COVID-19 immunization

Coronavirus immunization includes efforts to design, manufacture and distribute vaccines to immunize the population against the SARS-CoV-2 virus which caused the COVID-19 pandemic.

Alabama began administering vaccines to critical health-care workers in December 2020 and to the elderly and residents in group settings in January 2021. Between February and April, additional groups of senior citizens and critical workers were allowed to schedule vaccine appointments. Verifying those qualifications was unevenly applied, and anecdotal reports suggest that the demand from younger, healthy adults contributed to scarcity and long waits. Increasing supply allowed the state to open vaccination to most adult residents in early April. The number of daily doses administered peaked at 44,171 on April 8. Adolescents in the 12-17 age group became eligible for the Pfizer vaccine series on May 13. On May 18 Alabama had the second-lowest statewide rate of immunization against COVID with only 35.2 of adult residents having completed their vaccines. By October 27 that figure had risen to only 44.5% and was third-lowest after Wyoming and West Virginia.

Vaccine research

UAB and Southern Research participated in early clinical studies of several vaccine candidates.

Research teams headed by Troy Randall of the UAB Division of Clinical Immunology and Kevin Harrod of the UAB Department of Anesthesiology and Perioperative Medicine joined with several researchers from the UAB Department of Microbiology in performing certain preclinical studies of an "AdCOVID" trial vaccine developed by Altimmune of Gaithersburg, Maryland. The potential vaccine, which would be administered by nasal injection, showed promising therapeutic results and advanced to Phase 1 safety trials in late 2020. Additional preclinical trials were conducted under UAB Department of Microbiology chair Frances Lund. The FDA placed a hold on Altimmune's Phase 2 trials on December 22 as it gathered more data about manufacturing. Approval for a small-scale human trial was granted in February.

Southern Research carried out pre-clinical studies of another vaccine candidate, a single-shot live modified horsepox virus vaccine dubbed TNX-1800, in partnership with Tonix Pharmaceuticals of Chatham, New Jersey. Raj Kalkeri of Southern Research's Infectious Disease Research Group led the study from SR's research facility in Frederick, Maryland. The company's Phase 1 trials concluded in November with positive results. Phase 2 trials with non-human primates concluded in March and also brought positive results. Human trials began in the third quarter of 2021. Kalkeri's team also studied the immune responses of individuals who had been exposed to SARS-CoV-2 and no longer showed symptoms.

Beginning in late July, UAB began enrolling volunteers for a portion of a larger human trial study of a vaccine candidate developed by Oxford University and Cambridge-based AstraZeneca. The research was led locally by Paul Goepfert. In September UAB began a clinical study of the effectiveness of tranexamic acid (TXA) in suppressing the virus' infectivity in patients with elevated levels of the extracellular protease plasmin due to comordities. Sadis Matalon and Timothy Ness were involved in developing the study.

Vaccine distribution

Birmingham superintendent of schools Mark Sullivan received his first dose of the vaccination at Parker High School on February 11, 2021. Photo by Erica Wright for The Birmingham Times.

"Vaccine doses administered per weekday in Alabama in 2020–2021". Chart by Ramsey Archibald for al.com.

Church sign offering COVID-19 vaccinations and free breakfast in November 2021

The cost of the vaccines is free to all Americans, though some service fees may be charged to insurers or reimbursed through the Health Resources and Services Administration's Provider Relief Fund.

In anticipation of the FDA's first Emergency Use Authorizations for vaccines developed by Pfizer and Moderna in early December 2020, the Alabama Department of Public Health began preparing to implement its distribution plans, prioritizing first-line workers in healthcare settings.

In early December state health officer Scott Harris announced that the state was set to receive 40,950 doses of the Pfizer vaccine for distribution to frontline health-care workers later that month. The initial shipment was just enough to vaccinate 20,475 of the state's 300,000 healthcare workers. Pfizer's first shipment of vaccines reached Alabama on December 15. The Birmingham VA Medical Center was the first to administer the vaccine in Birmingham, and Lee Elm Creel of Snowtown was the first to receive it there. On December 17 ADPH learned that a second expected shipment of 20,000 doses would not arrive, greatly reducing the number of healthcare workers who could be vaccinated early.

Moderna's vaccine candidate earned FHA emergency use authorization on December 18, with an initial shipment of 84,000 doses to Alabama on Monday, December 21 for distribution to healthcare workers.

The second group of vaccine candidates, including people over 75 years of age and those with comorbidities making them especially vulnerable to COVID-19, began receiving vaccinations on January 18. The state had been allotted 271,925 doses as of January 11. By January 22, 224,000 vaccine doses had been administered statewide and Alabama was receiving 50,000-60,000 doses per week. The restricted supply continued to hamper the progress of vaccination beyond the initial group.

UAB initiated a drive-through vaccination site at the parking deck for UAB Hospital-Highlands in January. Expansion of those efforts was limited solely by available supply of the vaccine. UAB opened two more large-scale drive-through vaccination sites at the Hoover Met and at Parker High School in early February as the Biden administration ramped up allotments to states. UAB expected to be able to deliver 17,000 doses per week. Wal-Mart and Sam's Club began administering vaccines at selected locations in the Birmingham area on February 19. Cahaba Medical Care opened a mass vaccination site at the Miles College gymnasium on March 25. The Federal Emergency Management Agency opened a mass vaccination site, staffed by Alabama National Guard personnel, at Watermark Place in Bessemer on April 21.

Another vaccine from Johnson & Johnson became available in late February. It had the advantage of being safe to store at refrigerator temperature and requiring only a single dose, promising to greatly increase the availability of immunization in poorly-served areas. With increased supply, most Alabamians not prioritized due to age, medical condition or critical worker status, began to have access to vaccination as early as April. The number of daily doses administered peaked at 44,171 on April 8. On April 28 the Jefferson County Sheriff's Office began offering vaccination to inmates in the Jefferson County Jail.

The FDA and CDC approved the emergency use of Pfizer's vaccine on those aged 12-17 and vaccination sites began immunizing people in that age group on May 13. With the reduced demand for vaccines, UAB closed its Hoover Met mass vaccination site on May 18 for the 2021 SEC Baseball Tournament, and did not reopen it. The Cathedral of the Cross site closed on May 28 and the Parker High School site closed on June 18. As the mass sites closed, some providers made plans for "pop-up" vaccine clinics in poorly-served communities. In June Birmingham City Schools partnered with Alabama Regional Medical Services to provide vaccinations to pupils aged 12 and over as well as their families. The UAB Division of Gerontology, Geriatrics and Palliative Care provided in-home vaccinations at no cost through its "House Calls" program.

As the numbers of cases, hospitalizations and deaths dropped, and official restrictions on public gatherings were lifted, the rate of vaccinations also plummeted.

With a spike in new cases driven by the SARS-CoV-2 B.1.617.2 "Delta" variant at the end of summer, some mass vaccination sites reopened. The Legion Field site reopened on August 4, offering tickets to future events at the stadium as an incentive. The Alabama Department of Corrections, whose inmate population and workforce already had a higher vaccination rate than Alabama as a whole, offered a $5 canteen credit for inmates who got vaccinated.

On August 28, 2021 Charles Barkley headlined a vaccine rally organized by the UAB Minority Health and Health Disparities Research Center at Legion Field. The event was promoted on social media with a "#StuckWithChuck" hashtag, and offered free t-shirts to the first 300 people to be vaccinated there. That Alabama Department of Public Health partnered with the Bruno Event Team to offer vaccinations during college football tailgating weekends, offering $75 gift cards redeemable for team merchandise.

President Biden announced plans to mandate vaccines for federal employees, and for all employees of large companies through the authority of the Occupational Safety and Health Administration. Some groups organized to oppose such mandates, and a great deal of misinformation about vaccine safety and efficacy spread through social media and in public meetings.

The CDC began recommending vaccinations for children 6 months old and above in June 2022.

Vaccine requirements

Large national employers including Disney, Google and Wal-Mart announced that they would require employees to show proof of vaccination or medical exemption. President Joe Biden also announced that all federal employees and contractors working in federal facilities would be required to be vaccinated. Other large employers in the Birmingham area that announced vaccination mandates include Ascension Health (St Vincent's Health System) and Tyson Foods.

During the 2021 Alabama legislative session, a bill sponsored in the Alabama State Senate by Arthur Orr prohibited government entities and private businesses from making vaccination a condition for providing access to facilities or services. The bill, signed into Act of Alabama No. 2021-493 by Governor Kay Ivey on May 24, does not prohibit requirements made by employers for their workers.

References

• Patchen, Tyler (July 13, 2020) "Covid-19 vaccine trial involving UAB shows promising results." Birmingham Business Journal
• Thornton, William (July 22, 2020) "Southern Research collaborating on COVID-19 vaccine tests." The Birmingham News
• Pillion, Dennis (July 24, 2020) "Alabama hospital seeking volunteers for COVID vaccine trial." The Birmingham News
• Patchen, Tyler (October 13, 2020) "More promising news for UAB vaccine efforts with Altimmune." Birmingham Business Journal
• Yurkanin, Amy (November 16, 2020) "COVID-19 vaccine in Alabama will be free, first doses could be available by December." The Birmingham News
• Patchen, Tyler (November 19, 2020) "Southern Research and Tonix make headway in Covid-19 vaccine." Birmingham Business Journal
• Whites-Koditschek, Sarah (December 6, 2020) "Here comes the vaccine. But will Alabamians take it?" The Birmingham News
• Yurkanin, Amy (December 15, 2020) "World War II veteran receives first COVID-19 vaccine in Birmingham." The Birmingham News
• Stanley-Becker, Isaac; Yasmeen Abutaleb; Lena H. Sun; & Josh Dawsey (December 17, 2020) "States report confusion as government reduces vaccine shipments, while Pfizer says it has ‘millions’ of unclaimed doses." The Washington Post
• Whites-Koditschek, Sarah (December 18, 2020) "Alabama shorted 20,000 vaccines in next week’s shipment, say feds cut allotment." The Birmingham News
• "U.S. FDA puts early-stage trial of Altimmune's COVID-19 vaccine on hold." (December 23, 2020) Reuters
• "'The vaccine is coming': Alabama health officials call for patience amid slow rollout." (January 6, 2021) Associated Press / The Birmingham News
• Gore, Leada (January 11, 2021) "COVID vaccine update: 41,778 vaccines given in last week in Alabama, online scheduling portal opens." The Birmingham News
• Pillion, Dennis (January 17, 2021) "UAB launches drive-through COVID vaccine, shifts focus to 75+." The Birmingham News
• Sharp, John & Ivana Hrynkiw (January 27, 2021) "Alabama’s problematic COVID-19 vaccine program leads to a rise of vaccine tourism." The Birmingham News
• Yurkanin, Amy (January 30, 2021) "UAB opening two larger sites for more COVID-19 vaccinations in Birmingham area." The Birmingham News
• Yurkanin, Amy (February 2, 2021) "First large-scale COVID-19 vaccination sites open in Alabama." The Birmingham News
• Whites-Koditschek, Sarah (February 5, 2021) "UAB aims to expand vaccinations by the thousands in weeks ahead." The Birmingham News
• Wright, Erica (February 11, 2021) "COVID-19 vaccinations begin at A.H. Parker High School in Birmingham." The Birmingham Times
• Patchen, Tyler (February 17, 2021) "Altimmune and UAB vaccine candidate approved to begin clinical trail." Birmingham Business Journal
• Fulmore, Miranda (March 4, 2021) "UAB and JeffCo to Expand Vaccine Outreach in Underrepresented Communities." WBHM / BirminghamWatch
• Carter, Robert (March 9, 2021) "Gov. Ivey Calls Out Alabama National Guard to Help with Vaccination Push." BirminghamWatch
• Patchen, Tyler (March 22, 2021) "Southern Research, Tonix Pharmaceuticals make headway on Covid-19 vaccine." Birmingham Business Journal
• Whites-Koditschek, Sarah (March 30, 2021) "Alabama’s vaccine rollout again ranks dead last, CDC says." The Birmingham News
• Patchen, Tyler (April 19, 2021) "FEMA to establish vaccination center in Bessemer." The Birmingham News
• Love, Michelle (May 13, 2021) "As Demand Drops, Health Officials Look For Ways To Encourage Vaccinations" BirminghamWatch/WBHM.org
• Yurkanin, Amy (May 17, 2021) "Facing plunging demand for COVID shots, Alabama vaccine sites plan closures." The Birmingham News
• Archibald, Ramsey (May 18, 2021) "35 percent of Alabama adults vaccinated for COVID-19, but shots have slowed by more than half." The Birmingham News
• Hall, Mary Helene (June 4, 2021) "Birmingham City Schools providing COVID-19 vaccines to students, their families." The Birmingham News
• Archibald, Ramsey (July 3, 2021) "Forget July Fourth deadline, Alabama unlikely to hit Biden’s vaccination goal anytime this year." The Birmingham News
• Prickett, Sam (July 20, 2021) "Offering a Carrot Won’t Get People Vaccinated, Maybe It’s Time to Talk About the Stick, Health Official Tells Birmingham Council." BirminghamWatch
• Koplowitz, Howard (July 23, 2021) "State enticing inmates to get COVID-19 vaccination with $5 canteen credit." The Birmingham News
• Flanagan, Ben (July 24, 2021) "‘I’ve never been as frustrated professionally as I am right now’, UAB doctor says about low vaccination rate." The Birmingham News
• Iannetta, Jessica (July 27, 2021) "New Jersey pharma company to purchase R&D facility from Southern Research." Baltimore Business Journal
• Yurkanin, Amy (August 3, 2021) "Two large Alabama hospitals require all staff and volunteers get COVID-19 vaccinations." The Birmingham News
• Koplowitz, Howard (August 4, 2021) "Legion Field vaccination site to open Thursday due to ‘unprecedented demand’." The Birmingham News
• Yurkanin, Amy (August 5, 2021) "Mass vaccination site in Birmingham adds extra hours as demand rises." The Birmingham News
• Pillion, Dennis (August 19, 2021) "Charles Barkley to lead Birmingham COVID vaccine rally; blames unvaccinated ‘idiots’ for lockdowns." The Birmingham News
• Tesfaye, Eva (September 2, 2021) "Health Officials Launch New Vaccination Initiative For College Football Fans, Urge Precautions For Labor Day." WBHM.org
• Cason, Mike (October 28, 2021) "‘Save our Jobs’ rally calls for more Alabama resistance to Biden vaccine mandates." The Birmingham News

External links

• Vaccines.gov appointment-finding site