Legislature(2019 - 2020)BY TELECONFERENCE

12/17/2020 09:30 AM House HEALTH & SOCIAL SERVICES

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09:35:22 AM Start
09:36:25 AM Presentation(s): Statewide Covid-19 Vaccination Plan
10:50:39 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Dept. of Health & Social Services: TELECONFERENCED
Statewide COVID-19 Vaccination Plan by
- Dr. Anne Zink, Chief Medical Officer, Dept. of
Health & Social Services
- Tessa Walker Linderman, Nurse Consultant,
Dept. of Health & Social Services
- Dr. Bob Onders, Medical Dir. of Community
& Health Systems Improvement, Alaska Native
Tribal Consortium
- Mat Bobo, Alaska Immunization Program Dir.,
Div. of Public Health, Dept. of Health & Social
- Heidi Hedberg, Dir., Div. of Public Health,
Dept. of Health & Social Services
-- Testimony <Invitation Only> --
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       December 17, 2020                                                                                        
                           9:35 a.m.                                                                                            
MEMBERS PRESENT                                                                                                               
Representative Tiffany Zulkosky, Chair                                                                                          
Representative Ivy Spohnholz, Vice Chair                                                                                        
Representative Matt Claman                                                                                                      
Representative Harriet Drummond                                                                                                 
Representative Geran Tarr                                                                                                       
Representative Sharon Jackson                                                                                                   
MEMBERS ABSENT                                                                                                                
Representative Lance Pruitt                                                                                                     
OTHER LEGISLATORS PRESENT                                                                                                     
Representative Sara Hannan.                                                                                                     
COMMITTEE CALENDAR                                                                                                            
PRESENTATION(S):  STATEWIDE COVID-19 VACCINATION PLAN                                                                           
     - HEARD                                                                                                                    
PREVIOUS COMMITTEE ACTION                                                                                                     
No previous action to record.                                                                                                   
WITNESS REGISTER                                                                                                              
ANNE ZINK, MD, FACEP, Chief Medical Officer                                                                                     
Central Office                                                                                                                  
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Co-provided a PowerPoint presentation,                                                                   
entitled "Alaska COVID-19 Vaccine Task Force."                                                                                  
TESSA WALKER LINDERMAN, DNP, RN, Nurse Consultant                                                                               
Office of Substance Misuse and Addiction Prevention                                                                             
Alaska Department of Health & Social Services                                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Co-provided   a  PowerPoint  presentation,                                                            
entitled "Alaska COVID-19 Vaccine Task Force."                                                                                  
ROBERT ONDERS, MD, Medical Director                                                                                             
Community & Health Systems Improvement                                                                                          
Alaska Native Tribal Health Consortium                                                                                          
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Co-Provided   a  PowerPoint  presentation,                                                            
entitled "Alaska COVID-19 Vaccine Task Force."                                                                                  
MATTHEW BOBO, Director                                                                                                          
Alaska Immunization Program                                                                                                     
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:    Co-provided   a  PowerPoint  presentation,                                                            
entitled "Alaska COVID-19 Vaccine Task Force."                                                                                  
HEIDI HEDBERG, Director                                                                                                         
Division of Public Health                                                                                                       
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions  during the presentation.                                                             
ACTION NARRATIVE                                                                                                              
9:35:22 AM                                                                                                                    
CHAIR  TIFFANY  ZULKOSKY  called   the  House  Health  and  Social                                                            
Services  Standing  Committee  meeting   to  order  at  9:35  a.m.                                                              
Representatives   Claman  (via   teleconference),  Drummond   (via                                                              
teleconference),   Spohnholz  (via   teleconference),  Tarr   (via                                                              
teleconference),  and Zulkosky (via  teleconference) were  present                                                              
at  the  call  to order.    Representative  Jackson  arrived  (via                                                              
teleconference) as the meeting was in progress.                                                                                 
^PRESENTATION(S):  Statewide COVID-19 Vaccination Plan                                                                          
     PRESENTATION(S):  Statewide COVID-19 Vaccination Plan                                                                  
9:36:25 AM                                                                                                                    
CHAIR ZULKOSKY  announced that  the only  order of business  would                                                              
be a  presentation on the  statewide COVID-19 vaccination  plan by                                                              
the Department of Health and Social Services (DHSS).                                                                            
9:37:42 AM                                                                                                                    
ANNE  ZINK, MD,  FACEP,  Chief  Medical Officer,  Central  Office,                                                              
Division  of  Public  Health,  Department  of  Health  and  Social                                                              
Services,   drew  attention   to   slide  2   of  the   PowerPoint                                                              
presentation,  entitled  "Alaska   COVID-19  Vaccine  Task  Force,                                                              
which read as follows [original punctuation provided]:                                                                          
     ? Opening Remarks (Dr. Anne Zink)                                                                                          
     ? Overview of Vaccine Candidates (Dr. Anne Zink)                                                                           
     ? Alaska COVID-19 Vaccine Task Force                                                                                       
     (Tessa Walker Linderman)                                                                                                   
     ? ANTHC Partnership, Tribal Health Partner Work                                                                            
     (Dr. Bob Onders)                                                                                                           
     ? Phases & Allocations (Tessa Walker Linderman)                                                                            
     ? Ordering, Receiving, and Distribution (Matt Bobo)                                                                        
     ? Community Planning (Tessa Walker Linderman)                                                                              
     ? Vaccine Confidence (Dr. Anne Zink)                                                                                       
     ? Questions from the Committee                                                                                             
DR. ZINK  offered that all  the vaccine candidates  have undergone                                                              
rigorous study for  safety and efficacy.  She  then drew attention                                                              
to slide  4 of the presentation,  which read as  follows [original                                                              
punctuation provided]:                                                                                                          
     Vaccine Candidates  Pfizer                                                                                                 
     ? Authorized by FDA under an Emergency Use                                                                                 
     ? Final analysis 170 confirmed cases of COVID-19 were                                                                      
     evaluated, with 162 observed in the placebo group                                                                          
     versus 8 in the vaccine group; 95% effective against                                                                       
     COVID-19 7 days post dose 2                                                                                                
     ? Efficacy was consistent across age, gender, race and                                                                     
      ethnicity demographics; observed efficacy in adults                                                                       
     65 years of age was over 94%                                                                                               
     ? 43,000 participants; no serious safety concerns                                                                          
       -70 degrees Celsius storage                                                                                              
DR.  ZINK  added  that distribution  of  the  vaccine  is  closely                                                              
monitored  on an  ongoing  basis  and recalled  that  there was  a                                                              
report  of a  single adverse  reaction  recorded in  Alaska.   She                                                              
added  that   the  ultra-cold   temperature  storage   requirement                                                              
provides logistical  challenges, and that the vaccine  may only be                                                              
stored under refrigeration for up to five days.                                                                                 
DR. ZINK  explained that additional  information is  available and                                                              
contained in  publications and  drew attention  to slide 5  of the                                                              
presentation,   which  read  as   follows  [original   punctuation                                                              
     Publications for reference:                                                                                                
     The  FDA issued  an  emergency use  authorization  (EUA)                                                                   
     for the Pfizer                                                                                                             
     COVID-19 vaccine  on Dec 11, and the  Advisory Committee                                                                   
     Immunizations  Practices (ACIP)  voted to recommend  the                                                                   
     use of the                                                                                                                 
     Pfizer  COVID-19   vaccine  for  those  16   and  older.                                                                   
     Publications of note                                                                                                       
       Official MMWR release of "The Advisory Committee on                                                                      
     Immunization Practices'  Interim Recommendation  for Use                                                                   
     of  Pfizer-BioNTech COVID-19  Vaccine    United  States,                                                                   
     December 2020"                                                                                                             
     ? Pfizer-BioNTech  COVID-19 Vaccine  EUA Fact Sheet  for                                                                   
     and Caregivers                                                                                                             
       Pfizer-BioNTech  COVID-19 Vaccine  EUA Fact Sheet  for                                                                   
     ?  Pfizer-BioNTech   COVID-19  Vaccine  EUA   Letter  of                                                                   
DR.  ZINK  cited the  publication  on  slide  5 as  including  the                                                              
Advisory Committee  on Immunization Practices (ACIP)  which is the                                                              
advisory   entity  to  the   Centers  for   Disease  Control   and                                                              
Prevention (CDC)  and makes recommendations on who  should receive                                                              
the vaccine first.                                                                                                              
DR. ZINK  noted that additional  vaccines are scheduled  to become                                                              
available,  and referred  to slide  6 of  the presentation,  which                                                              
read as follows [original punctuation provided]:                                                                                
     Vaccine Candidates  Moderna                                                                                                
     ?   Submitted    for   Emergency   Use    Authorization;                                                                   
     happening this week                                                                                                        
     ?  Interim  analysis  95  cases  included  90  cases  in                                                                   
     group and 5 cases in vaccine group; vaccine efficacy                                                                       
     against COVID-19 was 94.1% 2 weeks post dose 2;                                                                            
     vaccine efficacy against severe COVID-19 was 100%                                                                          
     ? 30,000 participants; no serious safety concerns                                                                          
     ? On December 2, Moderna announced that it would soon                                                                      
     begin testing its coronavirus vaccine in children ages                                                                     
     through 17                                                                                                                 
       -20 Celsius storage                                                                                                      
     ? Information from manufacturer press release                                                                              
DR. ZINK  added that the Pfizer  and Moderna vaccines  are similar                                                              
to one another and are both   Messenger  Ribonucleic  Acid  (mRNA)                                                              
type  vaccines,  which  require   neither  a  live  virus  nor  an                                                              
attenuated virus,  but rather uses a small segment  of Ribonucleic                                                              
Acid (RNA)  which produces a  cleaner response with  fewer adverse                                                              
effects  to date.   She added  that, although  mRNA vaccines  have                                                              
not been widely used, they have been long studied.                                                                              
DR. ZINK highlighted  the information contained in  slide 7, which                                                              
read as follows [original punctuation provided]:                                                                                
     No steps are  skipped during the clinical  trial process                                                                   
     for  COVID19  vaccine.   Manufacturing  and  trials  can                                                                   
     happen at  the same time,  which speeds up  the timeline                                                                   
     for vaccines  to reach Alaska should once  authorized by                                                                   
     the FDA.                                                                                                                   
DR.  ZINK went  on  to explain  the  three phases  of  preclinical                                                              
trials.   Phase 1 tests the  safety [of the vaccine  candidate] in                                                              
a small  number of people;  phase 2 tests  hundreds of  people for                                                              
safety  and effectiveness;  and phase  3 consists  of testing  the                                                              
safety and  efficacy among  tens thousands of  people.   She noted                                                              
that Phase  3 had proceeded more  quickly than anticipated  due to                                                              
the  high  number  of  the  population   already  exposed  to  the                                                              
9:44:05 AM                                                                                                                    
DR. ZINK drew  attention to the information contained  in slide 7,                                                              
which read as follows [original punctuation provided]:                                                                          
     Vaccine Candidates                                                                                                         
     Safety is a top priority:                                                                                                  
     ? FDA scientists review all Vaccine                                                                                        
     Adverse Event Reporting System                                                                                             
     (VAERS) reports classified as                                                                                              
     ? CDC scientists will review VAERS                                                                                         
     reports for adverse events of                                                                                              
     special interest (AESI)                                                                                                    
     ? CDC and FDA coordinate on                                                                                                
     analysis of VAERS data and both                                                                                            
     agencies conduct data mining                                                                                               
DR.  ZINK  recounted  a  recent  adverse  reaction  as  a  working                                                              
example  of the  successful  cooperation between  clinicians,  the                                                              
Food  & Drug  Administration  (FDA)  and the  CDC  to monitor  the                                                              
event for safety and reporting.                                                                                                 
DR. ZINK  directed  attention to  slide 9, which  read as  follows                                                              
[original punctuation provided]:                                                                                                
     Vaccine Candidates                                                                                                         
     According  to  current  federal   government  estimates,                                                                   
     Alaska's initial                                                                                                           
     allocations of vaccines could include:                                                                                     
     ? Pfizer: 35,100 doses                                                                                                     
     ? Moderna: 26,800 doses                                                                                                    
     These  vaccine  doses  will   be  distributed  statewide                                                                   
     among public, private                                                                                                      
     and Tribal health systems.                                                                                                 
     The current  authorization for  the vaccine is  under an                                                                   
     EUA, which is                                                                                                              
     different  than   a  normal  vaccination   authorization                                                                   
     under a biological                                                                                                         
     license.  There are  specific  rules related  to an  EAU                                                                   
     that arguably limit                                                                                                        
     the ability of an employer to mandate a vaccination.                                                                       
     ? Complex Question    we do not provide  legal advice to                                                                   
     agencies, individuals                                                                                                      
     ?  Governor  Dunleavy has  indicated  that he  will  not                                                                   
     mandate a                                                                                                                  
     vaccination for Alaskans                                                                                                   
DR.  ZINK explained  that Alaska  is  coordinating with  Operation                                                              
Warp  Speed to  obtain the  state's entire  December 2020  vaccine                                                              
allocation,  rather than  on a  weekly  basis, due  to the  unique                                                              
logistical  challenges posed  in  Alaska.   She  noted that  these                                                              
allocations  are decided  by the  federal  government and  include                                                              
those  allocated through  the Indian  Health Service  (HIS).   She                                                              
added that  tribes are allowed to  choose to work either  with the                                                              
HIS  or  the   state  and  are  partnering  with   the  state  for                                                              
distribution logistics.   She added  that the vaccine  is approved                                                              
for use under  an Emergency Use Authorization (EUA)  rather than a                                                              
full authorization due to the status of the pandemic.                                                                           
9:47:43 AM                                                                                                                    
TESSA  WALKER LINDERMAN,  DNP,  RN,  Nurse Consultant,  Office  of                                                              
Substance Misuse  and Addiction  Prevention, Alaska  Department of                                                              
Health  &  Social  Services,  drew attention  to  slide  11  which                                                              
depicts  the  organizational  structure  of  the  Alaska  Covid-19                                                              
Vaccine Task  Force.  The Task  Force consists of eight  teams co-                                                              
led  by  the  Alaska Department  of  Health  and  Social  Services                                                              
(DHSS) and  the Alaska  Native Tribal  Health Consortium  (ANTHC):                                                              
planning,  operations,   software  solutions,   payers,  pharmacy,                                                              
education,  data, and  liaisons.   She  noted that  the full  team                                                              
consists of approximately 50 individuals.                                                                                       
9:49:09 AM                                                                                                                    
ROBERT ONDERS,  MD, Medical Director,  Community &  Health Systems                                                              
Improvement,  Alaska Native  Tribal  Health Consortium,  applauded                                                              
the efforts  of the  task force  in its  coordinated efforts  with                                                              
the  Indian  Health  Service,  the State  of  Alaska,  ANTHC,  and                                                              
regional  tribal associations  to  begin vaccine  distribution  in                                                              
Alaska communities.   He  noted that  many anticipated  challenges                                                              
with  logistics  and  government-to-government  coordination  were                                                              
mitigated  through existing  infrastructure such  as the  Vaccines                                                              
for Children Program  and proactive communication  and advocacy on                                                              
the part of the task force.                                                                                                     
9:52:00 AM                                                                                                                    
MS.  WALKER LINDERMAN  referred  to  slide 14,  entitled  "Vaccine                                                              
Availability  Phases," which  depicts  the current  status of  the                                                              
vaccine as  having gone from  the phase  of "No Vaccine"  to "Very                                                              
Limited  Availability" and  the  ultimate future  goal of  "Widely                                                              
Available".  She  then directed attention to slide  15, which read                                                              
as follows [original punctuation provided]:                                                                                     
     Vaccine Allocation  Federal                                                                                                
        ? CDC Advisory Council on Immunization Practices                                                                        
     approved the following recommendation by majority                                                                          
     (13-1) vote at its December 1, 2020 emergency meeting                                                                      
     When a COVID-19 vaccine is authorized by FDA and                                                                           
     recommended by ACIP, vaccination in the initial phase                                                                      
     of the                                                                                                                     
       COVID-19 vaccination program (Phase 1A) should be                                                                        
     offered to                                                                                                                 
     both 1) health care personnel and                                                                                          
     2) residents of long-term care facilities                                                                                  
     ? More information:                                                                                                        
MS. WALKER LINDERMAN shared with the committee the information                                                                  
contained on slide 16, which read as follows [original                                                                          
punctuation provided]:                                                                                                          
     Vaccine Allocation  Federal                                                                                                
     Further CDC Advisory Council on Immunization Practices                                                                     
        ? Healthcare personnel (HCP) with direct patient                                                                        
     -Unable to telework                                                                                                        
     -Including those who work in inpatient, outpatient,                                                                        
     or community settings                                                                                                      
     -Provide services to patients or patients' family                                                                          
     -Handle infectious materials                                                                                               
      ? HCP working in residential care or long-term care                                                                       
      ? HCP infected with COVID-19 within the preceding 90                                                                      
     days may                                                                                                                   
         choose to delay vaccination for other HCP more                                                                         
     susceptible to                                                                                                             
        ? No current data to inform recommendations for                                                                         
     pregnant or                                                                                                                
     breastfeeding women                                                                                                        
MS. WALKER LINDERMAN continued with the presentation of                                                                         
information depicted on slide 17, which read as follows                                                                         
[original punctuation provided]:                                                                                                
     Vaccine Allocation  Federal                                                                                                
     Further CDC Advisory Council on Immunization Practices                                                                     
     (ACIP) Recommendations:                                                                                                    
     ? Long-term care facility resident sub-groups                                                                              
     -Skilled Nursing Facilities                                                                                                
     -After Skilled Nursing Facilities:                                                                                         
     ?Assisted living facilities                                                                                                
     ?Intermediate care facilities for individuals with                                                                         
     developmental disabilities                                                                                                 
     ?Residential care facilities                                                                                               
     ?State Veterans Homes                                                                                                      
9:54:53 AM                                                                                                                    
MS.  WALKER   LINDERMAN   explained  that   the  Task  Force   has                                                              
communicated  to stakeholders  with an analogy  depicted  on slide                                                              
18, which read as follows [original punctuation provided]:                                                                      
     Vaccine Allocation  Analogy                                                                                                
     Decisions  on  who  gets initial  COVID-19  vaccine  are                                                                   
     nesting  dolls.  Each  layer   builds  on  the  previous                                                                   
     layer, and                                                                                                                 
     no layer stands on its own.                                                                                                
     The Alaska COVID-19 Vaccine  Task Force is working with                                                                    
     federal,   state,   Tribal,  military,   and   community                                                                   
     partners to                                                                                                                
     plan for Alaska's needs.                                                                                                   
MS.  WALKER LINDERMAN  explained that  in order  to meet  Alaska's                                                              
unique needs, federal  guidance on vaccine distribution  was taken                                                              
into consideration  and tailored  to those  needs as described  on                                                              
slide 19, which read as follows [original punctuation provided]:                                                                
     Vaccine Allocation  Alaska                                                                                                 
     The Alaska COVID-19 Vaccine Allocation Advisory                                                                            
     Committee meets regularly. It unanimously determined a                                                                     
     portion  of the people  that will  be included in  Phase                                                                   
     ?  Hospital  based  front-line health  care  workers  at                                                                   
     risk for COVID-19 infection                                                                                                
     ?  Long-term care  facility  residents  and staff  (also                                                                   
     Skilled Nursing Facilities, Assisted Living Homes, and                                                                     
     Department of Corrections infirmaries providing care                                                                       
     that is similar to assisted living)                                                                                        
     ? EMS/fire personnel                                                                                                       
     ? Community Health Aides                                                                                                   
     ? Individuals who are required  to perform vaccinations                                                                    
     Input  for  the  committee   may  be  submitted:  Alaska                                                                   
     COVID19 Vaccine  Allocation Advisory Committee  meetings                                                                   
9:56:53 AM                                                                                                                    
MATTHEW BOBO, Director,  Alaska Immunization Program,  Division of                                                              
Public  Health, Department  of Health  and  Social Services,  drew                                                              
attention to the  map graphic on slide 21 which  depicts receiving                                                              
locations  for vaccines  which consist  of  the existing  Vaccines                                                              
for Children  Program and  the Alaska  Vaccine Assessment  Program                                                              
MR.  BOBO  shared slide  22  with  the  committee, which  read  as                                                              
follows [original punctuation provided]:                                                                                        
     Ordering, Receiving and Distributing Vaccine                                                                               
      COVID-19 vaccination providers may enroll in the CDC                                                                      
     COVID19 Vaccination Program administered by the Alaska                                                                     
     Immunization Program, a program within the Alaska                                                                          
     Department of Health and Social Services:                                                                                  
     As of December 11, 342 health care providers are fully                                                                     
MR. BOBO  added that  360 providers are  enrolled in  the Vaccines                                                              
for Children  Program.   He shared  the information  on slide  23,                                                              
which read as follows [original punctuation provided]:                                                                          
     Ordering, Receiving and Distributing Vaccine                                                                               
       Integrated IT systems both public and private, as                                                                        
     well as new                                                                                                                
     and existingare needed to ensure successful vaccine                                                                        
     allocation, distribution, administration, monitoring,                                                                      
MR. BOBO explained  that there exists Fast Track,  an immunization                                                              
information system,  and additional systems are  being implemented                                                              
for scheduling and data tracking.                                                                                               
MR.   BOBO  explained   that   there   are  64   federal   vaccine                                                              
jurisdictions,  and   the  CDC  has  provided  the   guidance  for                                                              
jurisdictions  detailed  on  slide   23,  which  read  as  follows                                                              
[original punctuation provided]:                                                                                                
     Ordering, Receiving and Distributing Vaccine                                                                               
      Jurisdictions are not advised to purchase ultra-cold                                                                      
     equipment at this time:                                                                                                    
     ? Ultra-cold vaccine will be direct shipped from the                                                                       
     manufacturer in coolers that are packed with dry ice                                                                       
      ? Direct shipments to the vaccination provider site                                                                       
     will be in                                                                                                                 
     975-dose increments on a real-time, day to day basis                                                                       
     Ultra-cold  vaccine arriving  at  Alaska Native  Medical                                                                   
10:00:38 AM                                                                                                                   
MS. WALKER  LINDERMAN introduced  the community  planning  item on                                                              
the  agenda.     She  explained  that  the   Technical  Assistance                                                              
Advisors  (TAAs)on  slide  26  consist   of  the  focus  areas  of                                                              
hospitals, long  term care  facilities, pharmacies,  and community                                                              
health  centers,  and  they provide  assistance  in  preparing  to                                                              
receive the vaccine.   She shared the responsibilities  of TAAs as                                                              
outlined   on  slide   27,  which   read   as  follows   [original                                                              
punctuation provided]:                                                                                                          
     Community Planning  TAA                                                                                                    
     Technical Assistance Advisor (TAA) Responsibilities:                                                                       
     Assess planning progress                                                                                                   
     Provide individualized outreach and support                                                                                
     Provide updated information                                                                                                
     Assist with problem solving, provide resources                                                                             
     Engage in regular communication                                                                                            
     Support THE COMMUNITY's planning efforts                                                                                   
MS WALKER  LINDERMAN shared  the list  of community entities  with                                                              
whom the task force  and TAAs are coordinating on  slide 28, which                                                              
read as follows [original punctuation provided]:                                                                                
     Community Planning  TAA                                                                                                    
     Technical Assistance Advisors (TAA's) Serve as                                                                             
     Task   Force   Point-of-Contact    for   the   Following                                                                   
     Public Health Center Pharmacies                                                                                            
     Regional  Emergency  Preparedness  Home  Health/In  Home                                                                   
     Care Agencies                                                                                                              
     Emergency Management Law Enforcement                                                                                       
     Local    Government    Leadership    Agencies    Serving                                                                   
     Individuals with Disabilities                                                                                              
     Tribal Leadership EMS                                                                                                      
     Hospitals    Agencies   Serving   People    Experiencing                                                                   
     Community Health  Clinic (FQHCs, etc.,.) Long  Term Care                                                                   
     Tribal  Health  Organizations  Agencies  Serving  People                                                                   
     Critical Industry Partners                                                                                                 
MS  WALKER   LINDERMAN  then   listed  the  identified   community                                                              
planning  TAA   regions  as  Southcentral,   Interior,  Southeast,                                                              
Northern, and the Municipality of Anchorage.                                                                                    
10:03:45 AM                                                                                                                   
DR.  ZINK  introduced   the  final  agenda  item   listed  in  the                                                              
presentation on Vaccine  Confidence.  She suggested  that while an                                                              
efficacious may be  available, any vaccine will  only be effective                                                              
if  the State  is able  to  distribute it  safely  and people  are                                                              
willing to  take the  vaccine.  She  emphasized the  importance of                                                              
information and  outreach efforts.   She referred  to slide  31 as                                                              
an  example   of  a   public  service   announcement  to   aid  in                                                              
appropriate  messaging.    She directed  attention  to  slide  32,                                                              
which read as follows [original punctuation provided]:                                                                          
     ? Regular updates: Learn about vaccine availability                                                                        
         ? Communications tools: Weekly updated written                                                                         
        you can use to discuss COVID-19 vaccine in your                                                                         
         ? Learning opportunities: Weekly Thursday 2 PM                                                                         
       publicly-available virtual learning opportunity to                                                                       
     stay informed about                                                                                                        
     planning, distribution and vaccine science                                                                                 
        ? Planning resources: Healthcare stakeholder and                                                                        
     partner resources                                                                                                          
10:05:55 AM                                                                                                                   
CHAIR ZULKOSKY  referenced slide 19, entitled  "Vaccine Allocation                                                              
  Alaska"  and asked  how the  task force  has accommodated  rural                                                              
communities,  stating  that  there  is a  lack  of  professionally                                                              
trained personnel to perform vaccinations.                                                                                      
10:06:54 AM                                                                                                                   
MS.  WALKER LINDERMAN  answered  that in  addition  to the  people                                                              
listed on  the slide as included  in Phase 1A, allocation  is made                                                              
to tribal  organizations, and  she suggested  that the  analogy of                                                              
nesting dolls  on slide 18 depicts  the multiple levels  that will                                                              
be   engaged  in   vaccine  delivery   and   distribution.     She                                                              
acknowledged  that  many  unique  circumstances  exist  throughout                                                              
rural  communities  and  those  will continue  to  be  taken  into                                                              
10:08:06 AM                                                                                                                   
CHAIR ZULKOSKY sought  to clarify regarding vaccine  allocation if                                                              
the  vaccine  received  by  hospitals  will  be  distributed  with                                                              
flexibility considering the availability of trained personnel.                                                                  
MS.  WALKER LINDERMAN  noted  that the  task  force is  requesting                                                              
facilities  to  follow  federal  and  state  guidelines  with  the                                                              
understanding  that  the circumstances  are  continually  changing                                                              
and  stated that,  for  example, additional  doses  of the  Pfizer                                                              
vaccine were  found to  be available  in the  vials, and  the task                                                              
force  recommended that  communities evaluate  and distribute  the                                                              
extra  doses based  on  what is  best  for their  own  communities                                                              
while taking into consideration the prescribed guidelines.                                                                      
10:09:39 AM                                                                                                                   
CHAIR ZULKOSKY  inquired  when the recommendations  for Phase  1B,                                                              
expected to  result from a meeting  of the CDC  Advisory Committee                                                              
on  Vaccination Practices  scheduled  to take  place December  19,                                                              
2020, should be implemented by the State.                                                                                       
10:10:03 AM                                                                                                                   
DR.  ZINK indicated  that they  would  be implemented  as soon  as                                                              
possible,  considering supply  and what groups  should be  served.                                                              
She  noted that  the  tiered approach  to  prioritizing groups  is                                                              
regularly  reevaluated.   She allowed that  the circumstances  are                                                              
challenging due to limited supply.                                                                                              
CHAIR ZULKOSKY asked  whether the Phase 1B  implementations should                                                              
take weeks, or longer.                                                                                                          
DR.  ZINK conceded  that it  may  require weeks  to implement  the                                                              
recommendations and  will depend on  the clarity of  guidance that                                                              
emerges  from  the  CDC  and  how   it  should  comport  with  the                                                              
circumstances  in Alaska, and  considering science,  data, equity,                                                              
and logistical feasibility.   She added that people's  interest in                                                              
receiving the vaccine  is increasing and, accordingly,  the supply                                                              
would be diminished.                                                                                                            
10:13:11 AM                                                                                                                   
CHAIR  ZULKOSKY   asked  whether   the  task  force's   allocation                                                              
committee  was   taking  into  consideration,   regarding  vaccine                                                              
allocation during  Phase 1B, certain economic disparities  in very                                                              
rural locations,  such as multigenerational crowded  homes and the                                                              
lack  of   running  water  and   sewer  which,  when   compounded,                                                              
negatively  impact  communities   struggling  to  combat  a  viral                                                              
pandemic outbreak.                                                                                                              
DR.  ZINK   acknowledged  that   Alaska  Native  populations   are                                                              
disparately  affected  by  the  virus  with  hospitalizations  and                                                              
deaths.   She  added that  previous pandemics  and epidemics  have                                                              
also     disproportionately    affected     these     populations.                                                              
Furthermore,  in  addition  to   ethnic  disparity,  data  reveals                                                              
disparity  exists  among  socio-economic   and  healthcare  access                                                              
across the  country.   She stated  that access  to clean  water is                                                              
healthcare.     She  stated  that   disparities  that   exist  are                                                              
acknowledged  prominently   throughout  the  national   and  local                                                              
conversations  and that  the hope  and the intent  is to  mitigate                                                              
these disparities.                                                                                                              
10:15:55 AM                                                                                                                   
REPRESENTATIVE  DRUMMOND  asked whether  vaccine  lots shipped  in                                                              
975  dose  packages   could  be  broken  down   and  redistributed                                                              
according  to  the  plan  for  communities  with  fewer  than  975                                                              
residents.  She  asked also whether doses in excess  of the tiered                                                              
priority  groups  may  be  distributed   to  other  members  of  a                                                              
10:17:16 AM                                                                                                                   
MS. WALKER  LINDERMAN stated that  the packages can and  are being                                                              
broken down  to appropriate  sizes for  the communities  receiving                                                              
them  and  reminded  the  committee   that  there  is  a  five-day                                                              
refrigeration  storage   window  also  taken   into  consideration                                                              
during distribution.                                                                                                            
10:18:42 AM                                                                                                                   
CHAIR   ZULKOSKY  added   that   she  had   observed   communities                                                              
functioning  as  regional hubs  and  that chartered  aircraft  are                                                              
being deployed  to ensure  that the  fragile vaccine is  delivered                                                              
strategically and timely.                                                                                                       
10:19:16 AM                                                                                                                   
REPRESENTATIVE  DRUMMOND  applauded  the coordinated  efforts  and                                                              
the clear answer to her question.                                                                                               
10:19:47 AM                                                                                                                   
REPRESENTATIVE  TARR  asked  how  broader  distribution  would  be                                                              
funded  and whether  it would be  equally available  to all  those                                                              
who wish to receive it.                                                                                                         
10:20:44 AM                                                                                                                   
HEIDI  HEDBERG, Director,  Division of  Public Health,  Department                                                              
of  Health and  Social Services,  stated  that coordination  among                                                              
communities,  DHSS,  and the  Division  of Homeland  Security  and                                                              
Emergency  Management will  be required  and broader  distribution                                                              
will  vary  depending  on  community  resources  available.    She                                                              
stated  that some  of the  logistical  and clinical  costs may  be                                                              
reimbursable  and  that the  vaccine  itself  is available  at  no                                                              
10:21:58 AM                                                                                                                   
REPRESENTATIVE TARR  added that the  annual flu vaccination  is an                                                              
example of successful free vaccine distribution.                                                                                
10:22:42 AM                                                                                                                   
REPRESENTATIVE  SARA  HANNAN,  Alaska  State  Legislature,  stated                                                              
that populations  in infirmaries  are listed  in the  distribution                                                              
tiers  and  asked  where  the  congregate   populations,  such  as                                                              
prisoner  populations,  are  listed  in  the  tiered  distribution                                                              
10:23:28 AM                                                                                                                   
DR.  ZINK acknowledged  the  importance of  addressing  congregate                                                              
populations  including  those  in multigenerational  homes.    She                                                              
stated  that the  staff  and patients  in  correctional and  other                                                              
facilities are listed  in the distribution tier  that is currently                                                              
underway  and   that  congregate   populations  are   among  those                                                              
demographics being  considered for  prioritization in  the ongoing                                                              
distribution scheme.                                                                                                            
10:24:33 AM                                                                                                                   
REPRESENTATIVE   SPOHNHOLZ  expressed   concern   that  there   is                                                              
sufficient  supply in  the first  batch to  fully vaccinate  Phase                                                              
1A.    She asked how  many people in  Alaska meet the  criteria to                                                              
be vaccinated  under Phase  1A and  what the vaccination  schedule                                                              
would be for the next batch available.                                                                                          
10:25:07 AM                                                                                                                   
MS.  WALKER LINDERMAN  explained  that Phase  1A  consists of  two                                                              
tiers, and  a third tier  is in the  process of being  defined and                                                              
identified.    She  stated  that  tiers one  and  two  consist  of                                                              
approximately 25,000  people.  She added that 35,000  doses of the                                                              
Pfizer vaccine include  the 11,000 tribal allocation  and that the                                                              
Moderna vaccine  should be available  next week.  She  stated that                                                              
the Pfizer  and Moderna  vaccine supply  should accommodate  tiers                                                              
one and two  and that following  the vaccination of tiers  one and                                                              
two, distribution for tier three could potentially begin.                                                                       
10:26:33 AM                                                                                                                   
REPRESENTATIVE JACKSON  asked whether the  cost of the  vaccine is                                                              
known  and noted  that new  medications typically  cost more  when                                                              
they initially become available.                                                                                                
10:27:15 AM                                                                                                                   
MS. HEDBERG stated  that the federal government  has purchased the                                                              
vaccine and  ancillary supplies  on behalf of  the states  and the                                                              
cost   occurs   with   transportation   and   logistics   on   the                                                              
distribution of the  vaccine.  She added that  some clinical costs                                                              
may  be  reimbursable through  the  Federal  Emergency  Management                                                              
Agency (FEMA).   She explained that a primary goal  is to make the                                                              
vaccine available at little to no cost.                                                                                         
REPRESENTATIVE  JACKSON asked  whether data  concerning those  who                                                              
have  been tested,  those  who are  awaiting  test results,  those                                                              
awaiting vaccine,  and those who  have received the  vaccine could                                                              
be cross referenced.                                                                                                            
10:29:20 AM                                                                                                                   
MR. BOBO  stated that  VacTrAK is  the data  management system  in                                                              
place and that data can and will be shared with other systems.                                                                  
REPRESENTATIVE  JACKSON followed  up by noting  that there  may be                                                              
individuals awaiting  results and if  there exists the  ability to                                                              
access that data.                                                                                                               
MR. BOBO  answered that  when data  is available, cross  reference                                                              
is possible.                                                                                                                    
10:31:04 AM                                                                                                                   
DR. ZINK  added that  individuals  are not required  to be  tested                                                              
prior  to immunization.   She  added that  vaccination produces  a                                                              
more effective  immune response  than natural  infection  and that                                                              
individuals  who  have  contracted  the virus  are  encouraged  to                                                              
receive the  vaccine.   She added  that the  data systems  are not                                                              
configured  specifically  to  lookup  and compare  data  and  that                                                              
personally  identifying information  does not  accompany the  data                                                              
and is submitted voluntarily.                                                                                                   
10:31:50 AM                                                                                                                   
CHAIR  ZULKOSKY  asked Dr.  Zink  to  dispel myths  pertaining  to                                                              
adverse reactions,  to provide details of the  recently publicized                                                              
adverse  reaction  of  a  vaccine  recipient  in  Juneau,  and  to                                                              
provide information on what causes adverse reactions.                                                                           
DR. ZINK stated  that an allergic reaction occurred  in Juneau and                                                              
two other  similar reactions occurred  in England.   She explained                                                              
that the CDC  is monitoring and providing guidance  for monitoring                                                              
for adverse reactions.   She explained that while  the exact cause                                                              
of  adverse reaction  is  still under  investigation,  preliminary                                                              
thoughts  postulate  that  nanoparticles  that surround  the  mRNA                                                              
contains   structures   that   protect  the   mRNA   itself,   and                                                              
individuals  may  react  to  those.   She  stated  that  the  only                                                              
complete  contraindication  for  anyone  to  receive  the  vaccine                                                              
would be  for individuals  with known  reactions to components  of                                                              
the Pfizer  vaccine,  which consists  solely of  the mRNA  and the                                                              
nanoparticles afore  mentioned.   She added that  individuals with                                                              
known   reactions  to   injectable  medications   such  as   other                                                              
immunizations  are   monitored  for   a  longer  period   of  time                                                              
following  the  injection  to  screen  for  anaphylaxis  or  other                                                              
reactions.   She noted that the  single reaction in Juneau  is the                                                              
only severe adverse  reaction reported across the  entire country.                                                              
She  added  that  another  reaction resulted  in  swelling  of  an                                                              
individual's  eye that  was  successfully  treated with  Benadryl.                                                              
She  noted that  state and  federal organizations  and members  of                                                              
the healthcare  community  are in close  and timely  communication                                                              
to share  experiences and  report on any  adverse reactions.   She                                                              
stated  that to  her knowledge,  there  have been  only the  three                                                              
significant  adverse  reactions that  occurred  in  Alaska and  in                                                              
10:35:27 AM                                                                                                                   
CHAIR  ZULKOSKY  asked  how  many   doses  have  been  distributed                                                              
nationally over the last few days.                                                                                              
DR. ZINK replied  that data is available to track  vaccinations in                                                              
Alaska; however, national data is not yet available.                                                                            
10:36:22 AM                                                                                                                   
REPRESENTATIVE  DRUMMOND asked  when teachers  and school  faculty                                                              
and staff  will be vaccinated  considering schools  are attempting                                                              
to reopen  safely.  She stated  that Mt. Edgecumbe High  School, a                                                              
boarding  school  in  Sitka, has  been  open  since  approximately                                                              
August  and has  effective testing  and  mitigation strategies  in                                                              
place for  approximately 400 students,  and she expressed  concern                                                              
for other  schools at which  students coming  and going may  be at                                                              
higher risk for an outbreak.                                                                                                    
DR.  ZINK stated  that the  task  force has  a designated  liaison                                                              
working  directly with  schools and  districts to  assist them  in                                                              
planning,  testing, and  mitigation  strategies  to safely  reopen                                                              
schools.   She  acknowledged that  teachers and  school staff  are                                                              
classified  as  critical  infrastructure  and  are  not  currently                                                              
scheduled  for  vaccination.    She stated  that  the  vaccine  is                                                              
approved  for use  in children  age  16 and  up.   She added  that                                                              
after  the  first  tiers of  vaccination  recipients  receive  the                                                              
vaccine,   testing  and   other   mitigation   resources  may   be                                                              
redistributed.   She  added  that vaccination  is  one tool  among                                                              
several  in  public  health  to help  control  outbreaks  and  the                                                              
spread  of   the  virus,   and  redistribution   of  testing   and                                                              
mitigation  resources and  supplies  would  have positive  effects                                                              
among   high-risk  groups   that   are  not   yet  scheduled   for                                                              
10:39:51 AM                                                                                                                   
REPRESENTATIVE  TARR expressed  her  concern that  the public  may                                                              
become  overconfident  that the  vaccine  is available  and  cease                                                              
critical public  health measures, particularly due  to the holiday                                                              
season  and people  participating in  gatherings.   She asked  for                                                              
guidance and clear messaging on the same.                                                                                       
DR.  ZINK expressed  that  there  have been  many  cases and  many                                                              
deaths  throughout   the  country  and  in  Alaska.     She  urged                                                              
patience,  cooperation,  and  compliance  with  measures  such  as                                                              
masking and maintaining  physical distance.  She  drew the analogy                                                              
of the  pandemic as  like the  dark Alaska  winter and  that, with                                                              
time, both will end.                                                                                                            
10:41:40 AM                                                                                                                   
CHAIR ZULKOSKY stated  that her region has  had disproportionately                                                              
high  incidences of  infection  due  to factors  such  as lack  of                                                              
water  and  crowded,  multigenerational  households.    She  asked                                                              
whether  those   specific  factors  will  be   considered  ongoing                                                              
through the allocation development process.                                                                                     
DR.  ZINK  stated  that the  Alaska  COVID-19  Vaccine  Allocation                                                              
Advisory  Committee   is  actively   discussing  these   important                                                              
factors  not  solely  regarding  vaccination  but  also  regarding                                                              
other  public health  measures.   She noted that  there have  been                                                              
identified  delays  in  testing  and  treatment  options  and  the                                                              
vaccine  is a  critical  tool in  the  overall  management of  the                                                              
pandemic.   She  expressed gratitude  for the  cooperation of  the                                                              
officials in  the region  and expressed her  delight at  the long-                                                              
awaited arrival of the vaccine.                                                                                                 
CHAIR  ZULKOSKY  shared  her concern  of  observing  hospital  and                                                              
health  care workers  administering  care  with limited  resources                                                              
and many  basic needs  unmet and  expressed appreciation  that the                                                              
vaccine has arrived.   She asked for an explanation  of the status                                                              
of  the epidemiological  curve,  noting that  the  Yukon-Kuskokwim                                                              
Delta  region has  stayed in  the "exponential  growth" stage  for                                                              
some time.   She asked  where the state  overall is on  the curve,                                                              
taking into  consideration the hope  of the vaccine and  the risks                                                              
associated with people wishing to gather for the holidays.                                                                      
10:45:01 AM                                                                                                                   
DR. ZINK  stated that  hospitalization and  death rates  are still                                                              
unacceptably  high; however,  there  has been  a  decrease in  the                                                              
infection growth  rate, the  data for which  is under  scrutiny to                                                              
ensure  its accuracy  prior to  publicly  acknowledging the  fact.                                                              
She  attributed   the  slowed  rate  to  individuals   maintaining                                                              
distance and  wearing masks and,  conversely, when  those measures                                                              
are  not followed,  growth  rates increase.    She expressed  hope                                                              
that Alaskans remain  patient and committed to  slowing the growth                                                              
rate   through   individual  actions.      She  noted   that   the                                                              
reproductive  rate of the  virus has  dropped to  below 1  for the                                                              
first  time in  multiple  months,  but the  drop  in  the rate  is                                                              
fragile and depends on individuals' voluntary compliance.                                                                       
10:46:54 AM                                                                                                                   
CHAIR ZULKOSKY asked  Dr. Onders for an update  on capacity issues                                                              
in Alaska Native Medical Center (ANMC).                                                                                         
10:47:10 AM                                                                                                                   
DR.  ONDERS stated  that the  ANMC  critical care  unit (CCU)  has                                                              
been expanded by  bringing in additional staff and  equipment.  He                                                              
indicated that  the daily patient  average is slightly lower.   He                                                              
added that  higher acuity patients  exceed the number of  CCU beds                                                              
available.   He  noted  that the  pediatric  CCU  capacity is  not                                                              
exceeded  and can  be  used for  treatment  of  younger adults  if                                                              
needed.    He  expressed  his  cautious  optimism  and  hope  that                                                              
individuals continue  the mitigation strategies  including masking                                                              
and  social distancing,  to  help  stop the  spread  of the  virus                                                              
because the vaccine alone will not stop community spread.                                                                       
10:50:39 AM                                                                                                                   
There being  no further business  before the committee,  the House                                                              
Health  and  Social   Services  Standing  Committee   meeting  was                                                              
adjourned at 10:51 a.m.                                                                                                         

Document Name Date/Time Subjects
12.17.2020 COVID Vaccine DHSS House HSS Presentation.pdf HHSS 12/17/2020 9:30:00 AM
House HSS 12/17/2020