Friday marks the deadline for US state health officials to submit plans to the federal government for how they will vaccinate hundreds of millions of people Americans against Covid-19 as soon as a vaccine is approved.
States have about two weeks Establishing distribution centers across the country to meet the November 1st deadline set by the Centers for Disease Control and Prevention – a monumental undertaking made even more difficult by the fact that a vaccine was not approved by the Food and Drug Administration and was approved clinically The trials against two of the four leading candidates have been abandoned.
However, most potential vaccines require two doses Johnson & Johnson’s requires only one shot, and some of them need to be transported and stored at different and specific temperatures.
“Everyone needs to realize that it won’t be seamless,” said Dr. Marcus Plescia, Chief Medical Officer of the Association of State and Territorial Health Officials. “This is an ambitious endeavor but we will do it and I think the fact that we have the opportunity to step in front of something and plan it will make a difference.”
Operation Warp Speed
Once a vaccine is approved, US officials must do so Find out how many doses go to each state or region. States are then responsible for paying out the cans to local vendors in accordance with CDC guidelines.
“The government doesn’t do these large operational complex functions easily or well,” New York Governor Andrew Cuomo, a Democrat, told reporters on a conference call Thursday. “And the federal government has shown that it doesn’t have the operational capacity to do these things. That’s why the federal government only delegated everything to the states at the beginning of Covid.”
The federal government is “in the process of actively engaging tens of thousands of providers of these vaccines,” Paul Mango, deputy chief of staff for policy at the Department of Health and Human Services, told reporters on a call on Oct. 9. The CDC is also in the process of helping native tribes decide the best option for vaccine allocation, Infectious Disease Agency deputy director Jay Butler told reporters on the same call.
Mango added that the US currently has more than 40 million vaccination kits assembled with the bottles, needles and other items needed for the shooting.
“All of these products are in ready-to-use warehouses. So this is a major logistical task or undertaking,” he said. Consumables such as needles and syringes are automatically ordered in quantities that match vaccine orders.
However, the storage and handling of the vaccine depends on “which vaccines become available when and in what quantities,” said Butler.
because Pfizers The vaccine must be stored at 94 degrees below zero, which requires special storage facilities and transportation. The company only delivers around 500 to 1,000 cans at a time. The longer it’s on a shelf, the more likely it will go bad, Butler said. Compared, Modernas The vaccine candidate must be stored at 4 degrees below zero.
There are already tens of thousands of Potential vaccination centers in the US, but not all of them, have the ultra-cold freezers required for some of the vaccines.
So much for the CDC has assigned Lori Freeman, CEO of the National Association of County and City Health Officials, said $ 200 million is going into the jurisdiction to prepare Covid-19 vaccines, although much of that funding hasn’t made it to the local level.
In many cases, local health departments have not received funding to distribute vaccines. Many of them are already in financial straits and lack the critical data reporting and staffing infrastructure to run a vaccination campaign on this scale, Freeman said. The data systems will be critical to understanding what percentage of the population has been vaccinated, she said.
“If you’re talking about running a mass vaccination program on the ground, with all the money in higher levels of government, it doesn’t make sense,” Freeman said.
Plescia, who represents state health officials, said ASTHO asked the federal government for an additional $ 8.4 billion to distribute vaccines. Most of those funds would be used to address the staffing shortage and ensure that healthcare workers have adequate personal protective equipment, he said.
“The main problem that we are trying to be very clear about is that states need more funding,” he said.
Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges, said public health departments across the country “continue to be underfunded.” Health departments will either need more resources and staff to roll out the vaccine or massive support from hospital systems and private contractors, she said.
The vaccine is “very expensive” and complicated to distribute, Cuomo said.
“How do we give 20 million vaccines in New York State? And how do you do it quickly and how do you do it safely? How do you do it across the country?” Said Cuomo. “It is clear that states will not do it alone … we need to know what the plan is.”
Logistical challenges loom
In mid-September the CDC published a 57-page “Playbook“To help state health officials make their own plans for distributing a Covid-19 vaccine. In the playbook, the CDC assumes that a coronavirus vaccine will receive emergency approval first before it can receives full formal approval. “
Even with these guidelines, experts warn that the plans tabled Friday are likely to be rough draft and will vary from state to state as officials struggle Organize the infrastructure to deliver and store vaccines in sub-arctic temperatures and to alleviate potential safety concerns for people.
“We need national guidance. This will be challenging as states don’t know if they have enough vials or trained people to deliver vaccines – and some are two shots,” said Arthur Caplan, professor of bioethics at Langone New York University Medical Center.
Orlowski, who said she was briefed by federal officials who run the vaccination program, said “half the job is done” because states run large vaccination campaigns against the flu and other vaccines every year.
However, many of the Covid-19 vaccines require two shots, which begs a big question of how the government is going to pursue this the vaccinations to know when someone needs their booster shot.
“The CDC wasn’t clear,” she said, as to whether the vaccine registry will be a federal or a state effort. “I suspect they are planning to register with the federal government, but I don’t know how to do it. They told us they will have more details next week.”
Who will be vaccinated first?
The The vaccine will likely be distributed in four phases, with health workers, the elderly, and people with underlying health conditions who get it first. Next on the list are key workers, teachers and people in the homeless shelters, as well as prisoners. followed by children and young adults.
The vaccine hierarchy remains complex, however, and who belongs to those groups depends on where someone lives, said Freeman, whose organization represents more than 2,800 local public health organizations.
“It can’t be such a stamp approach. This hierarchy guide is really important to getting out of the federal level, but it still has to be community-specific as a rural community may look very different from a suburb or urban community “said Freeman.
Local health authorities have the expertise to reach these priority groups, identify ideal vaccination sites, and allay concerns about the safety of the medicine. However, Freeman said she was concerned that county and city health officials were not fully involved in the planning process for vaccine distribution.
“Our local health departments are doing their best to rely on everything they have done in the past about planning and delivering mass vaccinations. They know how to do that,” she said. “Our concern is that they could be excluded from it.”
Rural states could fight
It can also prove difficult to get the vaccine to people in poorer or more rural areas of the country.
This is because many states lack the adequate infrastructure to ensure the safe and effective delivery of Covid-19 vaccines that require special refrigeration, said Lawrence Gostin, professor of global health law and director of the O’Neill Institute for National and Global Health Law at Georgetown University.
“We sourced some ultra-cold chain freezers and transport freezers. Dry ice is still on the table and in the works,” said Molly Howell, North Dakota program manager for vaccinations. “Because we are such a rural state, we want to make sure that, if this is the only vaccine available, we are able to get it into the rural areas.”