Trump administration leaves states wondering how to distribute rare vaccines

“I don’t expect states to make uniform decisions,” he told POLITICO. “Some may prefer long-term care facilities or the elderly, while others may prioritize their health workers. It would be a mistake to vaccinate 18-year-olds first. I hope that no one will, but otherwise, it’s shades of gray.

Preparation time is getting shorter and shorter. Two potential coronavirus vaccines, from Pfizer and Moderna, could be available in December. Two others, from AstraZeneca and Johnson & Johnson, are breaking through the final hurdles ahead of the Food and Drug Administration review.

Federal government vaccine accelerator Operation Warp Speed ​​said 40 million doses of vaccine could be available next month, assuming regulators give the green light to injections from Pfizer and Moderna. They are now preparing to send the first 6.4 million doses as soon as a vaccine is authorized, General Gustave Perna, responsible for the logistics of Operation Warp Speed, told reporters on Tuesday.

The Centers for Disease Control and Prevention normally establishes guidelines for determining who should have priority for each vaccine, based on recommendations from a group of experts known as the Advisory Committee on Immunization Practices. The committee had not been scheduled to finalize its recommendations until the first vaccine was cleared by the FDA. But that changed abruptly over the weekend, with the group scheduled to meet on Tuesday to give advice to the highest priority groups – healthcare workers and residents of nursing homes and long-term care facilities.

“Typically, there’s a window of time after ACIP’s recommendations and before the vaccine hits the shelves,” said Nancy Messonnier, director of the CDC’s National Immunization and Respiratory Disease Center, at the group meeting last week. “This time we are talking about an almost instantaneous deployment.”

States are sketching out potential scenarios while awaiting information about which vaccine the government will first authorize and the number of doses they will ultimately receive.

Oregon, for example, is creating an advisory committee to help determine which groups should receive the vaccine after the first vaccines are likely sent to healthcare workers and nursing homes.

“After that it’s a little bit larger, and as the vaccine starts to flow or pour in, we’re going to have to make decisions about where to go,” said Paul Cieslak, Oregon medical director for communicable diseases and vaccinations.

The questions are whether the vaccine should be disbursed equitably to each county based on its population or to places in the state with high infection rates. The state is also wondering how to ensure that people who have been disproportionately affected by the coronavirus, such as Latin American communities, receive the vaccine.

In North Dakota, officials had looked at different options on how to prioritize doses, depending on which vaccines might be available first, and what might be the initial state fire distribution.

“Seeing that these vaccines work in the elderly population, we are also having discussions about moving long-term care residents off the priority list, directly with health workers,” said Molly Howell, manager, this month. of the North Dakota Immunization Program. .

Arthur Reingold, an epidemiologist at the University of California at Berkeley who heads the California Vaccine Safety Panel, said states will need to be nimble and re-evaluate where to ship doses based on the number of people refusing vaccination.

The federal government initially told Illinois officials that the state should plan to receive an initial shipment of about 400,000 doses. once the FDA cleared a shot. But in the past few days, federal officials have reduced that figure to around 80,000 doses, Ngozi Ezike, director of the Illinois Department of Public Health, said at a press briefing Tuesday.

“We remain very nimble so that we can adapt as the federal government gives us more information,” she said.

Eric Toner, a senior researcher at the Johns Hopkins Center for Health Security, said the federal government gives states the autonomy they need to allocate vaccines to meet the needs of their residents.

“Each state should have some flexibility in general guidelines to decide the order in which they vaccinate certain people,” said Toner, who led a vaccine allocation and distribution framework created by the Johns Hopkins Bloomberg School of Public Health.

“Throughout this pandemic, each state has done things a little differently, and to some extent, that’s okay,” Toner said.

But that autonomy translates into uneven deployment across states, which could undermine already fragile public confidence in the government’s response to the coronavirus and possibly even the vaccines themselves, Michaud said. The production delays caused a chaotic rollout of a vaccine against the 2009 swine flu epidemic, and this “certainly led to a loss of confidence in the government’s ability to distribute the vaccine in 2009,” he said. -he adds.

The state’s demand for the coronavirus vaccines, amid a pandemic that has killed more than 260,000 people in the United States so far, is already eclipsing that seen in 2009 for the flu vaccine. This raises the stakes for success – or failure.

“This is all going to be very complicated,” Michaud said. “There’s no question that paper plans are one thing, but putting them into practice and getting the vaccines in people’s arms is a whole other ball game. It will be a Herculean task.