Top 11 Logistical Concerns of the U.S. COVID-19 Vaccine Distribution Plan to Healthcare Workers

Vice President Mike Pence told governors during a conference call with the White House Coronavirus Task Force on Monday, November 30, that vaccine doses enough for 20 million people could begin to be distributed as early as mid-December. According to the Advisory Committee for Immunization Practice (ACIP), most jurisdictions expect to be able to vaccinate all their healthcare workers in just three weeks.

ACIP defined health care personnel as "paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials," and long-term care facility residents as "adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently."

On Friday, December 4th, states submitted final distribution plans to the federal government on where they want the vaccine to be delivered once one is authorized. Already, daunting decisions and logistical challenges have been identified in the process. Below is a high-level overview of the various concerns and questions outstanding.

1. The Trump administration has left the decision-making and distribution logistics to the states and has vowed that at least the initial round of vaccinations will be available to all Americans free of charge. Yet, Congress so far has allocated no federal funding for vaccine distribution.

2. Hundreds of millions of vaccine dosages must each be kept at a specific temperature every step of the way (receiving, storing, and administering), then administered twice, after varying intervals of time, to be effective.

3. The plan requires a colossal coordination effort among various authorities that often do not play well together in the sandbox:

• Several federal agencies
• U.S. military
• Countless agencies and authorities at the state and local level, including lawmakers and public-health officials, in 50 states and 14 U.S. territories
• Pharmaceutical companies and their manufacturing operations, some of which are overseas
• The U.S. health-care system, including countless public and private health-care facilities, all of which are already under enormous strain from the pandemic and still contending with a wave of COVID-19 cases
• Manufacturers and suppliers of equipment needed to administer the vaccines, including critical items like medical-grade vials and syringes
• U.S. health-insurance providers
• Companies expected to provide vaccine administration sites like pharmacies and grocery chains
• Shipping and logistics companies and at least one major airline

4. Who will get the vaccine first, when, and why?

5. Who will get which one of the three vaccines and why?

6. Assessing and addressing the safety concerns around the new vaccines.

7. How long will the vaccines provide immunity against COVID-19?

8. Deciding where and how the vaccines will be administered by:

• Hospitals
• State health departments
• Clinics and doctors' offices
• Pharmacies and some grocery-store chains
• Long-term-care facilities
• Military treatment facilities
• Certain federally run sites

9. Will Biden change the federal government's approach, and if so, how?

10. How much will the vaccines cost? How long will the federal government offer the vaccines for free?

11. Will COVID-19 vaccination be mandatory?

The first shipment of the Pfizer vaccine set for December 15 is contingent on the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee’s (VRBPAC) decision to recommend FDA to issue an EUA for the vaccine. The group will meet December 10 to review Pfizer’s data and a week later, on December 17, will review Moderna’s vaccine data. The first shipment of Moderna’s vaccine, also contingent on the VRBPAC’s decision, could be on December 22. The U.S. could vaccinate 100 million people against the coronavirus by the end of February, according to Moncef Slaoui, chief scientific adviser to the Trump administration's vaccine program, Operation Warp Speed.