We must rise to face multiple challenges in distributing a COVID-19 vaccine

THE ISSUE

Last week, Pfizer Inc. gave a pandemic-stricken world that has seen more than 1.3 million deaths from the novel coronavirus a welcome burst of promising news: The COVID-19 vaccine it is developing could be 90% effective. But having a safe, viable vaccine is only one step in the process. Public health officials in the United States “are gearing up for the biggest vaccination effort in U.S. history — a monumental undertaking that must distribute hundreds of millions of doses, prioritize who’s first in line and ensure that people who get the initial shot return for the necessary second one,” The Associated Press reported last week.

The COVID-19 vaccine challenges we face fit mostly into two categories: infrastructure concerns and vaccine hesitancy.

Understanding the extent of those challenges is essential to addressing them and being realistic about how the coming months will unfold. We aren’t going to have an immediate end to the pandemic. But if all goes well, we can make great strides toward lessening the danger posed by the virus by mid to late 2021.

That might sound too slow for some, but the numbers speak to what we’re collectively up against. There are nearly 8 billion people on the planet. Pfizer said it expects to have global production of 50 million vaccine doses between now and the end of 2020, and then up to 1.3 billion doses in 2021. It indicated last week that half of those initial doses — 25 million — could go to the U.S. Since each individual needs two doses for a vaccination, 12.5 million Americans could be vaccinated by the end of the year.

More optimistically, Dr. Moncef Slaoui, the head of Operation Warp Speed — a public-private partnership initiated by the Trump administration — said Friday that COVID-19 vaccinations should start in December with deployment help from the military. Slaoui said he hopes roughly 20 million Americans can be immunized that month.

Whether it’s 12.5 million or 20 million vaccinated Americans by the end of the year, that’s still a relatively small number. Expectations of progress must be reasonable. Those distributing the vaccine face an unprecedented logistical challenge given its transportation and storage requirements.

“The Pfizer vaccine is unusually difficult to ship and store: It is administered in two doses given 21 days apart, has to be stored at temperatures of about minus 100 degrees Fahrenheit and will be delivered in dry ice-packed boxes holding 1,000 to 5,000 doses,” ProPublica explained in a Nov. 10 article. “These cartons can stay cold enough to keep the doses viable for up to 10 days.”

Those requirements could prove problematic in getting the vaccine to far-flung parts of the country. Among the critical issues:

— Will the hospitals or pharmacies receiving the doses have sufficient facilities to store them on site and keep them at the necessary ultracold temperature?

— Who will be trained and available to store and administer the vaccine? This is an important question given how thin our national health care system has been spread by the current COVID-19 surge.

— Because the vaccination requires two doses, 21 days apart, how will we establish a scheduling infrastructure to ensure that both doses are received in the proper time frame?

“We have a lot of confusion at the state and the local health departments level, and a lot of concern about the nitty-gritty of deployment,” Dr. Saad B. Omer, director of the Yale Institute for Global Health, told The New York Times.

Lancaster County Commissioner Josh Parsons disclosed last week to LNP | LancasterOnline’s Nicole C. Brambila — without elaborating — that the county has a plan to assist in distributing a vaccine, once one becomes available.

That’s encouraging, but this is the kind of effort that will require significant attention and daily management of details. This is all the more reason we continue to push for a health department in Lancaster County, where emergency operations of this magnitude could be centralized.

But at least Parsons says Lancaster has a plan. For its Nov. 10 article, ProPublica learned that Pennsylvania was one of just three states still working on its preliminary vaccine-distribution plan and thus had nothing to share. That’s unacceptable. The Pennsylvania Department of Health has known for months that this moment would arrive.

Concern also extends beyond Lancaster and Pennsylvania.

“Health officials haven’t figured out how to get the ultracold doses to critical populations living far from cities,” ProPublica reported. “It’s especially challenging in smaller towns, rural areas and Native communities on reservations that are likely to struggle to administer that many doses quickly or to maintain them at ultracold temperatures.”

Some of those areas are among the hardest hit by COVID-19. A national response to deliver vaccines must succeed.

Growing hesitancy

Finally, another huge concern: After all the logistical hurdles are overcome, Americans must agree to be vaccinated.

That might not be easy.

“There is a general anti-science, anti-authority, anti-vaccine feeling among some people in this country — an alarmingly large percentage of people, relatively speaking,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN in June.

Disturbingly, vaccine hesitancy now involves more than just the “traditional” so-called anti-vaxxers this editorial board has criticized numerous times for their failure to get their children immunized against measles and other vaccine-preventable childhood diseases.

Writing for The Mercury News last month, Lisa M. Krieger noted that even proponents of heeding science have been “unnerved by reports of a rushed timetable, politicization and poor communication” regarding the COVID-19 vaccine. Those who are newly hesitant include liberals, libertarians and individuals from across the socioeconomic spectrum.

“I believe in vaccines. They’ve helped my family and reduced the mortality of poor people,” Margaret Gordon told Krieger. “But we need more evidence. We have no assurance they’ll work. There hasn’t been any real public education.”

This growing distrust is incredibly troubling. But to the extent that it’s out there, we must acknowledge it and counter it through education and the reinforcement of science. That will have to start at the federal level with reassurances from trusted scientists, like Fauci, who can vouch for the independence of those reviewing the safety of the vaccines.

It is overwhelming to consider all we must do for a successful rollout of an effective COVID-19 vaccine in America. But we are a nation that rises to challenges. And we’ll have an opportunity to prove again in the coming months that the United States is at its finest when the stakes are highest.

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Crédito: THE LNP | LANCASTERONLINE EDITORIAL BOARD