Who will receive the first COVID-19 vaccines?

As the first COVID-19 vaccines progress towards federal approval, California and other states are rushing to finalize plans for who will receive the first doses and how they will be distributed – critical decisions that have taken on new urgency as drug makers prepare to ship vaccines in just a few weeks.

State and federal health officials have broadly agreed that frontline healthcare workers who have direct contact with patients with COVID-19 should be vaccinated first, a vital step as infections mount. soaring this fall, filling hospitals across the country.

There is also a broad consensus that residents of nursing homes and patients of other long-term care facilities should be targeted in the initial vaccination campaign. The virus has been shown to be particularly fatal in these populations.

This means that most Americans shouldn’t expect to receive a vaccine from their doctor or pharmacy for many months.

Starting with a targeted vaccination campaign also for now also defers thorny questions about who deserves assistance, how minority and low-income communities hit hardest by the virus can be reached, and how the rich and well-connected. can be avoided. to skip the line.

The stakes are high, said Thomas J. Bollyky, who heads the global health program at the Council on Foreign Relations.

“If we are to achieve the immunization levels we need to control the pandemic, which will be difficult, we must maintain the public’s trust,” he said. “If we don’t have a fair distribution of vaccines, it could undermine the entire campaign in a way that causes lasting damage.”

State health officials are expressing cautious optimism that they will be ready to distribute the first vaccines when they start arriving next month.

“We worked really hard to be ready in December,” said Dr. Mark Ghaly, California Health and Human Services Secretary. “There are a lot of moving parts … but we feel like we’re on target.”

Ghaly and others have noted that state and local health officials have considerable experience in distributing vaccines, which is done each year before the annual flu season.

“Many health departments have learned a lot of hard lessons over the years,” said Dr. Cameron Kaiser, who heads public health in Riverside County and sits on the board of directors of the National Assn. county and city health officials.

Nonetheless, the vaccination effort is clouded by the nation’s struggles to implement effective screening for COVID-19 and the federal government’s continued inability to provide hospitals and other health care providers with the necessary equipment. the protection they need for their workers.

“I am terrified that the disasters we have seen with the tests will repeat themselves,” said Trish Riley, head of the National Nonpartisan Academy for State Health Policy, who has worked for decades with health officials across the country.

Money is also lacking, according to many state and local health officials, to fund a mass vaccination campaign.

To date, the federal government has provided only about $ 200 million to states and local agencies, far below the $ 6 billion that the U.S. Centers for Disease Control and Prevention has recognized is necessary for a robust vaccination campaign.

Dr. Helene Gayle, a former CDC official who now heads the nonprofit Chicago Community Trust, said avoiding a repeat of the mistakes of the past would require much better federal leadership.

“For a long time, we lack a strong national response to this pandemic,” said Gayle, who co-chaired a committee of the National Academies of Science, Engineering and Medicine which last month released recommendations on the way to fairly allocate COVID. -19 vaccine.

The Trump administration’s refusal to work with President-elect Joe Biden’s transition team on the coronavirus response has further complicated the efforts.

Nonetheless, there are signs that the vaccination initiative is better coordinated than the Trump administration’s other pandemic efforts.

Health officials have made it clear that vaccines will be distributed to states based on a simple demographic formula.

This contrasts with the opaque process of distributing ventilators and protective gear from the national stockpile, procedures the Trump administration refused to disclose until they were obtained by congressional investigators earlier this year.

The distribution formula should also avoid the political favoritism the president embraced earlier in the pandemic when he suggested that medical supplies would be routed to reward his allies.

“My main concern was that the vaccination process was going to be politicized,” said Pennsylvania Health Secretary Dr. Rachel Levine, who is the current president of Assn. state and territory health officials. “But despite the political comments that were made during the campaign, the process remained professional.”

The CDC oversees the development of detailed state immunization plans which, among other things, must outline how each state will prioritize vaccine distribution.

At the same time, federal officials working on Operation Warp Speed, a Trump administration initiative to accelerate the development and distribution of a COVID-19 vaccine, said this week that they were finalizing preparations for the shipment of vaccine doses to states.

This is a major logistical challenge, in part because the vaccine developed by Pfizer, which is expected to be the first available, must be stored at a very low temperature. The other current main vaccine candidate, from drugmaker Moderna, does not have the same need for extreme cold.

The first round of vaccine shipments are expected to go to medical centers that have the capacity to store the vaccine and are best placed to administer it to frontline health workers, state and government health officials say. federal.

A second delivery route for getting the vaccine to nursing homes and other long-term care facilities is being coordinated by major pharmacy chains CVS and Walgreen’s in partnership with the federal government.

US Secretary of Health and Human Services Alex Azar said on Wednesday that the federal government expects to be able to ship 40 million doses of the vaccine – enough to immunize 20 million people – by the time end December.

Initial distributions require states to identify their healthcare workers and residents of nursing homes, a lengthy process that many states are working to complete.

In California, Ghaly said state officials are still in the process of completing the identification process and recruiting medical providers who can administer the vaccine when it arrives.

Additionally, the state will likely need to put some sort of prioritization process in place, as not all of the estimated 2.4 million healthcare workers in California will be able to get the first round shot.

“There is a lot of work to be done,” Ghaly said.

Some states have clearly made more progress than others, said Jennifer Kates, senior vice president of the nonprofit Kaiser Family Foundation, which has reviewed each state’s vaccine distribution plans. “There is still a lot that states need to understand.”

The foundation’s review found, for example, that only about half of states mention plans to reach out to racial and ethnic minorities, despite the disproportionate toll the pandemic has taken on those communities. Only a quarter mention health care providers who could be used to help immunize these groups, according to the report.

Health officials have predicted that this will be just one of the challenges facing states as the vaccination campaign unfolds.

“There is going to be a drama,” said Dr. Georges Benjamin, the longtime chief of the American Public Health Assn. “So far this administration has done a very good job supporting the science of vaccine development. On the delivery side, the jury is still out.