A COVID vaccine is close to coming to NC. Here are some answers to common questions.

The Food and Drug Administration on Thursday authorized use of the Pfizer vaccine on an emergency basis, the first to be approved in the United States.

Now begins an elaborate distribution plan that leaders plan to roll out through 2021 — and beyond.

Dr. Mandy Cohen, Secretary of the N.C. Department of Health and Human Services, has spoken about the vaccine in recent weeks and gave an update Dec. 10, before the FDA authorized the Pfizer vaccine.

For starters, supplies will be limited when any COVID-19 vaccine is available in North Carolina. Cohen said she expects it will be closer to the springtime before a vaccine is widely available across the state for everyone.

But the state has sorted out who gets the vaccine first and how it will be distributed.

The state expects to receive 85,800 doses of the Pfizer vaccine next week and distribute it to front-line workers in about half of the state’s hospitals. Beyond that, the state hasn’t been told how much vaccine to expect in the second week or beyond, Cohen said Dec. 10.

North Carolina submitted its proposal for vaccine distribution Oct. 16 to the Centers for Disease Control and Prevention to outline the phased approach that will prioritize who will get the vaccine after that.

With a COVID-19 vaccine coming soon, here are some details about vaccinations in North Carolina.

Which vaccine will North Carolina receive?

Cohen said North Carolina is expected to get the Pfizer vaccine first. That vaccine is reported to have a 95% effectiveness rate and requires ultra-cold storage, which a number of NC hospitals can handle.

The second, developed by Moderna, could be approved for emergency use later this month. The Moderna vaccine was found to be 94.5% effective in clinical trials, according to the company.

How many vaccine doses will North Carolina receive?

Cohen said the state is slated to receive 85,800 doses to start. The federal government is distributing doses based on states’ populations.

The state will continue to receive more allocations of the vaccine after that on a weekly basis, Cohen said, though by then, they may come from Moderna. Cohen said Dec. 10 the state does not know how many doses will come each week; the federal government only has provided the number for the first round.

How does a vaccine work?

There is no COVID-19 virus in the actual vaccine themselves, Cohen said. “The vaccine imitates the infection so that our body thinks a germ like the virus is attacking, and this creates the antibody defense,” she said. “We need to fight off COVID-19 if and when the viral germ attacks.”

Who will get the vaccine first?

Cohen said the first phase of vaccinations in North Carolina will start with hospital workers at high risk of exposure — those who are caring for COVID-19 patients or cleaning areas occupied by COVID patients.

Once the Moderna vaccine has been approved, Cohen said Dec. 10, the federal government will begin working with Walgreens and CVS pharmacies to distribute it to nursing homes and other long-term care facilities in the state.

Other high-risk categories, such as front line workers, will receive vaccines next, followed by people at high risk of severe illness and death from COVID-19 and historically marginalized populations.

Who will get the vaccine after that?

According to the North Carolina plan released in October, about 1.57 million follow in Phase 2, when there are more vaccine doses available. That group includes teachers and school staff, migrant workers in congregate living arrangements who don’t have two or more chronic conditions and incarcerated people. It also includes residents of homeless shelters; frontline workers who are relatively healthy; adults 18-64 years old with one chronic condition; and people 65 and older with one or no chronic conditions.

Phase 3 could include up to 767,000 people, the plan proposes. Those include students as well as workers in critical industries that weren’t part of the first two phases. Getting people vaccinated in this phase will look a lot like the seasonal flu campaign, the state plan says.

Phase 4 will include everyone else — up to 4 million people.

What will the vaccine cost?

The federal provider agreement states that all providers must administer the vaccine regardless of a vaccine recipient’s ability to pay. Cooper and Cohen confirmed the vaccine will be available free to all, whether or not they have health insurance.

How effective are the vaccines?

Pfizer said on Nov. 20 that the vaccine is 95% effective in preventing COVID-19 among those without evidence of prior infection. By comparison, the CDC says a vaccine for influenza reduces the risk of flu illness by between 40% to 60% among the overall population.

Moderna’s vaccine candidate is 94.5% effective. Side effects include fatigue and pain or redness near the injection site as well as muscle and joint aches and headaches, McClatchy reported.

Scientists have said they hope a coronavirus vaccine will be at least 75% effective. White House coronavirus adviser Dr. Anthony Fauci has said that 50% or 60% effective would be acceptable.

Where can you get the vaccine?

The state’s phased distribution plan means that it will prioritize some providers first.

The Pfizer vaccine must be stored at ultra-cold temperatures until it’s ready to be administered. Earlier this week, the state Department of Health and Human Services released a list of 11 individual hospitals and hospital systems that have the freezers needed to store it.

The list, which in the Triangle included Duke University Health System and UNC Health system, comprised sites that will receive the first shipments of the vaccine in advance of the final federal authorization to begin using it.

On Thursday, the state said another 42 hospitals will begin receiving shipments packed in dry ice after the CDC gives the OK. Cohen said the state hopes to make the vaccine available to additional hospitals in the second week, but can’t say for sure.

Next will be providers who can reach critical populations, including Federally Qualified Health Centers, corrections facility providers, and employee healthcare providers that serve frontline workers.

Eventually, the state plans to distribute the vaccine to everyone at primary and specialty care providers, pharmacies and mobile vaccination providers. All providers need to enroll into the federal COVID-19 vaccination program.

The vaccine must be kept cold. Really cold. How will it be stored?

The vaccine can’t be removed from a temperature of minus 94 degrees (or minus 70 degrees Celsius) more than four times. According to the state’s vaccination plan, North Carolina will “assess cold-storage capacity across the state and will develop, coordinate and support an ultra-cold chain storage system.”

Moderna’s vaccine does not require the ultra-cold refrigeration, NPR reported, and can instead be stored at 25 degrees Fahrenheit.

What if people don’t want to get vaccinated?

The N.C. Department of Health and Human Services expects that hesitancy about the vaccine will be widespread, especially among historically marginalized people who the state wants to get vaccinated early. The department is planning a major public education push to get the word out about vaccines, Cohen said. Officials want to help people understand the benefits and risks and tell them how and where to get a COVID-19 vaccination.

The department’s communication will also aim to set realistic expectations for limited availability in the initial phases of vaccine delivery and “raise awareness and recognition of historical injustices to mitigate vaccine hesitancy,” the plan said.

Some of the hospitals that are among the first to receive the vaccine say it will be strongly recommended for employees but not mandatory.

So I need two doses? How will that work?

To work, both the Pfizer and Moderna vaccines need to be administered twice — 21 days apart for Pfizer and 28 days for Moderna.

Amanda Fuller Moore, the state Division of Public Health pharmacist, said the initial 85,800 doses next week will all be first doses, and that federal officials have committed to providing the second shots on time.

The state has a tracking system and will rely on health care providers to aid in making sure people get their second doses when they’re supposed to. Expect to schedule your second dose after you have the first shot. You’ll also get a shot card, so you can keep track of it yourself.

What’s important is to know which vaccine you’re receiving. The Moderna and Pfizer vaccines aren’t interchangeable, Fuller Moore said.

“It is nothing short of a challenge,” she said. “It it really will be because the vaccines are different.”

What about privacy? What will you do with our personal information?

Cohen and Fuller Moore emphasized that information will only be used to make sure people get the second doses of the vaccine. The information will not be distributed to any other agencies. It’s also a back-up for health providers in case the shot card is misplaced.

Will I need to get a vaccine every year, like the flu, or just this one time?

Like most everything with the coronavirus, we’re learning as we go. As trials continue and research continues on existing vaccines, we will learn more about whether we need to have vaccinations on a regular basis, Cohen said.

That means it’s also too soon to know what percentage of the population needs to be vaccinated to reach a point of general immunity.

“I would say we need as many people as possible to get this vaccine because if folks get this vaccine, it means it’s going to be way less likely that they will get the virus itself, and then the virus will have less places to go,” Cohen said.

Lynn Bonner contributed to this story. This story has been updated since its original publication.

This story was originally published November 12, 2020 at 7:30 AM.