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At some point in the In the next few months, before the end of the year, according to optimists, or more likely in early 2021, the United States will have a vaccine for Covid-19. We do not know which formula will be the first to reach the goal. We don’t know if that vaccine will be released under an emergency use authorization or a standard approval of a new drug. We don’t even know how many doses will be available. But one thing is for sure: The task of getting the vaccine up and running falls to state governments and health departments. And because each state is different, in geography, density, income, and the trust its residents have (or don’t have) in its leaders, each state will have to design its own plan.
Our attempt to control the coronavirus, in other words, will not be a war. There will be at least 50 separate battles, maybe 56, if Washington, DC, Puerto Rico and the other US territories are counted, they will be fought on different terrains and different time frames, with varying supply lines and still unclear on who. going to pay for all staff.
It could be tricky.
State and local health departments, and the organizations that advocate for them, are trying to rejoice in the task, but officials are clearly concerned. “This is unlike any other effort we’ve had to make in about 100 years, maybe never,” says Lori Tremmel Freeman, executive director of the National Association of City and County Health Officials. “The closest we’ve gotten to was the H1N1 flu, and in terms of vaccination, that wasn’t the magnitude of Covid-19. It is a completely new planning process. And it’s really difficult to plan when you don’t have all the information you need. “
The planning process has already started. The Centers for Disease Control and Prevention released a 57-page “interim playbook” in mid-September that outlines, in detail, what states should do now: create committees, identify vaccination sites, resolve requests, and warehousing, creating systems to track who gets vaccinated, and building the workforce to handle all of those tasks. The work specified in the playbook is not optional; the states have to do it to show the feds that they are ready to receive the vaccine once it is approved.
And it’s a fast-moving process. The states’ first communication to the CDC, the first version of their comprehensive plan to recruit vaccinators, receive the vaccine, and motivate their citizens to take it, expires today, October 16, exactly one month after the manual was released. . However, states must present those plans without access to crucial information: not just when the vaccine will arrive, but how many doses they will receive in the first round, how many will follow later, and when subsequent releases will begin.
“The states don’t know how much of the first supply they will be allocated,” says Marcus Plescia, a physician who is medical director for the Association of State and Territorial Health Officials, and who led a final call with leaders of the state health department. week. “Since that hasn’t been determined, they don’t know how to prioritize distribution.”
Two realities, not widely publicized so far, underlie this decision making. The first is that once a vaccine is approved, it is likely that it will not arrive all at once, but in installments; The initial assignment of a state could be only a few thousand doses. The second is that either formula will almost certainly require two injections, 21-28 days apart, to be effective. So no matter how many doses arrive in that first installment, they can probably be used to protect only half that many people, which means the number of people who are allowed to move to the front of the line in any state it can be quite small.
