Distribution of Covid vaccines: States face tough questions about who will receive Covid-19 vaccine after the first groups

States already face challenges when it comes to distributing vaccination to their priority group and when there are only limited distribution points and those who need to be vaccinated are very narrow. Dissemination and vaccine issues will become even more complex as states eventually move beyond top priority populations and open more vaccination sites to vaccinate larger groups of the population.

But the toughest decisions are still up to state officials: deciding which core workers will be eligible for vaccinations after the first group is completed, given the limited supply of vaccines and the unknowns of what the January and 2021 spring deliveries will look like.

Rob Brown, a pharmacist technician at Vail Health Hospital, will sign the necessary papers to the left to receive Covid-19 vaccines from courier manager Leo Gomez from the center while pharmacist Jessica Peterson monitors the process at the pharmacy on December 8, 2020 in Vail.  , Colorado.

Distribution of the vaccine to key priority groups and beyond

Although there is general agreement among states that healthcare workers and long-term care facilities should receive the vaccine first, states have different approaches to who will receive the vaccine first within the two groups, given that initial care how limited.
Josh Michaud, director of global health policy at the Kaiser Family Foundation, who analyzed all available public vaccination distribution plans, said it was difficult to compare how each state chose to vaccinate the population.
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“Some states had very detailed plans, and some states had very different types of general plans and didn’t have much detail, so in many, many cases, it’s hard to compare an apple to an apple,” Michaud told CNN.

For example, states like Alabama and Alaska plan to vaccinate health workers and long-term care recipients at the same time, while in Pennsylvania, the vaccine is first given to health care workers before they are members of long-term care facilities.

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“Things change on a daily basis, so it’s important for your ability to be agile and rotable,” Dr. Amy Young, chief clinical officer at UT Health Austin, told CNN.

“We think we can probably vaccinate healthcare workers in the first round, but we don’t really know that,” Young said. – More is unknown than known.

States are starting to get an idea of ​​how many doses they will receive in December, but this is empty in January. It’s easier to plan who qualifies as the first group worker for vaccination if officials know a large number of vaccinations will arrive in a few weeks, but it’s harder to call this when doses are limited, and even harder when I just don’t know how many doses will be if you get to that level, a government official said.

“It only gets exponentially more complicated when you start to expand your scope beyond a very defined early, high-priority population. When you think about how a group like core workers is going to be prioritized, your head starts rotating in all sorts of ways. it’s a hassle, “Michaud told CNN.

For example, in a state, a teacher or a police officer, both of whom belong to the core group of workers, could be vaccinated at a different time than their counterparts in neighboring states, based on their state prioritizing each subgroup.

A weak plan to address vaccination in larger populations also leaves room for the emergence of severe inequalities. If reliable channels have not yet been established to reach the rural or more inaccessible population, as vaccination becomes more widely available, it will continue to reach those who have the easiest access and not everyone who receives it.

“It’s going to get more and more complicated,” Michaud said. “There are so many obstacles, especially when it comes to reaching rural areas, the disadvantaged population.”

Where will the vaccine go after it has been approved?

In most cases, the first shipments of the vaccine will be delivered from Pfizer’s California plant in Kalamazoo to hospital systems and pharmacies working with the federal government, which will be directly responsible for administering the vaccine to their healthcare workers and residents. long-term care institutions.

But, as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN’s coronavirus town hall last week, “The state and local authorities can decide on distribution and its logistics on an individual basis.”

So in other states, such as Illinois, the delivery first goes to the state’s strategic national stocks and the initial doses of the vaccine are delivered from there to hospitals.

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The distribution from the vaccine company to hospitals and pharmacies in each state is different in almost every state, as instructed by the federal government. State health department officials are consulting with federal officials in Operation Warp Speed. However, there is no clear timetable to explain that this process works simultaneously in all 50 states.

Instead, states have developed individual vaccine distribution plans that differ slightly from the demographic and geographic needs of each state.

“I’m thinking about how we do vaccine distribution like this nesting baby,” Alaska Chief Medical Officer Anne Zink said at a news conference last week when she described how she articulates who controls what in the distribution process. – There are all kinds of different layers.

Officials at the U.S. Center for Disease Prevention and Control have been in close contact with state leaders about how their dissemination plans work and about challenges that could create states.

“Well-trained professionals in this area of ​​distribution have put in place a well-developed coordination and cooperation effort with the states,” said the operator of Warp Speed ​​Operation Perna last week. “They have daily, weekly meetings. They work on the detailed implementation of the plans.”

Rob Brown, a pharmacy technician at Vail Health Hospital, is working to practice the procedure for reconstituting Covid-19 vaccines in the pharmacy’s sterile mixing room on December 8, 2020 in Vail, Colorado.

What will the distribution look like after the first week?

Deacon Maddox, chief of Operation Warp Speed, plans, operations and analysis, told reporters on Monday that once the initial delivery of vaccine doses to the states, the federal government and the states involved in the vaccine dose regularly deliver the delivery doses. .

The Warp Speed ​​operation communicates with Pfizer on a weekly basis to determine how many doses are ready for delivery. This information is then fed into the data collection and tracking system for Operation Warp Speed, Tiberius. Once the numbers are in the tracking system, the OWS distributes the number of vaccine doses available to the states.

“Manufacturers have time until Thursday night to let us know how much they will ship. We’ll meet Friday morning, think through all the information. We’ll make a decision, publish the information, distribute, adjust order limits, and then states can order the next day, shipping 24-48 hours later it starts, ”Maddox said.

The hope lies in a steady flow of vaccine as manufacturers displace it, Maddox said.

CNN’s Samira Said contributed to the report.