I’m sure most of you have read that it will take time to produce enough vaccine to adequately vaccinate Americans to slow the spread of COVID-19. Manufacturing and distribution are massive undertakings. Storage will also be an issue for the earlier messenger RNA vaccines – Pfizer/BioNTech requires storage at minus 94 degrees Fahrenheit and the moderna vaccine at normal freezer temperatures.
The federal government has taken the lead on this and logistics experts, including Army General Gustav Perna, have been hard at work developing and implementing the plan. By the time you read this, three million doses of Pfizer vaccine have already been shipped from Pfizer’s facility in Michigan and will be arriving at 150 sites on Monday, 425 on Tuesday, and the final 66 on Wednesday.
The plan is for Pfizer and moderna to initially ship about 200 million doses of vaccine: 40 million in December, 50 million in January, and 50-60 million each in February. Hopefully the Johnson & Johnson, AstraZeneca/Oxford, and Novavax vaccines will show promise and be approved for shipment in late spring.
There have been thousands of health professionals planning and debating these issues for many months. One of these groups has been the Vaccines Work Group of the Advisory Committee on Immunization Practices (ACIP). This group published its recommendations for the ethical distribution of COVID-19 vaccines on 27 November (bit.ly/2VeR5O9).
The group distilled its deliberations into four recommendations: (1) maximize benefits and minimize harms, (2) promote justice, (3) mitigate health inequities, and (4) promote transparency. The Work Group has devised priority groups to receive vaccine that were selected based on available scientific data, vaccine implementation considerations, and ethical principles.
The group’s first point recommends initially immunizing frontline health care workers (24 million) and other essential workers (87 million). Immunizing both of these groups has a “multiplier effect,” meaning when persons in this group are protected, it will reduce viral spread and they can care for many other individuals.
The next two groups recommended to receive vaccine will be those with high-risk medical conditions (over 100 million) and those over age 65 (53 million). High-risk conditions include: cancer, chronic kidney disease, COPD, heart disease, immunocompromised status, obesity, pregnancy, sickle cell disease, smokers, and Type 2 diabetes. Determining which of these two groups receives the vaccine first, or in some combination, will be left up to the states.
The ACIP Work Group also addressed racial and ethnic disparities in their second and third recommendations. Millions of people have limited access to health care or experience inequities in social determinants of health. They frequently suffer from many of the high-risk health conditions listed above. They often can’t work from home and have an elevated risk of exposure to the virus in their home or work environment. Vaccine distribution will need to focus on making vaccine available to these traditionally underserved populations.
The bottom line is that states are responsible for distributing their vaccine shipments. They were required to submit their plans to the CDC for approval. The Indiana Department of Health (IDOH) developed an 86-page plan (bit.ly/3o2secP). Initial vaccine distribution will come from CDC in two waves to ensure that those who were vaccinated receive their booster doses 3-4 weeks later. The Indiana plan breaks down immunization into three phases.
Phase 1-A is designed to reinforce and support healthcare infrastructure and treatment of disease when there will be a limited supply of vaccine. This will include residents of long-term care facilities and frontline healthcare workers serving in settings such as hospitals, long-term care facilities, outpatient facilities, home health care, pharmacies, dialysis centers, and Emergency Medical Services who have the potential for direct or indirect exposure to the virus.
Due to ultra-low cold storage requirements, health care workers will initially receive vaccine through one of the hospitals designated as a distribution site. Residents of long term care facilities will be vaccinated by employees of contracted pharmacies.
Phase 1-B will protect the vulnerable including individuals who are at particular risk of injury and death associated with COVID-19 (i.e. some combination of the high-risk conditions above and those over 65). These folks will receive vaccine through their county health department, usually through a mass vaccination point of dispensing (POD) location or perhaps pharmacies.
Phase 2 is designed to mitigate the spread of COVID-19 when a larger supply of vaccine is available. These are individuals who are at an increased risk of transmitting the disease because of living or working circumstances. This includes people living in correctional facilities and group homes. It also includes essential workers who are require to work in settings where social distancing is not possible and transmission risk is high. They will likely receive their vaccination through county health departments and pharmacies
Phase 3 involves immunizing the remainder of the general public when there are enough doses for the entire population. As additional types of vaccines are approved, hopefully this will be able to occur in private medical offices. The road to getting everyone vaccinated is likely to be bumpy with so many moving parts.
So why get a vaccine for a virus that only kills about 0.3 percent of the people who get infected with it? The reason is that the virus has a much higher burden on humans than just death. The immune reaction kicked off by the virus can adversely affect virtually any organ system in the body, causing both short and long-term effects like strokes, heart attacks, blood clots, kidney failure, chronic fatigue and many others. Infection will result in billions, or even trillions in health care costs in post-COVID care for decades to come.
Remember that the vaccines will not be a silver bullet for many months. We will all need to continue to physically distance, wear our masks, and wash/sanitize our hands until public health authorities give the “all clear” to stop doing so.