With the clinical trials showing promising results and manufacturers of several vaccines already in production (even though they are still only in Phase III Trials), it’s time to start planning how to distribute the likely vaccine(s).
Immunizing the U.S. population to prevent COVID will probably be the largest vaccination campaign ever undertaken. A successful and equitable vaccination plan will require participation by county health departments, community health centers, healthcare providers of all kinds, emergency managers and private & nonprofit sector partners.
An effective response will need a comprehensive plan to address:
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prioritization of the vaccine to critical populations
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distribution of the vaccine from the manufacturers or the federal government to states
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legal considerations
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logistical considerations; and
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effective communicators and communication.
A couple of weeks ago the CDC outlined a general framework for vaccine distribution. Their initial plan alludes to a distribution model similar to the one we used for H1N1 vaccine. Manufacturers would deliver vaccine to a central distributor and states would get weekly allocations.
Vaccination sites (private providers, clinics, government-run points of dispensing) would make requests to the state for the vaccine and states prioritize and approve the requests after looking at their weekly allotment. When the state approves a request, the vaccine goes from the central distributor to the site.
The CDC also contemplates making direct allocations to retail clinics (like CVS and Walgreens).
Among the more challenging policy decisions will be prioritizing populations for early vaccination. The CDC urges states to “develop prioritization schedules based on CDC guidelines, disease burden, and vaccine supply”. A National Governor’s Association memo states that the current CDC leadership says that the top considerations should be:
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Maintenance of homeland and national security
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Provision of health care and community support services
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Maintenance of critical infrastructure; and
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Protection of the general population.
I personally take issue with this priority list. It makes no reference to health disparities or vulnerable populations. Indeed, does placing “maintenance of homeland and national security” suggest that employees of the border patrol for example would be the first to be vaccinated? I sure hope not!
The National Governors Association put out a policy memo this week that outlines a planning process that states can consider as they build their vaccination plan. It might seem a fair piece away, but the upcoming weeks will be critical in developing a workable plan so that decisions aren’t being made “on the fly” when the vaccine becomes available.
We urge the state to begin the vaccine prioritization and planning process right now.
