Alaska’s geography poses unique challenge in getting COVID-19 vaccine, treatments to rural areas

A health care provider places a band-aid on the injection site of a patient who just received a flu vaccine. (Lauren Bishop/CDC)

New COVID-19 treatments and vaccines are on the horizon nationwide, and for Alaska.

The two leading COVID-19 vaccines could hit the state next month. And monoclonal antibody infusions — a treatment received by President Donald Trump when he was hospitalized with COVID-19 — have already arrived in small numbers.

But health-care providers face unique challenges in distributing those medicines across Alaska, with its hundreds of communities that lack road access and hospitals.

The antibody treatments have been shown to reduce hospitalizations among at-risk patients. But they’re given through an IV and similar drugs can set off rashes or even anaphylactic shock, so they’re typically delivered in treatment centers where patients can be monitored and access higher levels of care if needed — very different environments than the remote clinics in many Alaska villages.

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One of the leading vaccines, meanwhile — the one produced by Pfizer — has to be stored at minus 95 F, and once it’s thawed, it lasts just five days in a refrigerator. That timeline could prove hard to meet for certain rural Alaska villages that are only accessible by air and can face weather-related delays during the winter.

“There’s places on the coast when the weather goes down for a week, and there’s no planes, there’s no medevacs of any kind,” said Dan Winkelman, chief executive of Bethel-based Yukon-Kuskokwim Health Corp., a tribal health-care provider that covers some four-dozen villages in Southwest Alaska. “We need to be smart about this.”

Alaska Native people are already seeing disproportionate rates of infection with COVID-19. And assuring equal access to the vaccines and antibodies will require disproportionate investment in rural Alaska distribution, said Dr. Bob Onders, administrator of the Alaska Native Medical Center.

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Dr. Bob Onders (ANTHC)

“We can’t have a neurosurgeon in every village clinic — that’s not reasonable,” Onders said. “But there are things like this where I think we need to look hard at: How can we do it in the widespread way and the most equitable way?”

State and federal health officials and tribal health care providers are already preparing for the arrival of vaccines and drafting plans to distribute and administer them.

State officials say tribal providers already have a strong network for distributing other types of vaccines that will serve as a kind of template for COVID-19. There’s also a second leading version of the COVID-19 vaccine, from Moderna, that has a longer shelf life and can be stored at warmer temperatures.

“We just did a practice run with all tribal communities and locations of getting flu vaccine out there,” said Matt Bobo, the manager of Alaska’s immunization program. “We do that every year, so this isn’t different than that.”

Tribal providers say they’re collaborating with the state but still in the planning phases for vaccine distribution.

Winkelman, from YKHC, said he has between 600 and 1,000 employees that could be among the first in line to receive the COVID-19 vaccine, based on plans to prioritize early supplies for health care workers.

If his organization can get access to the Moderna vaccine, with its longer shelf-life and warmer storage temperature, YKHC’s existing infrastructure should be adequate, he said.

But if it needs to distribute Pfizer’s version, with its super-cold storage requirements and five-day shelf-life, “we’re going to need help,” he said — potentially from National Guard aircraft and hangars.

Commercial airlines’ facilities in rural Alaska are limited, Winkelman said, and the benefit of using publicly-owned infrastructure is that health-care providers could access it at any time of day.

Bobo, the state’s immunization manager, didn’t respond to a follow-up question about whether that idea was under consideration. But Winkelman said he’s confident that the logistics can ultimately be sorted out.

“I think it’s going to take some brainstorming — quite honestly, that’s the easy part,” he said. “It’s just getting the vaccine — that’s what we need. We need it now.”

The first monoclonal antibody treatment, meanwhile, was just approved for emergency use by the Food and Drug Administration earlier this month.

The drug is still in extremely limited supply, and the state’s initial grant from the federal government was just 240 doses, said Coleman Cutchins, a pharmacist with the state health department.

But Eli Lilly, the company that makes the drug, says that enough of the antibody treatment for 1 million people will be available by the end of the year. And the FDA says that in clinical trials, it has reduced COVID-19-related hospitalizations or emergency room visits for patients at high-risk of severe disease.

Other antibody treatments are “notorious” for causing reactions like rashes and even anaphylactic shock, Cutchins said, which is why they’re generally delivered at an “infusion center” or another type of facility that’s close to a hospital or emergency responders.

He said there will likely be good access to the new antibody treatments even in Alaska’s smaller hospitals in rural hub communities — possibly better than in urban hospitals, because they handle fewer patients.

“But in terms of one or two degrees away from that, at this point, we don’t have a good enough understanding of the safety profile to say that we can give them in a home or in a clinic,” Cutchinss said. “Time will only tell.”

Initial, anecdotal reports suggest that patients receiving the antibody treatment have fared well, Cutchins said.

And tribal health care providers do administer other types of IV infusions at clinics across the state, said Onders, the Alaska Native Medical Center administrator.

He said it makes sense to try to provide the antibody treatment “as close to home as possible,” since the data indicate that the drugs only work early in the progression of COVID-19, before a patient needs hospitalization.

So far, Onders said, tribal providers have been invited to participate in planning around distribution of the COVID-19 vaccines.

And he said it appears that the state is trying to ensure even access to vaccines and drugs between urban and rural Alaska — though making sure that happens “will take effort,” Onders added.

“The easy route is to say, ‘The road system gets early vaccines, and rural Alaska waits for the others,'” he said. “And that’s not acceptable.”