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'Kind Of A Chess Game': For States, Distributing COVID-19 Vaccine Poses Myriad Hurdles

Dec 9, 2020
Originally published on December 9, 2020 6:40 pm

The first COVID-19 vaccine in the U.S. could get authorized for emergency use in a matter of days. But for state health officials, any excitement over any potential breakthrough is tempered by an overwhelming logistical test: distributing a vaccine to millions of Americans.

Claire Hannan, executive director of the Association of Immunization Managers, said there's "no shortage of challenges" for the people charged with planning the vaccination rollout for their state.

"The big question that program managers have is: Exactly how much vaccine am I gonna get?" Hannan said in an interview Wednesday with NPR's All Things Considered host Ari Shapiro.

She said the answer to that question is clearer regarding the Pfizer vaccine — the first coronavirus vaccine for which the Food and Drug Administration is expected to grant emergency use authorization as soon as this week.

With its German partner BioNTech, Pfizer has produced a vaccine shown to be 95% effective in clinical trials. But quantity is limited. The Trump administration has purchased 100 million initial doses of the Pfizer vaccine, a stockpile that will go first to front-line health care workers and residents in long-term care facilities

Meanwhile, immunization managers across the country are getting fluctuating estimates on the supply of another promising new vaccine from the biotech company Moderna, Hannan said, which is hindering their ability to plan.

"They have to factor in what their allocation is and what their allocation is going to be, because in order for them to flip the switch on their long-term care facility program, they have to have enough allocation in one brand or the other," she said. "It's kind of a chess game, making six moves in advance to get where they need to be."

Funding is yet another hurdle for states in pulling off their vaccination campaigns. As Dr. Rachel Levine, Pennsylvania's secretary of health, told NPR last week, the federal government allotted $340 million to states for vaccine distribution and administration, whereas it put billions toward producing a new COVID-19 vaccine.

Hannan said that amount is simply not enough to fund the distribution of a vaccine adequately.

"State and local governments could be just bankrupted by rolling this out," she said.

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ARI SHAPIRO, HOST:

Remember how hard it was to get coronavirus tests back in the spring? There were shortages of swabs and vials and long delays to get results. Well, distributing a coronavirus vaccine could make that process look easy. It has to be kept super-cold. People need two doses weeks apart. And each state and territory is responsible for distributing it to millions of citizens, a process that could start this month.

Claire Hannan is executive director of the Association of Immunization Managers. Welcome to ALL THINGS CONSIDERED.

CLAIRE HANNAN: Thank you. Thank you for having me.

SHAPIRO: So a big challenge ahead. I know that you are regularly speaking with state immunization managers all over the country, the people who are planning the vaccination programs. What are the biggest questions that they have right now?

HANNAN: Well, as you mentioned, there are no shortage of challenges. I think the big question that program managers have is exactly how much vaccine am I going to get? They know how much they're going to get of the Pfizer vaccine, first one out of the chute. But after that, it's just estimates. And so you know, they're saying to each other, is this estimate good? Is it real?

SHAPIRO: And it's not just a flat number that they're looking for. It's, like, a pace. How many doses will they get every week or every two weeks? And will that number increase quickly or at all?

HANNAN: Exactly. You hit the nail on the head. So with the Moderna vaccine, they got an estimate and then they got an estimate for week two that was much lower. So they're not sure. Is it going to continue to be lower? Or is it going to go back up? Is it going to be weekly? Am I going to get monthly allocation? Also, programs talking with each other about how they're prioritizing that first batch of Pfizer vaccine. There's right now a large group in Phase 1a, so states have to decide how to parcel out between health care workers and whether to start their long-term care facility program and how to provide guidance on prioritizing within the health care worker group.

SHAPIRO: And ultimately, are the differences in judgment here just a matter of preferences and values? Or can you say, oh, well, this state is doing it this way because they're more rural or that state is doing it that way because they are more of a hotspot?

HANNAN: I think it's more logistical at this point because the Moderna vaccine may be better for reaching rural communities because it comes in smaller packages, and it doesn't require the ultra-cold, where the long-term care facility program is a partnership between CVS and Walgreens and the federal government. And they are able to use the Pfizer vaccine to do that. It is logistical, and it's also mathematical. They have to factor in what their allocation is and what their allocation is going to be because in order for them to flip the switch on their long-term care facility program, they have to have enough allocation in one brand or the other.

SHAPIRO: And that goes back to the challenge of not knowing what the numbers are going to be.

HANNAN: Exactly. They're looking at their estimates. They're kind of planning it out. It's kind of a chess game - making moves, you know, six moves in advance...

SHAPIRO: Wow.

HANNAN: ...To get where they need to be.

SHAPIRO: Let's talk about the cost of this because last week I spoke with Pennsylvania's health secretary, Dr. Rachel Levine, and she said this.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

RACHEL LEVINE: Only $340 million has been allocated for the next part of the mission - the distribution and the administration. So clearly, states and territories and cities are going to need more funding from the federal government to finish and accomplish this mission.

SHAPIRO: Can states pull off this massive vaccination campaign without more federal money?

HANNAN: It is so critical for states to get federal money. I can't emphasize that enough. And Dr. Levine said it. We just got off the phone with the regional call. And we were talking with the state of Virginia about the cost of hiring a thousand vaccinators. And they were asking, you know, when are we going to get additional funding? So yes, the critical need for funding - state and local governments could be just bankrupted by rolling this out.

SHAPIRO: So what's the mood among state immunization managers now? I'm sure there is some excitement that the vaccine is finally coming, but it just sounds like an enormous logistical challenge.

HANNAN: There's definitely some excitement. We are seeing that they're overwhelmed. Things are changing so quickly. You know, guidance they got last week might be different this week. So it's excitement. It's nervousness. It's stress. It's hopefulness. It's a lot of different emotions altogether, kind of masked by being so busy - all of these meetings and stakeholders and...

SHAPIRO: They don't even have time to have feelings (laughter). They're just going from one thing to the next.

HANNAN: Yeah, yeah, exactly.

SHAPIRO: That's Claire Hannan, executive director of the Association of Immunization Managers.

Thank you very much.

HANNAN: You're welcome. Thank you. Transcript provided by NPR, Copyright NPR.