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Millions of Americans are counting on a Covid-19 vaccine to curb the global pandemic and return life to normal.
While one or more options may become available by the end of this year or early next, the path to delivering vaccines to a population of 330 million people remains unclear to local health officials who are expected to get the job done.
“We haven’t received much information on how this will be implemented,” said Umair Shah, executive director of the Harris County Texas Department of Public Health, which includes Houston.
In a four-page memo this summer, the Centers for Disease Control and Prevention (CDC) told health departments across the country to draft vaccination plans by October 1 “to coincide with the earliest release. possible of the Covid-19 vaccine “.
But health departments that have been underfunded for decades say they currently lack the staff, money and tools to educate people about vaccines and then distribute, administer, and track hundreds of millions of doses. They also do not know when or if they will receive federal aid to do so.
Dozens of doctors, nurses and health officials interviewed by Kaiser Health News and the Associated Press expressed concern about the country’s willingness to carry out mass vaccinations, as well as their frustration with months of inconsistent reporting from the federal government.
The gaps include figuring out how officials will keep track of who has received what doses and how they will keep workers administering the injections safe, with enough protective gear and syringes to do their jobs.
And since only about half of Americans say they will get vaccinated, according to a survey by the AP-NORC Public Affairs Research Center, educating people about the benefits of vaccination will also be crucial, said Molly Howell, who administers North Dakota. health department immunization program.
The unprecedented pace of vaccine development has left many Americans skeptical about the safety of Covid-19 vaccines. Others just don’t trust the federal government.
“We are in a very deep state,” said Ann Lewis, executive director of CareSouth Carolina, a group of community health centers that serve primarily low-income people in five rural counties in South Carolina, a state that votes Republican widely. trustworthy. “The message that is getting out is not a message of trust and confidence in the medical or scientific evidence.”
The United States has committed more than $ 10 billion to develop new coronavirus vaccines, but has not allocated money specifically to distribute and administer vaccines.
And while states, territories, and 154 large cities and counties received billions in emergency funds from Congress, that money can be used for a variety of purposes, including testing and overtime pay.
An ongoing KHN and AP investigation has detailed how state and local public health departments in the US have been starved for decades and that federal funding for the coronavirus has been slow to reach public health departments. .
States can use some of the federal money they have already received to prepare for vaccines. But the research found that many health departments are so overwhelmed with the current costs of the pandemic, such as those for testing and contact tracing, that they cannot set aside money for vaccine work in the future.
Health departments will need to hire people to administer vaccines and the systems to track them, and pay for supplies like protective medical masks, gowns and gloves, as well as warehouses and refrigerator space.
CareSouth Carolina is collaborating with the state health department on testing and responding to the pandemic. She used federal funds to buy modernized $ 140,000 mobile testing vans, which she plans to continue to use to keep vaccines cold and deliver them to residents when the time comes, Lewis said.
But most of the vaccine costs will be new. Pima County, Arizona, for example, already has at least $ 30 million short of what health officials need to fight the pandemic, let alone plan vaccines, said Francisco Garcia, deputy county administrator and director. doctor.
Some federal funds will expire soon. The $ 150 billion that state and local governments received from a fund in the Cares Act, for example, covers only expenses made through the end of the year, said Gretchen Musicant, a health commissioner in Minneapolis. That’s a problem, since vaccine distribution may not have even started.
Although public health officials say they need more money, Congress left Washington for the summer break without passing a new pandemic relief bill that would include additional funding for vaccine distribution.
“States are eager to receive those funds as soon as possible so that they can do what they need to be prepared,” said Kelly Moore, associate director of immunization education at the Immunization Action Coalition, a national vaccine education and advocacy organization with headquarters in St. Paul, Minnesota.
“We cannot assume that they can take existing funds and attempt the largest vaccination campaign in history.”
Then there is the basic issue of scale. The federally funded Vaccines for Children program immunizes 40 million children each year. In 2009 and 2010, CDC scaled up to vaccinate 81 million people against pandemic H1N1 flu. And last winter, the country distributed 175 million vaccines for the seasonal flu vaccine, according to the CDC.
But for the US to achieve herd immunity against the coronavirus, most experts say, the nation will likely need to vaccinate about 70% of Americans, which translates to 200 million people and, because the first vaccines are expected to require two doses to be effective. , 400 million shots.
Although the CDC has overseen immunization drives in the past, the Trump administration created a new program, called Operation Warp Speed, to facilitate vaccine development and distribution.
In August, the administration announced that McKesson Corporation, which distributed H1N1 vaccines during that pandemic, will also distribute Covid-19 vaccines to doctors’ offices and clinics.
“With few exceptions, our commercial distribution partners will be responsible for handling all vaccines,” said Paul Mango of Operation Warp Speed in an email.
“We are not going to have 300 million doses in one go,” said Mango, deputy chief of staff for policy at the Department of Health and Human Services, despite previous government promises to have many doses ready for the new year. “We believe that we are maximizing our probability of success of having tens of millions of doses of vaccines by January 2021, which is our goal.”
Amesh Adalja, a senior researcher at the Johns Hopkins Center for Health Safety, said it will take time for vaccines to become widespread enough for life to return to what is considered normal. “We have to be prepared to deal with this virus in the absence of significant vaccine-induced immunity over a period of maybe a year or more,” Adalja said in August.
In a preliminary guide for state vaccine administrators, the CDC said the doses will be distributed free of charge from a central location. Local health department vaccination plans can be reviewed by both CDC and Operation Warp Speed.
The CDC has examined state and federal vaccination plans in five places: North Dakota, Florida, California, Minnesota, and Philadelphia.
No actual vaccines were distributed during the planning sessions, which focused on getting vaccines to people in places as disparate as urban Philadelphia, where pharmacies abound, and rural North Dakota, which has few pharmacy chains but many managed clinics. by the federal agency Indian Health. Service, said Kris Ehresmann, who heads infectious disease control at the Minnesota Department of Health.
Those planning sessions have made Ehresmann feel more confident about who is in charge of delivering the vaccines. “We are now receiving more specific guidance from the CDC on planning,” he said. “We feel better about the process, although there are still many unknowns.”
However, many public health departments will find it difficult to properly track who has been vaccinated and when.
In Mississippi, for example, health officials still rely on faxes, said state health official Thomas Dobbs. “You can’t manually handle 1,200 faxes a day and expect something efficient to happen,” he said.
In the meantime, vaccinators will need medical-grade masks, gowns, and gloves to stay safe while handling the needles.
Many health officials say they feel burned by the country’s struggle to provide hospitals with ventilators and personal protective equipment (PPE), such as disposable masks, gloves and gowns last spring.
Those concerns are compounded by ongoing difficulties in providing enough test kits, assigning drugs like remdesivir, and recruiting contact markers.
Although Ehresmann of Minnesota said he is concerned the state will run out of syringes, he said the CDC has assured him they will provide them.
Since vaccines are much more complex than personal protective equipment and other medical supplies (a candidate vaccine must be stored at -94 ° F), Plescia said people need to be prepared for shortages, delays and confusion.
“It will probably be even worse than the problems with the tests and the PPE,” Plescia said.
