Vaccine questions answered: No cost, no ID required, and more

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You asked; we found answers. Last week, the News + Record fielded questions and concerns from Chatham’s Hispanic community members about the COVID-19 vaccines and the county’s distribution process. Reporter Victoria Johnson then posed these questions to Chatham County's health director, Mike Zelek, and Chatham Hospital's chief medical officer, Dr. Andrew Hannapel. Here's what they said, summarized. 

What fee, if any, will people have to pay to receive the vaccine? 

The vaccine is free to everyone who wants one. There is no cost, though some vaccine providers may bill your insurance if you have it.

"We, the health department, are not currently billing insurance for the administration of the vaccine, but providers are allowed to do that," Zelek told the News + Record. "But that would be a fee to the insurer."

Can I still receive the vaccine if I don’t have health insurance?

Yes. Everyone can get vaccinated with or without insurance, Zelek said, without paying any fee for the shot.

"If the individual is uninsured, they could be covered at the federal level by HRSA (U.S. Health Resources and Services Administration)," he said. "So all that to say, the individual should not be billed for the vaccine. ... Even if the provider is collecting insurance information, you say, “I’m uninsured,” they won’t turn you away."

Can undocumented immigrants receive the vaccine? What identification or information — if any — do sites vaccinating people require to get the shot?

Yes, undocumented immigrants can receive the vaccine. Providers don't require identification, including the health department and Chatham Hospital. People will, however, be asked to share basic information when signing up for the shot, including name, address, date of birth, ethnicity/race and contact information.

"We ask for your name, date of birth, race, and ethnicity to know to whom we are giving the vaccine," Hannapel said. "This tells us who is NOT getting the vaccine. We know that there is inequity in who is receiving the vaccine. Latino, Indigenous and Black people are not receiving vaccines in the same proportion to their representation in the general population."

The health department's vaccine registration form will also ask for prioritization information to determine someone's eligibility. For example: Are you 65 or  older?  

"For example, for us, if somebody came and met the eligibility criteria, say they were 65 and older, they can get the vaccine, period, end of story," Zelek said. "That shouldn’t be a limiting factor; they shouldn’t be concerned about sharing their information.

"(The form) also asks information about what arm the vaccine goes in, who administered it, things like that, but not documentation status," he added. "We want everybody to get vaccinated because ultimately, that’s what we believe in as a public health department (and as a) public health system."

There are a lot of vaccines — Moderna, Pfizer, and others coming in. Are some vaccines better than others, and how do people choose between them, if we can choose?

The only two vaccines that people can receive in the U.S. right now, Zelek said the Moderna and Pfizer vaccines because they've received Emergency Use Authorization from the FDA (Federal Drug Administration).

"They are very comparable," he said. " ... The way they work is very comparable; they’re both mRNA vaccines. They’re both very effective. Both have really high safety profiles as well."

"There is no significant difference between the Moderna and Pfizer vaccine," Hannapel agreed.

Both are around 94% or 95% effective in preventing infection; the only real differences, Zelek said, lie in their logistics, like how they're stored.

"I wouldn’t tell you one versus the other, other than where you’re able to get it because, of course, supply versus demand," he said. "Supply is very low versus the demand, which is very high. So I would encourage folks if they are eligible and interested in the vaccine, if they have the opportunity to get it, to take advantage."

The state allocates the doses to vaccine providers, he said, so people can choose their vaccines by choosing their providers. The Chatham County Public Health Department right now is receiving the Moderna vaccine, he said, and that's the vaccine they've been supplying their partners with as well.

"It just depends on the provider, what they are allocated from the state," he said. "We are getting the Moderna vaccine, and some other providers are getting the Pfizer vaccine."

Chatham Hospital and Piedmont Health Services only offer the Moderna vaccine, Hannapel said, which requires a second (booster) shot four weeks after receiving the first dose. The UNC-Chapel Hill Friday Center offers the Pfizer vaccine because it requires "ultra-low freezers to store the vaccine." Pfizer vaccines require a second shot three weeks after people receive the first one.

The CCPHD is currently receiving the Moderna vaccine. Might that change in the coming months?

It could, but Zelek said he hasn't received any indication yet that it would.

"Now, there are some vaccines that are out for Emergency Use Authorization, so if they do get approved, that could change," he said. "I don’t know what that will look like, but for now, all we have gotten to date, and all we are told we’re getting, is Moderna."

Should people still get vaccinated if they’ve already had COVID-19?

Yes. It's highly recommended, Zelek said, though he added that people should not get vaccinated if they have COVID-19 symptoms or are quarantining after potential exposure to the virus. 

"They’re still eligible," he said. "When you get the virus, you develop the antibodies, and the vaccine also leads you to develop antibodies that help your body respond if you are infected. There the thought is that the vaccine would have longer protection, a bigger antibody response, than just a virus."

It's possible to be re-infected with COVID-19, Hannapel added, so yes, those who have already had COVID should still get vaccinated.

"We do not know how long natural immunity lasts after having COVID-19," he said. 

The coronavirus has mutated and continues to mutate. How long can we expect vaccines to work against the virus and its variants?

No one yet knows for sure, Zelek said, because those studies are ongoing. The vaccines that we have now, though, he said, are expected to still be highly effective against the COVID-19 variant found in the United Kingdom. Companies are also working on booster shots for the future.

"So those are the things that we’re going to learn over time," he said. "I wouldn’t say that folks should say, “I’m not going to get the vaccine now because of it,” because there’s still very high efficacy, and there’s reason to believe that it is still quite effective against some of these variants, and maybe the others as well."

Good information indicates that the current vaccines protect against most variants, Hannapel said, though they seem to provide less protection against the South African variant.

"It is still being determined how much protection," he said. "The flu vaccine, depending on the year, is effective 35-60% of the time, and has been shown to save tens of thousands of lives, even more hospitalizations and serious illness."

Some community members have heard rumors of people dying or having allergic reactions after receiving the vaccine. Can you address these rumors? What are the most common side effects, and how many people are likely to experience them?

Be careful about where you get their information, Zelek warned.

"I know it can be alarming, and it’s tough to know, you know, 'Is this real? Is this not real?'" he said. "I would look to the scientific sources."

The health department offers information in both English and Spanish on its website  — information, he said, that comes from trusted sources, like the CDC, state and other scientific sources. Chatham Hospital also offers up-to-date vaccine information via yourshot.health or https://vaccine.unchealthcare.org/.

"That’s where I’d encourage folks to look for that information because sometimes those videos on Facebook or other sources, they may not paint the full picture,"  he said. "We’ve given over 1,500 first doses of vaccine, and strong reactions or severe reactions are very rare."

No one has died from receiving a COVID vaccine, Hannapel added, and vaccines do not cause any COVID infection.

"Serious allergic reactions (anaphylaxis) have occurred in 2.5 times per 1 million (Moderna) and 11 times per 1 million (Pfizer)," he said. "All were treated and no one died. 71% of these reactions occurred within 15 minutes of receiving the vaccine."

That's why vaccine providers observe patients for 15 minutes after vaccinating them, according to Hannapel and Zelek. If anyone has a history of severe allergic reactions to anything, doctors will observe patients for up to 30 minutes. 

"Those erratic reactions are rare," Zelek said. "We haven’t had anything that required hospitalization for us at this point."

The most common side effect, Zelek said, is soreness in your arm at the site of the shot, which he said wasn't "too unexpected, given you’re getting a shot in your arm." 

Other common side effects are tiredness and headache.

"Most common side effects are local to the vaccination site — discomfort, redness and swelling — that last for 2-3 days," Hannapel added. "Less common systemic side effects are fever, body aches and fatigue that last 24-48 hours. These reactions are more common after the 2nd vaccine."

What should people do if they have allergies? And what if they don’t have doctors to whom they can pose these questions?

If people have had serious allergic reactions (anaphylaxis), Zelek and Hannapel said they should speak with their health care providers to decide whether their risk of infection outweighs the risk of severe allergic reaction to the vaccine. 

If people don't have access to doctors, Zelek said they can call the Moderna helpline for advice (1-866-MODERNA or 1-866-663-3762). They could also call the health department's clinic, which has bilingual staff.

"If they're going through us, they call our clinic, and we would have our medical provider talk to them," he said. "And I'm sure that other medical providers would be willing to do that as well."

Some community members have heard of people who are currently not eligible but misrepresent their information on the online registration form and receive the vaccine anyway, when they show up for the appointment. Have you heard of any such incidents in Chatham? What measures does the Health Department have in place to prevent that?

Zelek and Hannapel told the News + Record that they hadn't heard of any such incident in Chatham County.

To determine eligibility, both providers ask people to self-identify as health care workers, long-term care residents and staff, or as adults 65 years or older, which Zelek said is by far their biggest group.

"We’re asking for their date of birth, and that would be our process to validate," he said. "We don’t require documentation. We don’t want that to be a barrier to folks. Is it possible that some have slipped through the cracks and misrepresented their information? Yes, it’s possible."

There's a reason, Zelek said, for prioritizing vaccines for certain groups first. Health care workers often work with COVID patients, and older adults have a higher risk of severe virus-related illness or death.

"It’s not done by me or the health department," he said. "It’s done by the federal level, and then the CDC and then North Carolina Department of Health and Human Services, and we’re required to follow it."

He can't say that people misrepresenting themselves to receive a vaccine hasn't been an issue at all, but neither does he "anticipate that we've had hundreds of people come through our clinics that have not fit the profile.

"We do have that process for data entry and then scheduling. Some may have come through," he said, "... but the Chatham community, I think, is a very understanding and honest community in my experience."

What do you do if you find out someone has misrepresented his or her eligibility, either before or after the appointment? Are there any consequences?

Right now, Zelek said, the health department has no mechanism to penalize ineligible people who jump in line.

"If we had strong evidence that somebody was not eligible for the vaccine, then we would follow the prioritization criteria, but I haven’t noticed a huge issue so far," he said. "... We just ask folks to be honest when they complete this information, and not just with us — with the other providers as well."

What kind of outreach attempts has the CCPHD made to Chatham’s Hispanic community to ensure everyone in that community who wants a vaccine can get one?

So far, the Health Department has been in conversations with the Hispanic Liaison and UNC Health to reach out to the Hispanic/Latinx community, build trust and vaccinate all those who want to be vaccinated.

"We’re working with our partners to get the vaccine out to the community, and we know that equity is a key piece of this," Zelek said. "The state has said it’s about speed and equity, and they’re beginning to allocate accordingly as well. And so for us, the partnerships are really key in terms of reaching folks, building trust in the vaccine and building access to it as well."

Their website is in Spanish, including their vaccine registration tool as well. Besides not requiring ID, the health department is also working with Chatham Transit to provide rides to their vaccination clinics for those without transportation.

"If somebody doesn't have a driver's license, for whatever reason, should that be the barrier to get a vaccine?" Zelek said. "I think most of us would agree that it shouldn't."

According to Hannapel, Chatham Hospital has interpreters available on their vaccine scheduling line (984-215-5485) and their vaccine appointment website is in both Spanish and English. They'll also be teaming up with Piedmont Health Service to help them vaccinate their patients, many of whom belong to historically marginalized communities.

"We are evaluating ways to reach out to Latino, Indigenous and Black communities that do not have access to the vaccine through online scheduling," Hannapel said. "We are looking at ways to work with our community partners like Piedmont Health Services and the Chatham County Public Health Department to aid in the vaccinations of the people of these communities and address the inequitable roll out of the vaccine."

Why has the county’s vaccine rollout been so slow? 

Like other counties across the state and the nation, Zelek said Chatham County's "limiting factor" right now is the limited supply of doses. 

"If we don't have the vaccine, we can't give the vaccine," he said, adding, "It's just that the allocation doesn't meet the demand right now. That's our challenge, and again, it's not unique to us as a county or as a health department as a provider."

Beyond limited supply, Hannapel said the rollout's also slow thanks to the "logistical difficulties" involved in mass vaccination of those most at risk of being infected with COVID-19.

Chatham Hospital, he said, uses all of the weekly first doses the state provides them; they don't hold any in reserve as second doses since the state ensures they receive the right amount for second doses when it's time to administer them.

"We are getting better with vaccinations," he added. "We are getting more people vaccinated and receiving increasing amounts from the state. We currently receive 400-550 vaccines/week for the first dose. We share some of these with Piedmont Health Services."

Will there be enough vaccines for everyone who wants them?

Yes, Zelek said, those no one knows precisely when and who will be able to receive the vaccine at what time.

"The state has made clear to us and to the public that there will be enough vaccines for everyone who wants one," he said, "but it will take time, and that’s what we’re seeing." 

The U.S government is purchasing additional doses to vaccinate another 300 million people with both doses, Hannapel said.

"It may take us until late summer to accomplish this," he said, "but we will do it!"

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