Used flu syringes appear through the opening of a container for bio-waste in New York City.
Photographer: Robert Giroux / Getty Images
Photographer: Robert Giroux / Getty Images
This fall, the U.S. will have to vaccinate huge numbers of Americans in the midst of a public health crisis. It will also be a valuable dry run if a coronavirus shot comes months later.
The annual U.S. vaccine for vaccines has been disrupted by Covid-19, with people staying away from pharmacies, schools, offices, hospitals and other places where they typically get their shoes. But with fears of a flu shot clashes with coronavirus pandemic, health authorities consider how one vaccine can inform another.
In Denver, public health officials are trying to increase the number of adults receiving the flu vaccine this year to 65% from 45%. To do so, they set up “regional teams” that can go from school to school by providing faxes, vans that can stop at construction sites and inoculate workers, and perform operations to hard-to-reach communities.
“This whole model we’re building can then be moved to Covid,” said Judith Shlay, a physician and associate director at Denver Public Health.
In Baltimore, the city has several vans it sends to perform Covid-19 tests, targeting high-risk residents. It will likely use those cars for flu vaccines and then Covid-19, City Commissioner Letitia Dzirasa said in an interview.
“Our flu vaccine distribution will inform a Covid distribution,” Dzirasa said.
The federal government has helped lead the development of a vaccine, more than $ 4 billion in contracts issued to drugmakers. The money is intended to accelerate production and cut financial risk for the most promising of the dozens of impositions in development. President Donald Trump has said a shot could be ready by November, although other experts in his government predict it will be good in 2021 before most Americans have access to one.
A Covid-19 mobile test truck was parked in Miami Beach, on August 5th.
Photographer: Jayme Gershen / Bloomberg
To date, federal health authorities have not provided much detail about their plans for administering vaccines. The U.S. has said it will likely rely on the private sector to disperse the shots, and last week extended a contract to health care provider McKesson Corp., potentially worth more than $ 300 million. But the government has said almost nothing about who will get the shots first, where they will be given, and how they will ensure they reach hard-to-reach and vulnerable communities.
At least 170,000 people in the US have died from the virus, many of them as a new emergence of cases has spread beyond the northeast to other parts of the country. While new cases have fallen from the daily high of nearly 80,000 a month, new outbreaks are reported in schools and colleges as students return, forcing some to close days or weeks after opening.
This week, the US Centers for Disease Control and Prevention is planning a call with health care providers to discuss flu vaccination, along with guidance for delivering vaccines during the pandemic and operating on it. “large vaccination clinics held at locations on satellite, temporary or off-site. ”
In the meantime, local authorities are still waiting for clarity. “We haven’t heard anything yet,” said Dzirasa of Baltimore.
The US has consulted with experts and medical ethics on Covid-19 vaccination allocation plans. The government plans to work with the existing medical distribution network to get shots for the public, said a Trump administration official, with possible assistance from the Department of Defense.
Never done before
There is not a single national U.S. vaccination campaign, per se. U.S. and global health authorities choose to target the flu strains, drugmakers produce the shooter, and they are provided by workplaces, schools, drugstores, local public health departments, doctors and hospitals.
The federal government typically plays a role in financing and promoting the faxes, but not in the physical distribution. This year, the Centers for Disease Control and Prevention purchased 9 million doses of the vaccine for adult flu, compared to 500,000 in a normal year.
The scale of the vaccination campaign needed for Covid-19 will be a daunting logistical challenge, said Howard Markel, a physician and historian of medicine at the University of Michigan School of Public Health. Previous attempts to vaccinate against pandemic threats have fallen short.
“We have never vaccinated an entire American population,” he said in an interview.
In 1976, following an outbreak of swine flu at Fort Dix, New Jersey, the Gerald Ford administration planned a mass vaccination program to prevent a pandemic. “They were held in large gyms and public meeting places,” said Markel, who recalls getting the shot when he was 16. “It really was quite an assembly line.”
The vaccination drive was dismantled after several cases of Guillen-Barre syndrome were identified in people who received the shot. In FS review of the campaign in 2003 confirmed the increase in cases of the disease, which can cause a form of muscle weakness or temporary paralysis, although the exact biological link between the vaccine and the condition has not been established.
In 2009, the H1N1 flu pandemic prompted another attempt to produce vaccines quickly. Eventually, only about 20% of the population got the shot, Markel said.
“It’s an enormous task, no question of it,” Markel said.
Public health officials will also have to overcome reluctance by some Americans to get a shot. On August 7th Gallup poll found that one-third of people would not get a Covid-19 vaccine when it was ready, even if it was free. And some Americans have rejected basic public health measures, such as wearing masks or social distances, raising more questions about how willing they are to participate in a vaccination campaign.
Some fax infrastructure already exists. An increase in demand for Covid-19 testing had set up drugstore chains, states and cities sites where people could set up or drive through. And the H1N1 flu pandemic also provided a roadmap for mass vaccination, said CVS Health Corp. Chief Executive Officer. Larry Merlo.
“That was really the spark plug,” Merlo said in an interview this month. The company is in planning sessions with officials for a possible vaccine for coronavirus, Merlo said.
A spokesman for Walgreens, the next-largest U.S. pharmacy chain behind CVS, said both existing tests and immunization infrastructure will support the future delivery of Covid vaccines.
Sanofi, the French drug maker working with GlaxoSmithKline Plc on a coronavirus vaccine, said it had been in contact with CVS and other drugstore drug dealerships.
“I would think that some of the blueprints we have developed for flu immunization will also hopefully be a blueprint for Covid-19 vaccination,” said Elaine O’Hara, Sanofi’s head of vaccines for North America.
Denver Plan
At the Department of Public Health in Denver, Shlay said she began thinking in June about how to deliver Covid-19 vaccines.
She knew that immunizations for children had fallen sharply since March, when Covid shut things down, and she thought her agency could build a model to get a Covid-19 vaccine for people who need it.
Under a $ 1 million grant from the CARES Act, the federal incentive law to respond to the pandemic, her team has begun working on alternative vaccination strategies for influenza. The strike teams they develop will target 84 schools where vaccination rates have slipped. And the agency works with leaders from the Black, Hispanic, Asian and Native American communities to bring flu shots to neighborhoods.
Private outreach will focus on insecure and unemployed adults – some of the same people are more likely to be hospitalized when they become ill – along with essential workers and homeless people.
“We will try to reach the group that people do not always think of,” Shlay said.
There will be challenges that make the switch to Covid-19. Early vaccines are expected to require two weeks apart, compared to a single flu dose. Health officials will need to keep careful records of who got which shooter when, and make sure to reach people when their second doses are available. They will also need to handle the logistics to keep faxes cool at the right temperature.
“A two-dose Covid vaccine will be much more complicated,” Shlay said. That’s part of why Denver health officials are planning now. “Covid has to do our things faster than we ever did before, and so we figure it out and we do it.”
– With the help of Anna Edney
.
