Submitted by San Juan County.

When the public health emergency declaration ended on May 11, 2023, that marked the shift in the COVID-19 response from a public health response effort to a privatized medical management model. The 2023-24 COVID-19 vaccine was approved on Sept. 11 by the Federal Drug Administration for all individuals over 6 months of age, staying consistent with influenza vaccine recommendations. It is the first COVID-19 vaccine roll out under the more traditional private provider model.

The biggest change in this vaccine rollout is that the federal government is no longer purchasing and providing the vaccine at no cost to providers. Now, individual providers are responsible for purchasing their own supply of the COVID-19 vaccine through the manufacturer and must seek reimbursement through insurance companies.

In general, most medical provider organizations across the state are not currently ordering vaccine for their patients. This is in large part due to the uncertainty of cost reimbursement from insurance companies. We hope that medical provider organizations across the state and within the county will be able to offer the vaccine to their patients once reimbursement rules are amended (which happens after FDA approval).

At this time, our local pharmacies are preparing to provide some vaccinations when the vaccine is available. For the most up-to-date information, please check your local pharmacy’s website directly. For Ray’s Pharmacy, please go to https://orcasrx.com. To learn about Lopez Pharmacy’s plans, please visit their website at https://lopezislandpharmacy.com. For Friday Harbor Drug, you may find updates on their plans at https://fridayharbordrug.com. This information may change over time, and we’ll do our best to update our website with local options.

Large pharmacies on the mainland are expected to receive their vaccine orders first. Those who can travel to the mainland may do so to receive their vaccine earlier than may be available locally. Large retail pharmacies can also bill insurance for the COVID-19 immunization.

Here at Health & Community Services (HCS), we are unsure if we will be able to provide mass vaccination clinics as we have in the past due to a number of developments. Since HCS is not an in-network provider for any insurance and operates outside of the traditional medical billing system, all the vaccine that we would purchase would be at our own expense. Despite our efforts to reduce the cost, we anticipate that we would have to spend over $100 per dose of vaccine. This is on top of the expense of running mass vaccination clinics, which includes ensuring that we have qualified professionals, supplies to ensure safe administration of the vaccine, and space rented out to hold the clinics.

We had hoped to be able to bridge the COVID-19 vaccine availability gap by providing mass vaccination clinics this fall as insurance matters were sorted out, but our plans have hit several roadblocks. The funding from the State, which we were relying on to purchase the vaccine, is no longer on the table – something we learned only Monday, Sept. 11. We have placed an appeal with the State, and are continuing to search for new, unrestricted funding to bridge the gap. Until we can secure funding for the vaccine, all our mass clinic plans are on hold indefinitely.

We anticipate that we will receive a very limited supply of the COVID-19 vaccine directly from the Washington State Department of Health through the Vaccines for Children (VFC) program and the Adult Vaccine Program (AVP). These vaccines will only be available to children through the age of 18 years and to adults who are uninsured, similar to our other vaccine programs (e.g., influenza). Again, supplies will be very limited. We anticipate that the pediatric vaccines we receive will be available for children 5 to 18 years. When they are available for younger children, we will be able to provide the vaccine for them as well.

Another important development that occurred on Sept. 11 s that the bivalent COVID-19 vaccine has been discontinued for all providers. This means that HCS has no ability to give the COVID-19 mRNA vaccine until the new vaccine arrives. We do not have an ETA for our limited supply of the updated COVID-19 mRNA vaccine at this time. We are still currently able to offer the Novavax vaccine as a 2 dose primary series for individuals 12 years of age and older who have not yet received any other COVID-19 vaccines. We can provide Novavax as a one-dose booster for individuals 18 years and older who have not already received a bivalent mRNA booster dose. (The FDA has only approved one Novavax booster dose.)

For those curious about the status of other seasonal vaccines, influenza (flu) and Respiratory Syncytial Virus (RSV), we are able to provide an update on those as well. HCS is offering the influenza vaccine to all children and adults who are uninsured or underinsured in November. Adults with insurance should contact their medical provider or their local pharmacy to schedule their flu shot. You can also get flu vaccines from one of the large retail pharmacies on the mainland. We are not currently able to offer the RSV vaccine. We will message publicly if this changes. Those interested in the RSV vaccine should contact their medical provider, a local pharmacy, or look to receive the vaccine on the mainland.

In conclusion, we understand that this massive shift from an emergency public health response to a privatized model and that it will limit local options, particularly while we are in this uncertain transition period. We are hopeful that amended insurance agreements with medical provider organizations will enable more local entities to provide vaccine for their patients in the future.

The continuous lesson from COVID-19 is how resilient islanders are. Nothing about the COVID-19 response has been easy or simple, and yet we have persevered as a county and as a community.