Getting states prepared to distribute COVID vaccines
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Pfizer, Moderna and now Oxford-AstraZeneca have reported the development of potential COVID-19 vaccines that are up to or over 90% effective, underlining how close we are to getting a federally approved product.
But is the U.S. ready for a broad national rollout of COVID vaccines in the next few months? Claire Hannan, executive director of the nonprofit Association of Immunization Managers, which represents state health officials, said states have been making good progress in their preparations.
“It is getting down to those down-and-dirty details to make sure that on day one, we know exactly where to send the vaccine,” Hannan told “Marketplace Morning Report” host David Brancaccio.
They spoke about why a lack of funding may be a serious issue for states down the road, the uncertainties that may delay vaccine distribution and what states are prepared to do right now. The following is an edited transcript of their conversation.
David Brancaccio: Now, we could have several vaccines soon or pretty soon. We don’t know which one, but what would you say — states are making good progress planning for giving the stuff out once we have it?
Claire Hannan: Yeah, the states have been planning in collaboration with [the Centers for Disease Control and Prevention] and Operation Warp Speed for several months, actually. And we’re really entering the homestretch now, getting ready for potentially two licensed or authorized vaccines coming out. And it is getting down to those down-and-dirty details to make sure that on day one, we know exactly where to send the vaccine. We’ve mapped out its course: where it’s going, who’s going to be giving it, who’s going to be getting it, who’s going to be opening the box with the right gloves on, who’s going to be putting it in the freezer. You know, who’s going to be doing everything. We’re mapping all of that out right now in the homestretch.
Do states have the money they need for vaccine distribution?
Brancaccio: Can states pay for all this? I mean, your organization along with the Association of State and Territorial Health Officials, I think, wrote to Congress last month asking for more than $8 billion to help pay for distribution. Is that money coming?
Hannan: We have not received any word that Congress will be passing additional funding. We’ve heard once again, you know, representatives of [the Department of Health and Human Services] saying that states don’t need additional funding. And this is really worrisome. States need additional funding, local health departments need additional funding to enroll providers, looking at enrolling tens of thousands of providers to make sure the vaccine is accessible. Looking at setting up hotlines, doing communication. We have to train all of these providers on how to handle the vaccine, how to give it properly. Hiring vaccinators to work at public health clinics, the training, the education, the equipment, the transportation — there’s so much that needs to be funded. It’s really worrisome that Congress may not pass funding or that there’s information circulating saying that states don’t need additional funding.
Brancaccio: I mean, would it have the practical effect, if there isn’t additional funding, of holding up distribution in some or all the states?
Hannan: I don’t think initially it would hold up distribution. You know, we’ve really been working hard on planning and we’re at that point where we would be ready to go. What I worry about is that further along down the road, when the vaccine supply becomes more robust, we don’t have the public health capacity to really spread it across providers. We haven’t been able to staff up to enroll all these providers to check their licenses, to check their credentials. I would hate to see us push the campaign further out or have long lines at pharmacies or private physician offices because public health has not been funded.
Deciding who gets the COVID vaccine when
Brancaccio: Now, typically who is going to decide who gets the vaccine first and who gets it second, who gets it later?
Hannan: There’s an advisory committee to CDC, the Advisory Committee on Immunization Practices, which will be making recommendations. They will be taking into account recommendations that have already been sent out by the National Academy of Medicine. We’re working off the assumption that it’s going to be health care workers, health care providers. And then as we move out into “phase 1B,” they’re calling it, it will be essential workers, those over 65 and those with high-risk conditions. So we’re still waiting on the final guidance that will come after they really pore over the data from the clinical trials. But we’re working off the assumption, at least initially, we will be targeting health care workers.
Communicating with the public about vaccine availability
Brancaccio: And how would it work, do you think? Is it that authorities would reach out to the group in question and say, “It’s your turn”? Or would the word get communicated more broadly? Let’s say, if you’re a public school teacher, it’s now your turn and someone would take it upon themselves to show up and prove they’re a teacher?
Hannan: You know, that’s a really good point. And obviously, another plug for additional funding to make sure that we have good communication going out to everybody to know where and when to get the vaccine. Initially, with health care workers, most of them would get the vaccine at their place of work. So you would work with the hospital, send out a communication to the health care worker, they would probably have a way to schedule an appointment to attend the clinic to get the vaccine.
Once we’re moving out past that and we’re looking at vaccinating more broadly, I think it’ll more or less be driven by supply, so that when supply comes in, there would be some communication going out. Yes, if you’re in this group, if you have multiple underlying conditions, “It’s your turn. Here’s where to go get the vaccine.” And the government is also setting up a vaccine finder, where people will have a chance to go on the website and check where vaccine is available. So the state would communicate, you know, “We’re opening up, we want you to go get a vaccine,” or “We have additional supply,” and we would have those people going to get it.
Now, as far as showing a credential, I don’t know that you would have to do that to show who you are. We don’t want vaccines sitting on the shelf. So as we get more supply, we will encourage more and more people to go get it. And hopefully, we would have just an efficient system of the right people showing up to get it.
Brancaccio: And of course, depending on the vaccine, you might have to see people for two shots some weeks apart.
Hannan: Yes, that’s correct. Currently, the two vaccine candidates that are furthest along and close to being authorized under emergency-use authorization are both two doses. One is 21 days apart, the other is 28 days apart, and they’re not interchangeable. I think that’s one of my other concerns, is that we are going to such meticulous efforts and planning to get health care workers vaccinated, and then we need to do it all again to get them to come back for their second dose. And hopefully, they will understand the importance and the critical need to get both doses in order to be protected. And they’ll all come back for the second dose.
Brancaccio: But just to underscore something: It’s got to be the same vaccine the second time, not interchangeable.
Hannan: Correct, it needs to be the same dose of the same brand, not interchangeable.
Training providers to administer the vaccines
Brancaccio: And some people have referred to just the distribution part of this as like another Manhattan Project, probably as big as the development of the vaccine to start with.
Hannan: Well, this campaign is certainly not without challenges. So there are different storage and handling requirements for each different vaccine candidate, so we need to make sure that providers are trained on each different vaccine, making sure that folks are getting two doses of the same brand, but also making sure that they’re storing each candidate correctly — one being ultracold, one being frozen, potentially the other four being refrigerator stable. So there’s a lot of puzzle pieces to come together. It’s not like the flu vaccine, which comes in a pre-dose syringe, you put it in the refrigerator, when someone shows up, you take it out, you pull the cap off, you give it to them. You can line those up and vaccinate 25 or 30 people an hour. This is not what we’re talking about with the COVID vaccine. It’s going to be a lot more effort, a lot more detailed instructions around how to do it, a lot more time making those syringes, mixing with the diluent, putting everything together, perhaps vaccinating only six or seven people an hour.
Brancaccio: So for people who think it’s just like giving out flu shots in a typical flu season, this is a bigger deal.
Hannan: Yes, this is a much bigger deal. This is not an ordinary vaccine. The vaccine that we’re expecting to come first is ultracold. It comes in a box with 975 doses with dry ice. It has to be handled very delicately. It also needs to be diluted at the time that it’s given. So, unlike the flu vaccine, this vaccine requires very special attention, strict requirements on storage and handling. And, because of the way it needs to be handled, it requires more staffing. And you can only vaccinate six or seven people an hour compared to the 25 or 30 with flu vaccine.
Brancaccio: If I’m reading your thinking correctly, you’re OK with where the planning is, but you’re not OK with where the funding is going to come from. Or is that not right?
Hannan: That’s correct. I mean, I think we’re working very hard on planning. I don’t want to say that we’re ready to push the Go button, partially because we don’t have a lot of information about the vaccine yet. Pfizer just recently filed for emergency-use authorization of their vaccine candidate. So any information that we’ve received from Pfizer about the vaccine, about how to handle it, about how it’s being shipped — that cannot be shared. They can’t share materials until after they file, until after there’s an emergency-use authorization. So it’s very difficult for the training materials to be developed. And it’s not enough to just ship the vaccine to the hospital door. And when you ship the vaccine to the door, someone has to be there to receive it. They need to know how to open the box. They need to know how to store the vaccine. They need to know how to administer it, and they need to recommend it. They need to be comfortable with it. They need to understand how it works. They need to know that it’s safe, it’s effective. And we don’t have all those materials out yet because we’re just getting the information from the vaccine trial. Everything looks good. And according to the press releases we’ve seen, it’s great news about the vaccine. But we need experts to give us the real guidance on the vaccine.
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