DOVER — A limited supply of the COVID-19 vaccine has made administering the second dose trickier than originally thought.

And as Delaware officials move forward with their plan to prioritize first doses, the guidance around the second dose has changed.

When the Pfizer and Moderna vaccines first were unveiled, the guidance was to wait around 21 days in between doses for the Pfizer vaccine and about 28 days for the Moderna vaccine. But the Centers for Disease Control and Prevention said last Friday it is possible to wait 42 days in between doses if it is not feasible to adhere to the recommended intervals, as most of the country has struggled with the limited supply.

Dr. Rick Hong, medical director of the Delaware Division of Public Health, said Delawareans should still focus on receiving their second dose even if they encounter delays which prevent them from getting it within the 21-day or 28-day window.

“You need to get the second dose,” Dr. Hong said. “In a perfect situation with plenty of vaccine you should get it as close to Day 21 or Day 28 as possible. But don’t give up and not get the second dose if you missed it. You need the second dose. Get it as soon as possible. Don’t be anxious if you can’t get it, you have a window of 42 days.”

Delaware is currently in Phase 1B of its vaccination distribution plan, which is focusing on those 65 years old and up. Phase 1B also includes frontline essential workers such as fire, police, correctional officers, teachers and education staff (including child care providers), U.S. postal workers, food manufacturing, agriculture, transportation, and grocery store workers.

As part of its phased approach, Phase 1A is still receiving vaccine as well, including health care personnel and nursing home residents and staff.

With about 200,000 Delawareans in Phase 1B and issues surrounding the amount of vaccine available, the state’s timeline for future phases is likely to change. The remainder of Phase 1 is tentatively scheduled to start at the end of February.

“We are concerned Phase 1C might not start as quickly as we would like,” Dr. Hong said. “We moved to Phase 1B because of the need to vaccinate those at the highest risk. We’re glad we did that but the supply did not follow with the transition. It appears that we are struggling a little bit. I am confident with the new administration that vaccine supply is a top priority and hopefully we see some more vaccine come into the state.”

Delaware has received 120,850 doses of vaccine from the federal government, based upon reports from the federal tracking database Tiberius. According to the state’s immunization information system DelVAX, it has used 100,678 of those doses as of Saturday at 11:59 p.m. That number is likely higher as the state is dealing with reporting delays which means there are less than 20,000 doses in storage statewide.

Delaware’s allocation from the federal government for the week of Jan. 25 was 18,725 doses (11,900 Moderna and 6,825 Pfizer), according to a DPH spokesperson. These doses were ordered on Jan. 22 and arrived in the state between Monday and Wednesday.
Gov. John Carney said at a virtual town hall on Tuesday the Biden administration has stated it will increase doses by 16% over the next three weeks. For Delaware, a 16% increase will only provide an extra 2,500 to 3,000 doses, depending on the week.

“The Biden administration made an ongoing commitment to distributing the vaccine proportionally to each state by their number of adult population,” Gov. Carney said. “Every governor wants to get proportionally their fair share and that’s what we’ve been told that we’ll get. It’s just a matter of limited supply. … We have more people who want the vaccine than vaccine to go around.”

According to the DPH, science has shown the first dose of the COVID-19 vaccine provides 52% to 80% protection by itself. When paired with the second dose, it goes up to about 90% to 95%.

Those looking for second doses have plenty of options; its just unknown if those options will have adequate supply to meet the demand.

The DPH last week recommended its vaccine partners schedule second doses between 28 and 35 days after the first dose is administered, given the extremely limited supply of the vaccine.

A list of pharmacies and medical providers accepting public requests for vaccination is available at de.gov/covidvaccine by following the link “Find Where to Get Vaccinated.” Users who are 65 or older can then click on “Pharmacies,” “Vaccination Events,” or “Your Doctor” to attempt to schedule.

All scheduling must be done online from the link provided for pharmacies. No walk-ins, email or phone scheduling is available for those appointments. The state notes emails received by requesting a vaccine through the state’s online system cannot be used to receive a vaccine in a pharmacy.

“We’re trying to build a structure to give people multiple options to get vaccine,” Dr. Hong said. “The limiting structure right now is supply. We do understand the struggles with the second doses. We have worked with our partners explaining we need their help to get the second doses out but we’re waiting for the supply.”

The state has held several large-scale vaccination clinics at Delaware Division of Motor Vehicles sites for first doses. Dr. Hong said the DPH is shifting to smaller, more community-based clinics for the second dose as well as relying more on pharmacies, urgent care centers and provider offices.

“We realize its not a one size fits all,” Dr. Hong said. “We have to have multiple methods to distribute vaccines to different populations. We saw that with H1N1 and we’ve seen it with the flu. We’re aware we need multiple avenues. Mass vaccination is a great option to get a lot of people through at one time so it can improve our numbers in terms of how many vaccines went into arms. But we also have to think of smaller sites within certain communities for those that are seeing challenges to their access to vaccine. Of course we also rely on the normal delivery channels, pharmacies, provider offices and urgent cares. They already have relationships with patients and they are trusted sources because people already use them for other vaccines.”

If an individual who is 65 years or older is not on the waitlist yet, they can register at vaccinerequest.delaware.gov and then will be contacted by the CDC’s Vaccine Administration Management System when an appointment at a vaccination clinic is available. As of now, the VAMS system is only scheduling first doses.

The DPH is advising seniors to look around for different options. If they can receive a dose before being contacted by VAMS, they should do so. The second dose does not have to be administered at the same place as the first.

However, the DPH notes all individuals who are vaccinated must receive the same formulations of the vaccine for their second dose — those who received Moderna for the first dose should receive Moderna for their second dose. The same goes for the Pfizer vaccine.

Therefore, the DPH is strongly encouraging vaccinated individuals to keep their vaccine card to ensure they know what vaccine they received and when.