Experts discuss logistical challenges of COVID vaccines

Dec. 11, 2020

Operation Warp Speed officials have already told states how many doses of the initial allotment of vaccines they will get and will begin shipping them out to 636 locations once Emergency Use Authorizations (EUAs) are issued, according to Operation Warp Speed CEO Gen. Gustave Perna in a report from the Center for Infectious Disease Research and Policy (CIDRAP).

Once the vaccines are shipped to the states, they will be administered in a variety of settings, from hospitals to nursing homes to pharmacies to special vaccination sites.

Chief among those challenges will be the rollout of the initial limited doses of the two vaccines – a massive logistical task that will involve several moving parts. But the federal government is responsible for only part of the effort to get the vaccine into people's arms. States and a network of health departments, hospitals, doctors' offices, and pharmacies will play the biggest role.

"This is going to be up to the states…to determine the final allocation process and to figure out the logistics on how to distribute these vaccines," William Moss, MD, MPH, director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, said at another recent briefing for reporters.

And at the moment, states say they've received only a fraction of the money that they need to undertake this effort. In an October 15 statement, the heads of the Association of State and Territorial Health Officers (ASTHO) and the American Immunization Program (AIM) said the CDC had distributed $200 million to support state planning efforts for COVID-19 vaccine distribution and administration – only a fraction of the $8.4 billion the two groups told Congressional leaders was needed to distribute COVID-19 vaccines in a timely and equitable manner.

"This funding is a necessary first step but equals approximately 60 cents per person," ASTHO CEO Michael Fraser, PhD, and AIM executive director Claire Hannan, MPH, said. "It is not adequate to vaccinate every American with the expected two dose course at this amount."

The Department of Health and Human Services, in a document responding to questions from the National Governors Association, said that an additional $140 million will be awarded to the states on December 15.

"At this point, the states still need support for their vaccine efforts," Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy said in a recent episode of the Osterholm Update podcast. "They don't have the financial support to hire people to go and do many of these vaccination clinics that will be required for public health do."

The ultra-cold storage that the mRNA vaccines require – minus 94°F for the Pfizer-BioNTech vaccine and -4°F for the Moderna vaccine – will present challenges, said Moss's colleague Rupali Limaye, PhD, MPH, director of behavioral and implementation science at the International Vaccine Access Center.

While Pfizer has created special containers with dry ice to store vaccine doses during shipping, "we will need freezers at the sites of distribution in the states," said Moss. He noted that it will be easier to set up and maintain cold storage for the first two groups of recipients, but it will be more challenging once larger segments of the population start getting vaccinated.

Tracking who gets the two-dose shots will be another challenge, one that will involve federal and state immunization tracking and notification programs and paper reminder cards. The second dose of the Pfizer-BioNTech vaccine needs to be administered four weeks after the initial shot, while the second dose of the Moderna vaccine comes three weeks later.

"It will be very important ... for all Americans who get the Moderna or the Pfizer vaccine to have their first vaccine dose and then come back either 3 or 4 weeks later to get their second vaccine dose, to complete the immunization schedule," Operation Warp Speed chief science adviser Moncef Slaoui, PhD, said at a recent press conference.

CIDRAP has the report.

More COVID-19 coverage HERE.