That story ran in the New York Times. It can be republished for free.
WASHINGTON – Even before there was a vaccine, some veteran doctors and public health experts warned Cassandra-like that spreading it would be “a logistical nightmare.”
After week 1 of the rollout, “Nightmare” sounds like an apt description.
Dozens of states say they haven’t received nearly as many promised doses. Pfizer said there were millions of cans in the storage rooms because no one on President Donald Trump’s Operation Warp Speed Task Force told them where to ship them. In some states, there are few locations where the ultra-cold storage required for Pfizer’s product is possible. For example, frontline workers in Georgia had to drive 40 minutes to get a picture. In some hospitals, local residents treating COVID patients protested that they had not received the vaccine, while administrators did so despite working from home and not treating patients.
The potential for more chaos is high. Dr. Vivek Murthy, who was named next surgeon general under President-elect Joe Biden, said this week that the Trump administration’s prediction – that the general population would receive the vaccine in April – would only be realistic if everything went smoothly. Instead, he predicted widespread use by summer or autumn.
The Trump administration had expressed confidence that the rollout would go smoothly as it was overseen by a four-star general, Gustave Perna, a logistics expert. It turns out, however, that in many ways it is easier to get fuel, tanks, and tents into war-ravaged mountainous Afghanistan than to distribute a vaccine in our privatized, for-profit, and highly fragmented medical system. General Perna apologized this week and said he would “take personal responsibility”. It really isn’t his fault most of the time.
During the COVID pandemic, the U.S. healthcare system showed that it was not designed (among other things) to provide a coordinated pandemic response. The states have taken very different COVID prevention measures. Individual hospitals differed in their ability to face this type of national disaster. and there were large regional variations in test availability – with a slow increase in availability, at least in part because no payment or billing mechanism was in place.
Why should the vaccine distribution be different?
During World War II, toy manufacturers were drafted to make parts for military hardware aircraft and commercial shipyards to make military transport ships. The Trump administration was reluctant to invoke the Defense Production Act, which could help expedite and coordinate the process of manufacturing and distributing vaccines. On Tuesday it said it might be possible, but only to help Pfizer obtain scarce raw materials so the drug maker in the US can make and sell more vaccines.
In lieu of one central health-focused strategy, we have several companies competing with one another to capture their financial portion of pandemic health care, each with its own patented product and its own supply chain and shipping method.
Add to that mess the current distribution decision tree: the Centers for Disease Control and Prevention have made official recommendations on who should get the vaccine first – but during the pandemic, many states have felt free to ignore the agency’s proposals .
Instead, Operation Warp Speed has assigned initial doses to states based on population. From there, an unfathomable mix of state officials, health officials, and lobbyists seems to be determining where the vaccine should go. In some states, the counties applied for an allocation from the state, and then tried to accommodate requests from hospitals that developed their custom algorithms for distributing the precious cargo. Once it became clear that there wasn’t enough vaccine, each company made its own adjustments.
Some cans are shipped by FedEx or UPS. But Pfizer – which didn’t fully participate in Operation Warp Speed - is delivering much of the vaccine itself. In nursing homes, some vaccines are delivered and administered by CVS and Walgreens staff, although staffing and consent issues remain.
The Moderna vaccine, which launches this week, will be packaged by “pharmaceutical services company” Catalent in Bloomington, Indiana and then shipped to McKesson, a large pharmaceutical logistics and distribution company. It has offices in places like Memphis, Tennessee, and Louisville that are near air hubs for FedEx and UPS, which will ship them.
Is your head turning yet?
Looking ahead, fundamental questions remain unanswered for 2021: How will key vulnerable workers (transit workers, teachers, grocery store workers) know when it is their turn? (And it does matter which city you work in.) What about people with chronic illnesses – and then everyone else? And who administers the vaccine – doctors or the local drug store?
In Belgium, where many hospitals and doctors are private but work in a major central organization, residents receive an invitation “when it’s their turn”. In the UK, the National Joint Vaccination Committee has established a priority list for vaccination – people over 80, people living or working in nursing homes, and high-risk healthcare workers. The National Health Service will “let everyone else know when it is your turn to get the vaccine” from the national health system.
In the United States, I’m afraid of a crazy mess – like “Did you hear CVS got a broadcast on P Street?” But this time it’s not toilet paper.
Combine that vision of disorder with the high death toll in the nation, and it’s not surprising that schools, unions, and even people with different types of pre-existing illnesses argue intensely over who should get the vaccine first, second, and third . In a country with 200,000 new cases and up to 2,000 new COVID deaths per day, “your turn” is difficult – a tragic per capita order of magnitude higher than many other developed countries.
So kudos and thanks to science and the scientists who made the vaccine in record time. I will eagerly stretch my arm – so that I can see the family, friends, and co-workers I have missed all these months. If only I can figure out when I’m eligible and where to go to get it.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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