Vaccine optimism runs up against distribution challenges

Optimism around two promising coronavirus vaccines is quickly shifting to concerns that there won’t initially be enough doses for everyone, and distributing them nationwide will be a massive undertaking.

Both Health and Human Services Secretary Alex Azar and Anthony Fauci, the government’s top infectious diseases expert, said last week that April was the target for getting the vaccine to the general public.

On Monday, following news of a second vaccine candidate that’s more than 90 percent effective, both officials made clear it could be months later until everyone in the country is vaccinated.

“By the time we get through December, January, February, March, April, we hopefully will have been able to get to the people who are listed as priority people,” Fauci said on a call with reporters.

“I would say starting in April, May, June, July as we get into the late spring and early summer, that people in the so-called general population who do not have underlying conditions or other designation that would make them priority could get them. This does not mean in April everybody who’s going to be wanting a vaccine who’s not in a priority group is going to get it,” he added.

Every month is crucial as the country heads into a brutal winter with ever-mounting numbers of cases, hospitalizations and deaths.

Moderna’s announcement Monday that its vaccine was 94.5 percent effective in an interim analysis, and Pfizer’s similar announcement last week, are extremely positive developments, particularly since having a safe and effective vaccine is the crucial first step.

But in addition to the problem of simply having enough doses, there is the logistical challenge of getting those doses distributed across the country and into millions of people’s arms.

The vaccination plan will be shifting into the manufacturing and distribution phase at a time when the Trump administration is handing off power to the incoming Biden administration, but Trump officials have yet to coordinate with their successors.

“More people may die if we don’t coordinate,” President-elect Joe Biden told reporters Monday, calling on the Trump administration to work together on a vaccine plan.

“A vaccine is important. It’s of little use until you are vaccinated. So how do we get the vaccine, how do we get over 300 million Americans vaccinated? What is the game plan? It is a huge, huge, huge undertaking to get it done,” Biden added.

State health officials, who are responsible for much of the distribution, are warning that they don’t have the money needed to properly disseminate the vaccine, including getting it into tougher-to-reach rural areas.

The Association of State and Territorial Health Officials, which represents state public health officials, told Congress last month that states need $8.4 billion for vaccine distribution — funds they currently don’t have. Their request included $3 billion for workforce recruitment and training and $1.2 billion for transportation and storage of the vaccine at the required cold temperatures.

Congress, though, has been deadlocked for months on a coronavirus relief package that could carry those funds.

Despite those challenges, there is some near-term hope for the most vulnerable Americans, who could start receiving the vaccine next month, assuming it is authorized by the Food and Drug Administration by then.

Azar said Monday that between Pfizer and Moderna, he expects the U.S. will have 40 million doses of vaccine in December, which is enough for 20 million people, given that each person requires two doses.

In the early months of 2021, priority groups like health care workers, the elderly and people with underlying conditions would be vaccinated, with the general public expected to have access starting in the spring.

The Trump administration’s projections, though, depend in part on whether additional companies are able to come forward with successful vaccines, adding to the supply from Moderna and Pfizer. Four other companies are in development, but they do not yet have the same clinical trial data.

With just Moderna and Pfizer’s doses, the summer would be a more realistic timeline for vaccinating all Americans.

“Our projections are probabilized based on multiple additional entrants from across our six-vaccine portfolio,” Azar said.

Azar said that with additional companies coming on line, he expects that by the “second quarter” of next year there would be enough for everyone who wants one.

Prashant Yadav, a health care supply chain expert at the Center for Global Development, said there is still much to be done in terms of figuring out vaccination sites and coordinating personnel.

“There is still more work to be done at the state level,” he said.

Improving communication between states, the Trump administration and the Biden team would help, he added.

“The nature of information sharing and the nature of trust does depend on politics in Washington,” he said.

The current vaccine candidates require giving people two shots weeks apart, posing a logistical challenge. Another complicating factor is the fact that the Pfizer vaccine requires storage at ultra-cold temperatures.

Moderna said Monday its vaccine can be kept in a standard refrigerator for 30 days, easing the storage difficulties there.

Stéphane Bancel, Moderna’s CEO, said on a call with reporters Monday that the company is exploring ways to speed up manufacturing, as people will be clamoring for a vaccine.

“The output is going to increase every month,” he said. “We are looking at more possibilities to potentially do more doses.”