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Even the most effective, safest coronavirus vaccine will not work to stop the spread of the virus unless a large number of people are vaccinated. And getting vaccinated from manufacturers to people’s arms requires complex logistics – and it can take months.
Today, public health officials across the country are in a hurry to finalize the first draft of plans on how to distribute a coronavirus vaccine if and when it is approved, and they are working with many unknowns they are trying to design a system for releasing the vaccine to all who want it.
The Centers for Disease Control and Prevention only gave state immunization managers 30 days to formulate a comprehensive vaccine distribution plan on COVID-19 – and Friday is the day plans are due.
Vaccine research and planning time is full of politics, with presidential elections a few weeks away. When the CDC announced the October deadline last month, critics feared that political pressure would undermine the process, as President Trump repeatedly promised a vaccine that would be ready immediately.
“If you listen to the White House, [vaccine distribution] may be just a week away, “New York Governor Andrew Cuomo told reporters on Thursday. He and Arkansas Governor Asa Hutchinson sent a letter to President Trump on behalf of the National Governors Association, asking for a meeting to discuss many unanswered questions about the process.
“We need to know: What is the plan? What is the federal government doing, what do you expect the states to do? When will it start? Who is funding it?” Cuomo said. “Let’s find out now, because this virus is ahead of us every step of the way – it’s about time to catch this country.”
Planning is fast, with expectations changing
For dozens of public health officials across the country, the process over the past month has been like “shepherding a lot of cats,” said Claire Hannan, director of the Association of Immunization Managers. “It’s really cramming three to six months worth of strategic discussions […] in 30 days, “he said.
States need to lay the groundwork for distribution today, said James Blumenstock, vice president for responding to the pandemic and recovery for the Association of State and Territorial Health Officials. That means deciding who is in charge of responsibilities such as ordering supplies, signing up vaccine providers, training personnel, running mass vaccination clinics and outreach campaigns , he explained. They will also need a data management system to keep track of who received the initial dose of the vaccine, and to remind them to return for their second dose.
“We’ve been working with fever for the past few weeks,” said Decrecia Limbrick, assistant director of the Houston Department of Health, which is one of several large cities receiving direct funding from the CDC. “I think we’re ready to submit a plan – a ‘Version One’ of a plan.”
Then there are conflicting messages from the Trump administration. “Initially we talked about hurrying and ending your plan because the vaccine is ready before the election,” said Kris Ehresmann, director of infectious diseases for the Minnesota Department of Health. When the Food and Drug Administration recently stated that vaccine tests should be approved two months after the last experimental dose was given, that guideline was “changing the timeline”.
“It’s like being in a continuous earthquake,” he added. “The ground is constantly moving.”
Overcoming logistics barriers
No one knows which vaccine will be given first, when it will happen, which populations it will be given, and how many advance doses will be available.
Adding to this uncertainty is the possibility that early coronavirus vaccines will be extremely difficult to handle. The CDC playbook states that vaccines are likely to require cold chain storage – perhaps “ultra-cold” storage, which is cooler than Antarctica – should be given in two doses of a certain number of days which are far apart, and can have a minimum order of 1,000 doses.
“For regular vaccines, [providers] will order 10 doses at once or 20 doses at a time, “immunization director of the Department of Health and Human Services Bob Swanson explained. It is harder to imagine – how can we use a thousand doses to endanger the populations in a rural province? “
Initially, the focus will be on priority groups that will be the first line to be vaccinated. Details of who it is are still being sought by a CDC advisory committee, though front-line health workers will almost certainly be at the top of the list. There are also concerns about the distribution of the vaccine evenly in communities that, for example, speak different languages or are difficult to reach, especially at first when the dose is limited.
As vaccination managers look forward to the coming year, different areas across the country are facing a range of challenges.
Then there are seasonal issues. During the winter in North Dakota, freezing temperatures and snowfall make outdoor clinics unstable, says Molly Howell, North Dakota vaccination program manager, so they are considering using of warehouses or sports for mass vaccination campaigns, so that people can gather indoors while maintaining physical distance. “Those are some of the ways we try to be creative about vaccinating people safely during the pandemic,” he said.
In Houston, officials anticipate the complications of a hot, humid summer. “If we get those hot days, we want to make sure we maintain the integrity of the vaccine,” Limbrick of the Houston Department of Health said, and they should think about caring for the medical staff administer the vaccine. in those conditions.
“Then [health officials] push that button on Friday afternoon, on Saturday morning, they will continue to work on their planning efforts going forward in the coming days and weeks and months, “said ASTHO’s Blumenstock. And when the first vaccine is approved,” it is close to a year of effort, “he said, to vaccinate everyone across the country who wants to be vaccinated.
Finding money to carry out plans
CDC director Robert Redfield said in Congress last month that states would need approximately $ 6 billion dollars to distribute vaccines.
“It will take huge resources,” Redfield told lawmakers. “It is time for us to bring those resources to the state[s]. “
On Thursday, ASTHO and the Association of Immunization Managers wrote a letter formally requesting $ 8.4 billion from Congress for these efforts.
The letter said the CDC had so far distributed $ 200 million to states, territories, and some major cities to fund the vaccine planning process – but described this amount as “just a down payment.” And as the election approaches, the chances of having a new COVID-19 bill to help through the legislature anytime soon fade.
“Funding I have no control over, but I have control over how we get the vaccines when they are available,” Swanson said. “And I tell you, public health is strong, and public health works well, and vaccinations are bread and butter to public health.”
Michigan has received $ 5.9 million so far, and Swanson said the money was lost to expedite state immunization enrollment, and to local health departments for personnel.
Lack of clarity about funding problems with Dr. Kelly Moore, associate director of immunization education at the Immunization Action Coalition and former director of the Tennessee immunization program.
States need additional funding to implement the plans they have submitted to the CDC, he said. “They need to be able to invest in manpower, in IT systems and in people to use it,” he explained, adding that those brought in to run vaccination campaigns from other parts of the health department such as STD and family planning clinics, will also need to be restored.
“There are a lot of things that have to be paid for billions of dollars,” he said. “Even the best laid out plans are not feasible if you do not have the resources to do so.”