use a new mRNA technology that essentially provides directions to your body to create the spike protein on its own, Staben explains. Your body then immediately recognizes it as a threat and attacks, creating antibodies.

Novavax’s vaccine is more like those that have been used over previous decades to prevent illnesses like hepatitis. The protein that the body needs to attack is created in a lab setting (not by the body), then injected via the vaccine along with an adjuvant that helps the body’s immune response to the foreign protein. Similarly, your body then recognizes the threat and creates antibodies, which later help you defend against an infection from the virus.

Growing the proteins in the lab takes longer than creating the mRNA vaccines, which is partly

why this vaccine is reaching its phase three trial later than the two that are already approved, Staben says.

Similar to Pfizer and Moderna’s vaccines, the Novavax vaccine requires two doses. None of those options contain the entire virus, so you cannot get COVID-19 from them, but some cold-like side effects are possible while your body reacts to the foreign proteins.

Significantly, the Novavax vaccine doesn’t require that doses be kept at incredibly low temperatures until they’re ready for use, as the Moderna and Pfizer options do.

“This vaccine doesn’t have any cold storage requirements; it’s stored at normal fridge temps,” Staben says. “So this will be a lot easier down the road to get in rural areas, third world countries, that kind of thing.”

Staben says he’s been on calls with officials planning for the country’s vaccine rollout and leaders have noted that it’s key to have a mix of options, especially those that can be stored without specialized equipment.

HOW TO PARTICIPATE Volunteers can signal their interest in participating by going through MultiCare’s website at go.multicare.org/covid-vaccine. html. You do not need to be a MultiCare patient, and the available spots are expected to fill up quickly.

Generally, researchers are hoping to enroll people from a variety of age groups, racial groups, and health backgrounds.

While most of the in-person stages of participating in the trial will happen within the first three months, researchers will check in with participants over the course of 24 months to complete the study. Emergency use authorization could potentially come soon after enough participants have been given the second dose of the vaccine.

“There’s several key factors we’re kind of targeting here,” Staben says. “First they have to be over 18. They have to be medically stable, and that would be determined by our staff, especially me as the principal investigator.”

Participants can still have medical problems, for example diabetes or hypertension, Staben says, as studying the vaccine’s safety for all types of people is one of the goals.

“It is important to study these in people that have health care problems, not just young, healthy people,” he says. “We just want people who are not medically fragile and undergoing frequent changes in their medications and so forth.”

People that are over 65 are important to enroll, Staben says, as well as those who may have risk factors for getting COVID, such as those who work in crowded industrial plants or as first responders.

Researchers are also hoping to enroll people from racial backgrounds that have been historically underrepresented in clinical trials – in part due to distrust built over time by the medical system’s mistreatment of minorities – and whose communities have been disproportionately impacted by the pandemic.

“That would include African Americans, Native Americans, Asian Americans, Latinx populations,” Staben says.

You don’t need to meet all of those factors that researchers are looking for, but those are things they’ll look for as they select participants.

A few things may disqualify people from participating, including if you’ve already tested positive for COVID (from a PCR swab test, not a rapid test). However, while participants will be tested for COVID-19 antibodies, a positive antibody test wouldn’t disqualify them from the study, Staben says. It’s important to note that participants won’t be told the results of those tests, though, he says.

Additionally, if it’s likely you’ll be among the groups with early access to the other vaccines that are already approved, you may just want to wait your turn for that vaccine rather than trying to sign up for this trial, Staben says.

“We don’t want someone enrolling in the trial and then having something offered to them and feeling like they can’t get it,” Staben says.

More information about the Novavax vaccine can be found at novavax.com/covid-19-coronavirus-vaccine-candidate-updates. n samanthaw@inlander.com

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