(upbeat music) - [Narrator] Major funding for "Aging Matters" is provided by the West End Home Foundation, enriching the lives of older adults through grantmaking, advocacy, and community collaboration, the Jeanette Travis Foundation, dedicated to improving the health and wellbeing of the middle Tennessee community, the HCA Healthcare Foundation on behalf of TriStar Health, Cigna, together all the way.

Additional funding provided by Jackson National Life Insurance Company, the Community Foundation of Middle Tennessee, and by members of NPT.

Thank you.

- Older adults in Tennessee are eligible for the COVID-19 vaccine, but supply is limited as the state also vaccinates frontline workers in it's phased vaccination plan.

Over the next half hour, we'll learn what older adults can expect as the vaccine becomes available, where you can find current information as the rollout continues, and what you need to know to stay safe as the broader population seeks immunity from the virus.

Here to help us understand the facts about the COVID-19 vaccine in Tennessee, are Dr. Lisa Piercey, Commissioner Tennessee Department of Health, Dr. Stephanie McClure, an Internist and Geriatrician with Meharry Medical Group, Ami Mitchell, South Central Regional Director of the Tennessee Department of Health, and Rebecca Kelly, State Director at AARP.

Thanks for joining us.

Really excited to have you all here.

Wanna get sort of a temperature gauge of what have we been experiencing so far in this rollout in the early stages of the rollout of the vaccine in Tennessee.

- I can take that one.

Thanks again for highlighting this important topic, Will.

In Tennessee, we've done a really good job at distribution.

We've got one problem only, and that is supply.

We have been working on our planning and our logistics since August and September and we have worked through several scenarios.

And so far the distribution itself is going really, really well.

It's just the supply.

And that's a problem that's being felt all across the nation.

And so, we are super focused on getting it to the most vulnerable population, which are elderly and senior citizens - Right.

And you've got the phased rollout as well that's happening.

Talk about how this works on a county-by-county level as well as your role as the Commissioner for the Department of Health.

- Sure.

So, we have rolled out a plan statewide, but one really important part of our plan is that we want counties to be able to progress through phases as they get through their different categories.

So, while we have started with 75-plus right after healthcare workers, there are some counties that have a relatively low population in that age group and they're already starting to move forward.

We want counties to be able to do that because we don't want them hindered locally by what the state is doing at large.

And so, that makes for a little bit of a messier process.

But what it does is it gets vaccine to people who need it, the quickest.

And so, right now we are still deep in the midst of vaccinating 75-plus at last count.

We still have about 100,000 people on the waiting list.

So, it's gonna take us a bit to get through that.

But we have almost a half a million Tennesseeans that are 75-plus.

And when we're only getting between 60 and 80,000 vaccines a week, that's gonna take a little while to get through that population.

In 75-plus, some counties have already moved down to 70, as I mentioned.

And then so the next big thing will be going 70-plus statewide and then down to 65, along with our 1B population, which is teachers and childcare staff.

- Rebecca Kelly, you've been doing a lot of listening across the state of the experience that folks have had so far.

What kind of questions are you getting about how to register, access.

- So, it of course runs the gamut.

Some folks are very anxious and very worried.

And they've lost loved ones.

And they have people in facilities who have also struggled.

So, we've talked a lot to caregivers and there is very much hope that the vaccine will do what we hope it will do.

And we won't even be talking about this in several months.

But I think what we've tried to do is just get the right information to people.

There's a lot of misinformation out there.

There's a good bit of fear.

And we just wanna get the facts to folks.

I applaud the administration and the Department of Health for focusing on the 75-plus.

We think that's important.

I understand that other states have reduced it and are sorry that they did.

And they're kinda wishing that they had not opened it up.

I think the hardest thing to get across to families and to caregivers and the most important thing is exactly what Commissioner Piercey just said, the supply is not what we wish it was and it's not readily available.

And so, there's a waiting period.

And that period is a while.

It's longer than people are used to waiting for things.

And so, I think part of it is just take a deep breath and recognize that the supply is not keeping up with the demand.

If you are a caregiver for a loved one that is not tech-savvy, then I highly recommend that you take a charge of that situation and try to get them an appointment and get them in line for an appointment on waiting lists.

We know that there are waiting lists everywhere.

So, all you can do at this point is get them on a list to be called back for an appointment.

And think just knowing that.

If you're tech-savvy, then online is the best way to go.

But I think the most important message we can give right now is if you're caring for somebody, please help them go online and help them get in on the list for the vaccine.

- How do you get the best information, the most current information about this vaccine, about the availability of the vaccine, your information in your county.

Talk a little bit about the state resource.

So, statewide resource online, the portal that you're pointing people to, which is covid19.tn.gov.

- Right now, we have online signup where you do go to covid19.tn.gov and you search for your county.

That's how you get started.

You search for your county and see what phase your county is in.

Once you do that, it will give you the option to request an appointment.

And then you put in your contact information.

And when that health department has an opening and they have supply, they'll reach out and get that schedule.

Now, I will tell you that in the coming weeks, we are moving towards actual online scheduling.

That is gonna require a bit more consistency in the supply chain, but we anticipate that in the coming three to four weeks and look forward to rolling that out.

- So, eventually there may be a unified portal.

It's all still gonna be located at covid19.tn.gov, right?

Because right now you have to click on a county, you click "Register," it takes you to the whatever portal that county is using for the registration process.

Is that correct?

- Yeah.

So, we started out with a lot of disparate parts and pieces.

And there's nothing wrong with that, but there is surely benefit to consistency statewide.

And so, we are moving towards that over the next few weeks.

We're inviting our metro health department partners to do that.

Many of them have expressed interest.

And so, ideally in the next few weeks, you can go on that side and schedule anywhere across the state.

So, we're looking forward to rolling that out.

- And so what is that actual, the county?

Let's talk a little bit about county-by-county, what that rollout has looked like for older adults so far and kind of what we're projecting forward.

- So, there are actually a handful, maybe five or six counties today that are moving into the 70-plus population because they feel like they've gotten through a substantial portion of their 75-plus.

That doesn't mean that people in an earlier phase can't still be vaccinated, but they're just opening up that eligibility a little bit further.

And so, as Rebecca mentioned earlier, we're trying to do that in a measured way for a couple of different reasons.

One, we know that there are 1.1 million Tennesseeans that are 65-plus.

We can't even get to all the 75-year-olds right now.

So, it really doesn't do much, but cause a log jam to open it up to 65.

And the reason that we're focused on the 75-plus is we've looked at the Tennessee data and there are drastic drop-offs in every five-year increments in hospitalization and death.

So, that's why we're taking this very evidence-based approach.

The other reason that we're not opening it up very broadly to 65 or some states have even done 55 so far, is because those at highest risk probably have the highest barrier to getting vaccination.

For example, an 84-year-old might rely on someone else for transportation.

They might not be tech-savvy.

And we don't want them competing with a highly-mobile and tech-literate 65-year-old because we know the 84-year-old is at much higher risk.

So, we are really taking a focused and evidence-based approach in Tennessee.

And so far, it looks like it's working.

- Rebecca Kelly had mentioned earlier And just as a caveat for folks who are listening, we might talk about like, you know, statewide, we're at 75 plus right now for eligibility for the vaccine, but that may change.

It's going to change quickly.

Information about availability of vaccine, what vaccines are available, and where, that is all available at COVID19.TN.gov.

- Rebecca Kelly had mentioned earlier kind of this idea of if you can register online for the vaccine, do that.

The online portal, covid19.tn.gov has the most current information.

It is the most capable of getting people registered.

But there is that digital divide.

So again, if you can choose, if you have the capability to register online, you should be doing that.

Correct?

And then if you're kind of in that gray zone of you may not have internet, but you've got a loved one who could register for you, that's an option.

- From what we're seeing in the rural regions now, in the rural counties, all of the above, people are taking care of their parents, they're taking care of their neighbors.

We have senior citizens centers that are being opened up to help people get registered online.

We really do need people in the system.

We really don't care how they get there, if it's their child or if it's their neighbor or a niece or a grandchild.

Public libraries have also stepped up and said that they would help people get online in the system.

And once they're in the system, we are going to get to them when it's their turn and we're gonna get them in for a vaccine.

If they're not tech-savvy and they don't have email access or they don't check their email, we're gonna call them.

And I'm gonna tell you from personal experience, that it is very easy to get somebody 75 and up on the telephone if they know you are calling them to tell them it's their turn to come get a vaccine.

This is a very motivated population and a very grateful population.

So, it's been once we can get them in the system, we can get to them when it's their turn.

Also, I wanna thank Rebecca, Dr. Piercey both for mentioning that the supply has been kind of the hang up.

We get asked, I get asked on a daily basis, "Why aren't you moving ahead?

Why is it taking so long?

Do you need more people to give vaccine?

How can we help?"

And that message of our capacity to give vaccine greatly outweighs what we have to give right now.

And everybody is doing everything they can to make sure we get the vaccine in our hands, but that's just the reality of the situation.

- Rebecca, I know we have heard some cases of fraud.

What are your concerns?

What are the things that you're hearing they are related to fraud and the vaccine rollout.

- Yeah, unfortunately, it's weird, its ugly head with this opportunity as well.

And AARP fought hard to make sure that this vaccine is free to you.

So, if in any form, email, phone call, or whatever, you hear that somebody is trying to charge you to make sure that you get on a waiting list or charge you to make sure that you get an appointment, that's false.

So, I just encourage people to stay alert.

And if you hear that, it's not true.

- Well, and that brings up a good point of the county health department is not gonna call you out of the blue to get you registered.

You are gonna have to reach out to the county health department in order to get registered.

The couple of ways to get registered are again, the primary way is covid19.tn.gov, the online portal.

Click on your county, register there.

Or eventually when the statewide portal is available, schedule that away.

Dr. McClure, that online portal is the primary way.

So, what are you recommending for folks who may be only have phone access and don't have access to the internet?

- That's right.

I've been recommending to have a loved one or friend who knows you well to go on the internet for you to get you scheduled for the waiting list.

I anticipate that I might have to do that for my own mother who doesn't have internet.

And I look forward to doing that for her.

- When you're registering, I think early on, there was some reporting around people showing up at their county health department trying to get access to a vaccine, standing in long lines then getting turned away because those numbers are low.

Will the registration process help to avoid that?

Because you'll only be getting a call if there is an actual dose that is for you to come and get it, right?

- That's right.

And that was one of the things that motivated us to put out that short-term solution of that online signup.

I kinda described online signup now and then full-fledged online scheduling coming probably in the month of February.

And that did a couple of things.

One, it helped us match supply to demand because there is nothing more frustrating for both staff and patients, for people to be in line for hours upon end only to get close to the front of the line and then be turned away.

The other thing that this online signup or online scheduling helps us to do, it helps us to ensure that who is getting vaccinated actually qualifies.

What we've seen on a limited basis in this state and really egregious violations or egregious examples in other states, are people really jumping line and going out of turn.

And we are super focused on risk here in Tennessee and risk-based approach.

And if we had enough vaccine, we'd give it to everybody in the state.

But while there is limited supply, we have to do it in an orderly fashion.

So, by going through an actual scheduling process, we're further able to confirm that that person meets eligibility.

It's pretty easy to figure out if you're over 75 or not.

That will become more at play when we get into the work-based immunization.

- We've kinda started to shift into a little bit of the challenges.

And a lot of those are supply-based, but some aren't.

Some of the challenges that we've seen in this year when it comes to who has been affected by the COVID virus, COVID-19 virus, and disproportionately that has affected populations of color.

And there's been a disproportionate infection as well as death.

And then there's some distrust out there that has justification because of the racial disparities that this country has seen over a long history along a course of time.

How do you sort of counteract that in order to meet this goal of getting everybody vaccinated that we can?

- From a state perspective, we have had a focus on communities of color, underserved populations, and eliminating health disparities from the very beginning of the pandemic.

And we've always known that health disparities exist and there's nothing like a pandemic to really highlight a lot of those disparities.

And we've seen that that goes all the way back to testing.

And now we're talking about vaccine.

At the Department of Health, we have an Office of Minority Health and Health Disparities Elimination.

It's a real mouthful, but it works well because these leaders engage leaders in communities of color and healthcare leaders trusted and respected voices.

Because that we know without a doubt, that that is going to be a much more effective tactic than somebody from the government saying you should do something.

So, whether it's testing and now with vaccine, we've really had a focus on making sure we go into communities, making sure that we engage in not only in the planning process, but in the execution process of having those trusted voices.

Whether that be faith-based leaders, healthcare leaders, academic leaders.

And you've seen that.

We have Meharry Medical College and Dr. Hildreth and many of his staff have helped us in the Nashville area.

And we've seen similar examples statewide taking it into those communities and where they can be comfortable and where their barriers are reduced.

The whole thing about vaccine is reducing barriers to increase compliance and increase comfort.

That's what we wanna do.

And it's what we keep trying to do with vaccine.

Although we do recognize there is a good bit of hesitancy in some of our communities.

- Yeah, Dr. McClure, do you wanna talk a little bit about that from your perspective?

I know you said with older adults, you're a geriatrician and you have seen a lot of your patients have been really sort of excited or anxious to get the vaccine.

But you dealt with any questions of hesitancy or I've heard this, is it true?

Some of those issues.

- Not exactly.

I think a number of the questions that people wanted me to address is, "Should I get a Pfizer vaccine or should I get Moderna?"

And I comfort them that just get the vaccine.

And they've been very open and want to be engaged in getting those vaccines.

In fact, we've had a number of people who will quote Dr. Fauci.

That if Dr. Fauci approves it, then they're gonna take it.

And there's a number of people in the community, especially the older adults who actually believe in the system, although they may not believe in research.

And again, as you had mentioned, Will, there is a long history of guardian research and communities of color particularly in the African-American community.

But when you're talking about the vaccine itself, I think people are wanting to not only protect themselves, they want to protect their families and the communities.

And they really wanted to get back to normal.

I've had a number of patients who haven't seen their families in a long time.

They don't have access to internet.

They may call each other, but it's just not like getting together and giving those hugs.

And so, people really want to get back to normal.

And when they see leaders such as President Hildreth who's the President of Meharry Medical College getting out into the community, they believe in him.

They believe in the frontline workers that look like themselves, watching people getting the vaccinations and understanding that this is for the public good.

- Well, and one thing that I know mentioning studies and trials and how this vaccine was conducted, some of those trials were conducted, it looks like there were more diverse groupings within the trials than had been previously done.

Also, like I know older adults were included in the vaccine trials, older adults with co-morbidities, folks who are at risk, folks who have really been at risk with this virus.

And that's seems like a step in the right direction.

It was the creation of the studies for the COVID-19 vaccine were built purposely for those populations that have been disproportionately affected.

I mean, and I'm not a doctor or a scientist.

This is what I'm reading and discovering.

But if y'all can speak to that, is that the case?

- Sure, I can speak to that.

You're exactly right, Will.

The trials that were conducted specifically recruited not only participants of color, but older participants.

Because you're exactly right, they knew, the study designers knew that those people were at higher risk.

And so, we wanted to make sure, we, as a medical industry wanted to make sure that we were getting a representative sample in those trials, so we can make sure that they are protected too.

Because sometimes, our genetics make immune systems respond differently.

And whether that's because you're older or younger or you're of one ethnicity or another, we wanted to make sure that as a scientific base, we had the knowledge that this is going to protect these most vulnerable folks.

So far, it looks great.

I think it's people tend to forget a good vaccine is 70% effective.

I mean, that's sort of what we were hoping for.

We were hoping for 60 or 70% effectiveness.

The fact that we now have a vaccine that is over 90% effective, is mind-boggling.

It really is a huge scientific advancement.

Which is another reason that when people ask me, "Yeah, I have this condition or that condition, "should I get the vaccine?

My answer unequivocally is always, "You should get it as soon as it's offered to you."

- At this point, there are very few conditions that would make you ineligible for this vaccine, right?

- That's right.

There are very, very few exclusions.

Basically a good rule of thumb is you're eligible to get it, unless you have had a severe allergic reaction that required emergency medical treatment.

Usually an EpiPen or a trip to the ER.

Anything short of that, you're probably still eligible.

It does warrant a conversation with your doctor, and particularly if you have any unusual conditions, but for the vast overwhelming majority of the population, they are perfectly eligible to get it.

- One thing that I wanna talk about, another challenge that again, we're in this area of somewhat unknown as far as supply, right?

And we hope that that supply situation is going to improve, particularly as there maybe come future vaccines that are also hopefully just as effective that can then ramp up and we can get more produced vaccine.

What about the fact that you also have to have, for Pfizer or Moderna so far, you have to have two shots.

So, is that affecting supply as well?

Because now we're getting more people who have had a first dose, fewer folks have had a second dose at this time.

We're needing to control those dosage to make sure that you get those two doses to be fully vaccinated.

- Well, what it makes for is a tricky operational planning.

Because there is no difference between the first dose and the second dose.

It's just two doses of the same shot.

So, it's not like there is a box of second shots and a box of first shots that's easily distinguished.

So, our health departments have done a fabulous job at creating a system to say, "Okay, I know I have this many people that I gave a first vaccine to four weeks ago or three weeks ago and they're gonna need their second dose next week."

And so, they're having to calculate that, put those aside, reach out to those folks and get them in and get them scheduled.

Because one of the worst situations we could put ourselves in is to get overzealous and give all of those doses as first doses, which is great, but it really leaves the second dose folks out to dry.

So, it's an operational challenge.

We're getting it done.

No problem.

But we are excited about the one-dose shot coming, which may come as soon as March, perhaps April.

Not only will that be more convenient for patients in just having a one-and-done, it's gonna be a good bit easier on the operational side as well.

- And that brings us to one kind of last point of people who are able to get both doses are fully protected.

We still won't have achieved population immunity for some time.

What about the continued masking, the continued social distancing and the need to keep safe until we have full population immunity?

- That's probably one of the hardest pills to swallow for folks right now because they think after they get that second shot, they'll rip off their mask and never have to wear it again.

And that day is coming soon.

We're just not quite there yet.

You mentioned herd immunity, which is a very important phenomenon, although it's a little bit difficult to define.

Is that 70%?

Is that 85%?

We're not exactly sure yet, but we know we're nowhere close.

The other thing we're not so sure about yet from a scientific standpoint, is that once you're fully immune, whether that is from previous infection or immunization, we're not 100% sure about whether or not you can still transmit it, some people call that being a carrier, and transmitting it to other people, even though it doesn't make you sick.

I think we're gonna get to a point where we can prove that that does not happen, but we're not there yet from a scientific standpoint.

So, while we still have a lot of susceptible and vulnerable people in our society, we need to continue doing the masking, doing the distancing, the things that have protected us up until this point, until we can get some better scientific answers.

But hang in there.

I think it's coming pretty soon.

- I wanna thank all of our panelists for participating in this discussion.

And thank you for watching.

I hope this conversation has helped you understand the COVID-19 vaccine rollout in Tennessee.

To learn about your eligibility and how to register for the vaccine in your county, visit covid19.tn.gov.

I also wanna thank the public television stations across the state that have brought this conversation to you, WKNO in Memphis, West Tennessee PBS in Martin, WCTE in Cookeville, WTCI in Chattanooga, and East Tennessee PBS in Knoxville.

To see all of the programs and NPT's "Aging Matters" series, visit our website wnpt.org/aging matters.

Thanks for watching and stay safe.

(upbeat music) - [Narrator] Major funding for "Aging Matters" is provided by the West End Home Foundation, enriching the lives of older adults through grantmaking, advocacy, and community collaboration, the Jeanette Travis Foundation, dedicated to improving the health and wellbeing of the middle Tennessee community, the HCA Healthcare Foundation on behalf of TriStar Health, Cigna, together all the way.

Additional funding provided by Jackson National Life Insurance Company, the Community Foundation of Middle Tennessee, and by members of NPT.

Thank you.

(upbeat music)