As Massachusetts prepares to adopt a new strategy to vaccinate nearly 900,000 children who could become eligible for COVID-19 shots in the coming months, public health officials are looking at an interim solution to a problem at least one drugmaker is working on: how to repackage vaccine vials into smaller bundles so that pediatricians can vaccinate patients in their offices.
So far, only the Pfizer vaccine has been authorized for people 12 years or older and authorization for its use in kids as young as 5 is expected this fall or winter. When it is available, the state's approach to vaccinating children is likely to focus on two primary channels of distribution: school-based clinics and pediatrician's offices, Health and Human Services Secretary Marylou Sudders told lawmakers during an oversight hearing Monday.
But right now, state and Pfizer officials said, it is not practical for a local pediatrician to order, store and administer a complete order of the Pfizer vaccine, which requires strict cold storage and must be used within hours of being thawed. The vaccine has been supplied in cartons with 195 vials, each vial containing enough vaccine for six shots, but Pfizer realized that won't work for the next phase of the vaccination effort, the drugmaker's senior medical director of its vaccines pipeline said Monday.
"We're working on a 25-pack, which will be available exclusively going forward in the next month or so. So the 195-pack will be unable to be ordered," Dr. Mary Moran said. "But we recognize that we even need to make smaller packs and so we are exploring that as well, doing whatever we can do on our end trying to listen to stakeholders and frontline immunizers to allow them to do their jobs."
Massachusetts officials have been among those pressing the federal government to fund the packaging of smaller bundles that could make it easier for primary care practices to vaccinate their patients, Sudders said Monday. Acting Public Health Commissioner Margret Cooke said DPH is working on its own plan in the meantime.
"We are currently working on a plan to make these doses smaller, so that [they] are packaged smaller," Cooke told lawmakers during an oversight hearing. "We now can work with our state lab to store and help out and to do 60 doses, but we are trying to make that even more accessible."
What Moran was less clear on, she said, is how the smaller 25-vial packs will get to local pediatricians' offices once they become available in early August.
"Right now it's not clear, how's it going to get to an office, right? It's been going to bigger centers, more like mass vaccination centers," she said, adding that a change in distribution patterns is something being considered at the federal level. "I don't have a good handle on how that transition is occurring."
Public health experts said Monday that schools and pediatricians are among parents' most-trusted sources of information and that it is important that doctor's offices have the vaccine on hand so patients and their families can get the shots as soon as they have a conversation with their doctor and decide to get vaccinated.
Dr. Lloyd Fisher, president of the Massachusetts chapter of the American Academy of Pediatrics, said making the vaccine available in the places where children and teens already receive care will be key to a successful vaccination push. He said he treats many teen and young adult males in his practice who are eligible and willing to get the vaccine when he discusses it with them in the exam room.
"However, when I tell them that I, unfortunately, don't have it in my office to give it to them at the time of their visit, and then encourage them to walk into one of the many options that do exist locally, I find that oftentimes the answer is, 'well, it's just a lot of work. I'll do it eventually.' " Fisher said. "We need to make vaccination as easy as possible and allow them to receive it whereever they are and not require them to go to a different location and go out of their way."