COVID-19 Vaccine Q&A with Ronald Balajadia, Hawai‘i Department of Health Immunization Branch Chief

The rollout of the COVID-19 vaccine has many asking wondering: When will it be available here? How does it work? Is it like the flu vaccine? Are there any side effects? Can it cause you to get very sick? We spoke with Ronald Balajadia, Hawai‘i Department of Health Immunization Branch Chief, who answers some of the most frequently asked questions about the vaccine:

Q: When will the vaccine be available for people in Hawai‘i?

Ron: The first supply of the COVID-19 vaccine will likely be available in mid-to-late December 2020. Once a vaccine is authorized or approved by the FDA, the CDC will make recommendations on who should receive the vaccine. Initially, vaccine supply will be limited, but supplies will increase over time, and all adults should be able to get vaccinated later in 2021. A COVID-19 vaccine may not be available for young children until more studies are completed.

Q: Why is it taking so long to develop a COVID-19 vaccine? It only took a few months for the H1N1 influenza (flu) vaccine to be developed.

Ron: When a new flu strain is identified, like H1N1 in 2009, vaccine manufacturers can use the same processes that are used to make the annual seasonal flu vaccine, saving valuable time. Unlike flu, coronaviruses do not yet have licensed vaccines or processes to build on. In addition, the coronavirus that causes COVID-19 is a new virus, so entirely new vaccines must be developed and tested to ensure they work and are safe. There are many steps in the vaccine testing and approval process. Multiple agencies and groups in the United States are working together to make sure that a safe and effective COVID-19 vaccine is available as quickly as possible.

Q: What are some of the challenges Hawai‘i will face in distributing the vaccine?

Ron: The COVID-19 vaccines require special storage criteria, so distribution will be limited to those with the capacity to meet these requirements.  Some of the neighbor islands may not have this capacity, so we are trying to ensure that our plans address the capacity issues for the neighbor islands.

Q: Will there be enough vaccine for everyone in Hawai‘i?

Ron: When the FDA first authorizes or approves the use of one or more COVID-19 vaccines in the United States, there will be a limited supply. This means not everyone will be able to be vaccinated right away. That’s why we are prioritizing groups of individuals who are most vulnerable and could benefit from the vaccine. Eventually, the goal is for everyone to be able to receive a COVID-19 vaccine. As soon as large quantities are available, the vaccine will be available at doctors’ offices, retail pharmacies, hospitals, and federally qualified health centers.

Q: What is the Department of Health’s role in the distribution of the vaccine? What is required for an effective rollout?  

Ron: The Hawai‘i Department of Health formed a Core Planning Team with local, state, and federal representatives as well as private sector partners under the leadership of the Disease Outbreak Control Division’s Immunization Branch to develop the state’s COVID-19 Vaccination Plan. More than 150 stakeholders representing more than 90 organizations are participating in vaccination work groups to design and implement an operational plan that will support the state’s efforts to implement a comprehensive vaccination program to reduce COVID-19 related illnesses, hospitalizations, and deaths.

Collaboration between all stakeholders is required for an effective rollout. We have made progress in planning and coordinating a statewide COVID-19 vaccination effort to effectively request, secure, receive, store, stage, distribute, dispense, and recover vaccine assets and are preparing for distribution as early as mid-December.

Q: How do COVID-19 mRNA vaccines work? How is the COVID-19 vaccine different from the flu vaccine?   

Ron: mRNA vaccines are a new type of vaccine to protect against infectious diseases. To trigger an immune response, many vaccines put a weakened or inactivated virus into our bodies. For mRNA vaccines, a different process is used to teach our cells how to make a protein —or even just a piece of a protein—that triggers an immune response inside our bodies. This immune response, which produces antibodies, is what protects us from getting infected if we are exposed to the real virus. 

Q: Can COVID-19 mRNA vaccines give someone COVID-19?

Ron: No. The COVID-19 vaccine cannot give someone COVID-19. mRNA vaccines do not use the live virus that causes COVID-19.

Q: How many doses are needed and why?

Ron: Nearly all COVID-19 vaccines being studied in the United States require two shots. The first shot starts building protection, but everyone needs a second dose, usually after 21 to 28 days (depending on the type of vaccine used) for the vaccine to be effective.

Q: How effective will the vaccine be? And how long will the vaccine protect people?

Ron: Clinical trials of COVID-19 vaccines must first show they are safe and effective before any vaccine can be authorized or approved for use. The known and potential benefits of a COVID-19 vaccine must outweigh the known and potential risks of the vaccine for use under what is known as an Emergency Use Authorization (EUA). COVID-19 vaccination will help protect you by creating an antibody response without having to experience sickness. At this point, we do not know how long the vaccine will protect people because the vaccine is still new.
Q: Are there any side effects? Can it cause you to get very sick?

Ron: Clinical trials have found that in general, most people do not have serious problems after being vaccinated. Your arm may be sore, red, or warm to the touch. These symptoms usually go away on their own within a week. Some people report getting a headache or fever after receiving a vaccine. These side effects are signs that your immune system is doing exactly what it is supposed to do. It is working to build protection against disease.

Q: What can we share with our family members or friends who are hesitant about getting vaccines because they are so new?

Ron: You can share with those who are hesitant that the COVID-19 vaccines are being tested in large clinical trials to assess their safety and effectiveness. These vaccines will continue to be studied and we may learn about very rare or long-term side effects as more people are vaccinated. That is why safety monitoring will continue. CDC has an independent group of experts that reviews all safety data and will provide regular safety updates. If a safety issue is detected, immediate action will take place to determine if the issue is related to the COVID-19 vaccine and determine the best course of action.

Q: What is “herd immunity” and how does it work?

Ron: Herd immunity is a term used to describe when enough people become immune to a disease —either from previous infection or vaccination—making the spread of disease from person to person unlikely. The percentage of people who need to have protection to achieve herd immunity varies by disease. Experts do not know what percentage of people would need to get vaccinated to achieve herd immunity to COVID-19.

Q: Do I need to wear a mask and avoid close contact with others after I have received two doses of the vaccine?

Ron: Yes. While experts learn more about the protection that COVID-19 vaccines provide under real-life conditions, it will be important for everyone to continue using all the tools available to us to help control the pandemic, such as covering your mouth and nose with a mask, washing hands often, and staying at least six feet away from others. Experts need to understand more about the protection that COVID-19 vaccines provide before changing recommendations on steps everyone should take to slow the spread of the virus that causes COVID-19. Other factors, including how many people get vaccinated and how the virus is spreading in communities, will also affect this decision.

Q: What are the most important things people in Hawai‘i should know about the COVID-19 vaccine distribution or how it works?

Ron: Initially the COVID-19 vaccine supply will be limited and doses will be provided first to those at highest risk of exposure (e.g., healthcare workers to ensure they are available to care for persons with disease), and to those most vulnerable (e.g., nursing home residents). As an increasing number of doses become available, all persons should be able to be vaccinated. In the meantime, it is important to continue to follow measures to limit your exposure to and prevent the spread of COVID-19 including covering your mouth and nose with a mask and staying at least 6 feet away from others.

For additional information about the COVID-19 vaccine, click here.

About Ron Balajadia

Ron Balajadia, DOH Immunization Branch Chief, has over 20 years of experience working in Immunizations in the Pacific region. He started as the Immunization Program Manager on Guam and worked there for 10 years. He then transitioned to being the Regional Pacific Immunization Consultant for the US Associated Pacific Islands working as a contractual employee for the Centers for Disease Control and Prevention (CDC) providing Immunization guidance and assistance to the islands of Palau, Guam, CNMI (Saipan), FSM (Federated States of Micronesia), Marshall Islands and American Samoa for 7 years based out of Honolulu, Hawai‘i. Upon completion of that contractual work, he then started with the Hawai‘i Department of Health as the Immunization Branch Chief and is currently serving in that capacity and has been with the DOH for close to 10 years.

Ron is currently on the Executive Board for the Association of Immunization Managers (AIM) and has held a post as Treasurer/Secretary and Executive Committee member numerous times in the past providing a voice for immunizations for the Pacific region. He also serves in various task force groups, work groups and committees dealing with immunizations in Hawai‘i and nationally.