Questions remain over who qualifies as essential and verifying vaccine candidates’ jobs, raising the risk of fraud.
New York City, US – Stephanie Cal was stringing up Christmas decorations at her family home in Long Island on December 13 when she got the text from a hospital co-worker.
The 58-year-old nurse stared at her phone – she had qualified for the first round of Pfizer-BioNtech’s COVID-19 vaccine. Days earlier, the US Food and Drug Administration had given the green light to the pharmaceutical giant’s vaccine for emergency distribution.
“This is the most wonderful Christmas gift,” Cal, a surgical ICU nurse at Long Island Jewish Medical Center in the greater New York metropolitan area, said.
The next morning, Cal rolled up her sleeve to receive the vaccine during her shift at the medical centre in Queens.
She was the third American to be inoculated with the Pfizer vaccine.
“I just feel like it was the right thing to do,” Cal said. “This is hope in a little vial.”
‘I want to get back to living life’
This spring, Cal’s emergency unit became a morgue. Dozens of her own patients were carried away in body bags.
“One by one, our unit was filled with COVID patients coming in from ER,” she said. “The hospital became unrecognisable.”
As people slipped into death, Cal held their hands or played their favourite music. She told them they were not alone. Their beds were usually taken by a new patient within the hour, she said.
“I can count on one hand the ones that I took care of that survived,” she recalls. “It was just unbelievable that they could just all be gone.”
Nearly a year later, the trauma lingers. The caterwaul of unanswered mobile phones echoing through her emergency unit – at the bedsides of intubated and dying patients – still haunts her, she said.
“They were completely sedated and often medically paralysed because their lungs were in such bad shape,” she said. “Yet these cell phones were constantly ringing because their family and friends were looking for them and they were unable to answer.”
The vaccine is a “blessing”, she added – and the first step towards normality. Cal plans to receive her second dose of the Pfizer vaccine in three weeks.
“I believe in the science and I want us to get back to living our life,” she said. “If I could show people that it’s OK to do it and I wasn’t afraid, then maybe it helps somebody else feel the same way and take it.”
On December 18, Massachusetts biotechnology firm Moderna won emergency approval for its vaccine, further bolstering New York City’s vaccine roll-out.
The arrival of two different vaccines was met by surging infections, hospitalisations and death tolls nationwide. Nearly 1.3 million new cases have been recorded in the past week alone, bringing the total number of infected Americans to more than 19 million, according to the Centers For Disease Control. Globally, fears of a new variant of the virus have thrust Europe into new lockdowns as nations everywhere began jockeying for vaccines.
Yet, the immunisations represented a flash of hope for New York City’s healthcare workers who, this year, have lived through some of the bleakest chapters in the city’s history. More than 25,000 New Yorkers have perished as the virus ripped through the metropolis.
‘There’s light at the end of the tunnel’
“I remember feeling defeated when I left work every day,” Dr Adam Berman, 37, told Al Jazeera. “I had done as well as I could but there was physically no way I could give as much as was needed in the situation.”
Berman was in the trenches during the pandemic’s first wave. The Manhattan doctor treated hundreds of infected patients and compared the contagion to a “nuclear bomb”. Berman was vaccinated on December 14. Getting the shot, he said, was like “coming back from war.”
“It makes me proud to be a New Yorker. I think we went from some of the darkest times that this city has seen in modern history to hopefully turning a corner,” he said.
Berman said he believes the federal government’s overall response to the virus has been “abysmal”. He feels that President Donald Trump endangered the lives of millions by downplaying the virus.
“This country could not even admit at the highest level that this was a problem. The messaging was horrible.”
He was pleased to see President-Elect Joe Biden vaccinated on live television on December 21.
Berman, however, fears the worst is far from over. Thousands more New Yorkers will likely die in the coming months. Vaccines are not an off-switch, he cautioned.
“There’s light at the end of the tunnel but the tunnel is very long,” Berman said. “Our lives may never be exactly the same as they were before.”
The ‘weapon to end the war’
This has all happened before. In 1947, Eugene LeBar, a Maine rug merchant, rode a bus from Mexico City to New York. He stumbled into Manhattan with a fever and died of smallpox days later. Officials, fearing a deadly outbreak, vaccinated millions in weeks. Not since smallpox has the city been forced to launch such a grand immunisation crusade – until now.
In the final weeks of 2020, more than 67,000 New Yorkers – and more than 2.1 million Americans – have been vaccinated for COVID.
“This is the weapon that will end the war,” New York’s Governor, Andrew M Cuomo, said earlier this month, as he watched the first vaccinations via livestream.
Approximately 140,000 vaccinations – out of nearly 1 million available doses – have been administered statewide, the governor’s office said.
Meanwhile, New York City’s Mayor, Bill De Blasio, hailed the moment as a “shot of hope” on December 14, pledging vaccines would be “safe, free, and easy to get” for the city’s 8 million residents.
Inoculating the masses, however, who hail from a spectrum of varying cultural, racial, ethnic and socioeconomic backgrounds, is a staggering task, some experts said.
“This will be an unprecedented mass vaccination situation – we’re in the middle of a pandemic,” Dr Bruce Y Lee, a vaccine supply chain expert and health policy and management professor at the City University of New York’s School Of Public Health, said. “It’s a huge city with so many different components and people.”
Lee estimated that 70 to 80 percent of New York’s population will need to be vaccinated to largely “extinguish” the threat of the virus.
“Even if you do vaccinate a lot of people, it alone is actually not going to stop the pandemic,” he explained. “You really have to reach every single neighbourhood.”
New York’s nurses, doctors, first responders and hospital workers, as well as care home staff and patients, will be inoculated into January, officials have said. The exact hierarchy, however, of who gets vaccinated next – and how and when – is unclear.
The elderly and essential workers unable to physically distance – teachers, taxi drivers, subway conductors, barbers, police officers, firefighters, postal workers and daycare workers – will qualify next, followed by those with at-risk medical conditions, according to CDC recommendations.
Vaccines are expected to become available to the city’s general population in mid-2021. City leaders promised the vaccine roll-out will prioritise – and boost access to vaccines in – neighbourhoods hit hardest by the coronavirus.
A historic effort
“We’re in a period now where we just have to wait,” Dr Eric Toner, a senior scholar at John Hopkins Center for Health Security, told Al Jazeera.
The pandemic healthcare response expert described the coming months as “vaccine purgatory”.
“We’re trying to find out when and where we’ll be vaccinated – it’s frustrating to people not to have the answers to the questions,” he said. “This is extraordinarily complicated. People are just going to have to be patient, as they have to be with so many other aspects of this pandemic.”
City health officials, this week, rolled out the early blueprints for an “all-hands-on-deck” immunisation effort and urged municipal workers to volunteer at points of distribution sites across the city, where vaccines will be given.
“The Health Department has several thousand individuals who have been trained in [distribution] operations and can support this historic effort,” Dr Dave Chokshi, the city’s health commissioner, wrote in a letter to municipal leaders. “But we cannot do it all alone – we need your support to fully staff and mobilise these [locations], so we can operate a network of NYC COVID-19 vaccine distribution sites on a large scale.”
Beginning in January, vaccination sites will open in municipal buildings across New York City, with a potential capacity of serving thousands a week.
The city is also banking on the approval of additional vaccines at the federal level in the coming months. Three other vaccines – from Johnson & Johnson, Oxford-AstraZeneca, and Novavax – are currently in Phase 3 trials. However, initial results are not expected until early 2021.
“If you want to have enough vaccine to vaccinate all the people in the US who you’d like to vaccinate – up to 85 percent or more of the population – you’re going to need more than two companies,” Dr Anthony Fauci, America’s top infectious disease expert, said on Monday.
The combined current national supply of vaccines – 400 million doses – is only enough to cover approximately 60 percent of the country’s 330 million people. Both Pfizer and Moderna vaccines require two doses per person.
The Pfizer and Moderna vaccines are limited, logistically. Both require a booster shot, have short shelf lives, and need sub-zero storage conditions.
Shipped in pizza-sized boxes of nearly 1,000 doses, the Pfizer-BioNtech vaccine is especially fragile. Its vials, packed in custom-fit containers and insulated with dry ice, need to be stored in special deep freezers ranging between -60 and -80 degrees Celsius (-76 to -112 Fahrenheit). Once thawed and opened, the doses need to be administered within hours. This, experts said, vastly restricts the Pfizer-BioNtech vaccine’s reach.
“They’re only useful in a place that can vaccinate nearly 1,000 people in one day and that’s not too far away from the freezer where they’re being stored,” Toner explained. “If we want to vaccinate the vast majority of the population, we’ve got to get it into doctors’ offices, urgent care centres, clinics, as well as neighbourhood pharmacies. That’s not going to be feasible until we get a vaccine that’s much easier to handle than these first two.”
Moderna’s vaccine, while requiring long-term storage at sub-zero temperatures, is not as fragile as the Pfizer vaccine. It remains stable at -20 degrees Celsius for up to six months or in refrigerated conditions for up to 30 days; at room temperature, it lasts for 12 hours. It is, therefore, better-suited to rural regions and more remote areas of the country.
The Johnson & Johnson vaccine, on the other hand, would be key to roll-out efforts, if approved, because it only requires a single dose. It is also less fragile. “The Johnson & Johnson vaccine does not require handling differently than most routine vaccines and specifically does not require an ultra-cold chain,” Toner said.
‘Just a little pinch’
“The more vaccines we can get, the more people that can receive it, the quicker I really believe this will come to an end,” Jamie Piekarski, a nurse practitioner at Mount Sinai Beth Israel hospital in Manhattan, said.
Piekarski received the Pfizer vaccine on December 15. Her grandmother died this spring after the virus tore through her Connecticut nursing home. There was no funeral.
“We couldn’t be there to say goodbye,” Piekarski, 31, recalls. “It’s hard not be with the people you love when they’re suffering like that.”
The Brooklyn nurse practitioner said she was initially on the fence about getting the shot.
“In the very beginning I had some initial hesitation given that this was something novel – this is a novel vaccine,” she explained.
In recent months, however, she’s monitored vaccine trials and studies. Both vaccines, which utilise synthetic messenger ribonucleic acid (mRNA) technology, were found to be 95-percent effective against COVID. Piekarski ultimately decided she had a “responsibility” to be inoculated.
“The brightest minds in the entire world have been working meticulously to get this done,” she said. “The benefits outweigh the risks.”
Piekarski has not experienced any unpleasant side effects apart from a sore arm, she said.
“There’s just like a little pinch. Then I went right back to work, I didn’t have any problems at all. There’s a little bit of soreness in my arm but nothing that’s keeping me from doing what I have to do. It was pretty benign.”
Health authorities are investigating half a dozen allergic reactions linked to the Pfizer vaccine – out of hundreds of thousands of immunisations – since the countrywide roll-out began.
On December 24, a Boston oncologist with a shellfish allergy suffered one of the first-known allergic reactions to the Moderna vaccine. He was discharged the same day after treating himself with his own epi-pen, according to hospital officials.
Individuals with a history of anaphylaxis are susceptible to adverse reactions, health authorities have previously warned.
Several thousand people who were vaccinated mid-month also experienced minor “health impact events”, according to the CDC. Some people were unable to work, perform other daily activities or required medical care. Symptoms, which included nausea, light-headedness or headaches, typically subside within a day, and are a manifestation of the body’s robust immune response to the vaccine, medical experts said.
Reaching all Americans?
Nationwide, nearly 340,000 people have died from the virus, according to the CDC. Yet, a significant number of Americans are hesitant to roll up their sleeves and have the vaccine.
Black Americans, who suffered alarmingly disproportionate infection and death rates throughout the pandemic in New York and across the country, are particularly wary.
Only 49 percent of Black Americans said they were planning on taking the vaccine, compared with 63 percent of white Americans, and 61 percent of Latinos, according to polling by Reuters/Ipsos this month.
A lack of Black vaccine trial participants and public health figures, historically unaddressed racial disparities in medicine, as well as a grave lack of trust in the public health system, have contributed to vaccine scepticism in many of America’s communities of colour, according to some experts.
“This mistrust is real based on the disparities that we see today,” said Virginia C Fields, founder and CEO of the National Black Leadership Commission on Health.
For 40 years, the federal government experimented on hundreds of Black men in Alabama, who had contracted syphilis, without their informed consent. Neither proper care nor treatment was provided. Many died or went blind or insane. The Tuskegee Experiments, as they became known, were discontinued in the 1970s following widespread condemnation. However, such atrocities, as well as ongoing racial disparities in medicine, have sown a grave generational distrust in federal health initiatives among Black Americans.
“Blacks are disproportionately impacted by diseases that make Blacks more vulnerable to COVID,” Fields added. “Very little has been done to arrest these conditions.”
At the peak of the pandemic’s first wave back in the spring, Manhattan’s white, wealthy neighbourhoods such as Gramercy Park, clocked 31 deaths per 100,000 city-dwellers, according to data. In contrast, Far Rockaway, Queens, a majority Black and Latino neighbourhood – roughly an hour away by subway – recorded 444 deaths per 100,000 residents.
Fields, the former Manhattan borough president, said her organisation will be working closely with Black civic associations, faith leaders, tenant groups and city officials to amplify vaccine information and persuade Black New Yorkers to get their shots.
“Education is critical to this – period,” Fields said. “We need to have boots on the ground. We’ll be engaging people, block by block, building by building.”
If the city’s mass immunisation campaign falls short, a bill currently before the state senate, could make mandatory vaccinations the law, barring proof of a medical exemption. The proposed measure has triggered protests and fierce criticism among thousands of so-called vaccine rights advocates in the city and neighbouring counties.
‘I’m not going to allow COVID to win’
This spring, Arlene Ramirez’s entire family was stricken by the coronavirus. The coughing spells were so brutal, the Queens nurse, 44, said, she often pictured her own death.
“It was two weeks of hell. I feared for my life.”
In April, her elderly father, a retired jeweller, died of COVID. The 82-year-old spent 36 days in critical care before he was taken off life support.
“He put up a very good fight,” Ramirez said.
Ramirez was one of the first New Yorkers to receive the Moderna vaccine. She got the shot on December 21.
Despite any immunity her body may have developed following her bout with the virus, the 44-year-old still opted to vaccinate out of caution.
“I’m not going to allow COVID to win the war on my life,” she said. “We don’t know what that immunity means to my body. I don’t want to die and I don’t want to go through that again.”
As Ramirez stared down the needle earlier this month, she thought of her father.
“The message is clear, don’t fear the vaccine,” Ramirez said. “We do need to be scared of COVID.”