You might be interested in Isaac Arnsdorf, Ryan Gabrielson and Caroline Chen’s article at ProPublica’s on how prepared the states are for mass innoculations of their residents. Short version: not very:
As the first coronavirus vaccine takes a major stride toward approval, state governments’ distribution plans show many are not ready to deliver the shots.
The challenge is especially steep in rural areas, many of which are contending with a surge of infections, meaning that access to the first batch of COVID-19 vaccines may be limited by geography.
Pfizer announced Monday that its vaccine demonstrated more than 90% effectiveness and no serious bad reactions in early trial results — an impressive outcome that will pave the way for the company to seek an emergency authorization once it collects more safety data for another week or two. But establishing that the vaccine is safe and effective is just the first step.
The Pfizer vaccine is unusually difficult to ship and store: It is administered in two doses given 28 days apart, has to be stored at temperatures of about minus 100 degrees Fahrenheit and will be delivered in dry ice-packed boxes holding 1,000 to 5,000 doses. These cartons can stay cold enough to keep the doses viable for up to 10 days, according to details provided by the company. The ice can be replenished up to three times. Once opened, the packages can keep the vaccine for five days but can’t be opened more than twice a day. The vaccine can also survive in a refrigerator for five days but can’t be refrozen if unused.
Health officials haven’t figured out how to get the ultracold doses to critical populations living far from cities, according to a ProPublica review of distribution plans obtained through open records laws in every state. Needing to use 1,000 doses within a few days may be fine for large hospital systems or mass vaccination centers. But it could rule out sending the vaccine to providers who don’t treat that many people, even doctors’ offices in cities. It’s especially challenging in smaller towns, rural areas and Native communities on reservations that are likely to struggle to administer that many doses quickly or to maintain them at ultracold temperatures.
My naive suggestion is that ice cream trucks and the many reefer trucks already set up for frozen storage transport might be more effective means than retrofitting thousands of FedEx and UPS delivery trucks. It’s still going to be a massive logistical challenge and dealing with the states is like herding cats.
Products are shipped dry ice all the time in Styrofoam containers in non- refrigerated vehicles.
Maybe the bigger problem is “selling out the theatre”.
!,000 doses? Need 1,000 people in line when the container is opened.
Maybe the packaging can be reconfigured but as you noted, everything takes time.
The problem isn’t so much the shipping but maintaining while you hand them out. According to their instructions, you need to use within 5 days after opening. Since we won’t have enough vaccine to start should probably wait to try to cover those sparse rural areas. You could set up shot centers in rural areas and let people know that if they are high risk they can travel to the shot center during a given date range after making an appointment. However, my sense is that in most of those areas they are now convinced it is all a hoax and wont show up.
“dealing with the states is like herding cats.”
But, but federalism!
Steve
“But, but federalism”
Can’t let the camel’s nose under the tent. Crisis is the usual excuse.
Why not command those thousand to show up for their shots? Why not? It’s for their own good, after all. Reason is, you’d need to use escalating levels of force. Civil liberties be damned.
Then another crisis, and another…..
I would expect the initial doses will be reserved for health care workers and vulnerable populations like nursing homes. That should make the initial logistics a bit easier.
The article explains that each state has its own priorities. Some will prioritize health care workers and people in nursing homes. Others will prioritize all “essential workers”.
Additionally, we should keep in mind that we can’t control the priorities of other countries and that the supplies of vaccine will be distributed among many countries. Since Pfizer has partnered with a German company in creating its vaccine I would assume that European countries will get vaccine, too. 650 million vaccinated in a year sounds like a lot but the global population is 7.6 billion. 650 million is just 8.5%. It will take a lot of years and a lot more vaccine producers to do the whole job.
We don’t need to control the Euros distribution of vaccine. Just honor any contractual allocation.
As for here, it will be a shit show. But I, for one would keep the same focus I’ve always had: protect the vulnerable, and those caring for the vulnerable. I know three young people now who tested positive and the whole event was a piffle. The statistics are now well worn.
As I’ve previously stated, I probably had it. A three day event. But for a segment of the population this is real. At a minimum over-allocate to them. Or, say, teachers, to get kids back in school before irreparable damage is done.
For what we’ve spent and the economic cost of lockdowns we surely could work a grand bargain among the drug companies to expand production.
It’s still not certain that Pfizer’s vaccine will be the first approved, its announcement was particular to its own Phase III plan. There are probably others on track to be approved around the same time because (barring some other issues) the speed of progress has largely been slow because people in the study needed to get infected. The surge in community spread has helped that.
I listened to the NPR interview with the national logistics coordinator the other night. He’s military, which is probably good for this. And it sounded like they have plans in place; the first set is distributing the vaccine to pre-identified locations across the country that have the capacity to store the vaccine, mainly hospitals. The other sets of plans I infer are guidance to state and local government about how to handle and administer the vaccines. State and local government will have to execute or direct the second plans with their own personnel. For example, they’ve identified where dry ice can be acquired. That’s pretty standard federalism, the feds have the advantage in planning capacity, but not boots on the ground.
However, I suspect the initial locations to which the vaccines ship will have a strong influence on the initial distribution.
FYI, this appears to be the interview, with an article summarizing parts of it.
https://www.npr.org/sections/health-shots/2020/11/09/933060635/operation-warp-speeds-logistics-chief-weighs-in-on-vaccine-progress
The ProPublica piece links to the Illinois plan, but incorrectly describes it as prioritizing healthcare workers and those over 65. This is the priority schedule in the plan:
a. Critical workforce members who provide health care.
b. Staff and residents in long term care facilities.
c. Critical workforce members who provide essential functions of society.
I’m not sure where they got 65 from — I think they would be hesitant to make specific plans with that age group without specific vaccines in mind.
Ah, yes, the lamp post strategy. The drunk who searches for his dropped keys under a lamp post because the light is better there. 😉
There are low temp freezers you can buy to handle the vaccine. We are buying them now so that we will be prepared. I dont think distribution will be so clear. You also have to think about who is actually spreading the disease. I am thinking there will need to be some models and numbers run to see how we use it most effectively. Will probably come out to older pts, other very high risk professions (public transport?) and health care people who work most closely with Covid pts.
“That’s pretty standard federalism, the feds have the advantage in planning capacity, but not boots on the ground.”
Pretty much, though in times of disaster the feds can bring in extra support. If we had good leadership at the federal level they would already be working with the states to see what help is needed. This will all be much more difficult as each state will have its own computer system, its own record keeping and ordering system. Will be very inefficient. Just part of the price we pay for the way we do things.
Steve
Most countries of any substantial size have federal systems. So, for example, Canada and Germany both have federal systems. Relatively few large countries have systems like France’s in which each area is a department of the national government.
It isn’t the federal system that gives us these problems but the federal government. It needs a reset. Bureaucratic processes are decades behind the times. You can call it “Deep State” or “civil bureaucracy” or whatever but our processes are cumbersome.
I would bet a case of beer that Germany’s federal system(s) talks to its national system better than ours. Probably communicate better with each other for that matter.
Steve
Depends on the German state. Some, particularly Bavaria, Saxony, and Thuringia, are a bit more independent-minded than others. There’s an ongoing debate in Bavaria as to whether to separate from Germany entirely.
I fail to see any problem here. When the Salk vaccine for polio came out there were mass inoculations of children. I remember as a young boy standing in an enormous line of parents and children in a school gymnasium, waiting to get a shot in the arm.
Have our governments gotten so corrupt and incompetent that they can’t repeat what was done 70 years ago?
The U. S. government was at its most trust and most competent then.
Got the shot and the sugar cube, also at school. The issue here is that the vaccine requires fairly special treatment that a school (excluding universities with research capabilities) will not be able to provide. Also, as I recall, we only vaccinated kids so we had a lot fewer people to vaccinate. Also, the current vaccine requires 2 shots, again needing special handling. Personnel may also be more of an issue.
I have worked in a shot clinic when I was a corpsman. Wonder if you need to do anything special when actually giving the shot? Hope not since that would mean it could take longer to get it done.
Steve
I received a shot. I think the oral vaccine was after my time.
I also recall getting a TB patch test every year pretty much throughout elementary school.