Over the last few months, much has been learned about how Covid-19 spreads and ways to slow that transmission. Vaccine development is also progressing, but the news that AstraZeneca paused its Covid-19 vaccine trial to investigate the possibility of an adverse reaction is a reminder of the importance of conducting these trials with the utmost care.
Attention is also needed on creating a national strategy to distribute a Covid-19 vaccine. As former state health officers in Massachusetts and Texas, we saw firsthand how the Centers for Disease Control and Prevention led efforts during the H1N1 flu outbreak in 2010-2011 to efficiently distribute a vaccine against it to residents.
That effort taught the CDC, states, and local public health agencies a lot about vaccine distribution. What we learned can help inform a successful national Covid-19 vaccine distribution strategy.
The time to plan is now. Several Covid-19 vaccines are currently under development, but the country can’t wait for a finished product to create a distribution plan. Public health officials will be faced with a mountain of new tasks once distribution begins, and they must take advantage of this time to identify potential problems and develop solutions for an efficient and safe vaccination process. The key to an effective national distribution will be robust, customized local efforts programs that will vary from place to place. Those cannot be thrown together quickly, but take careful, thoughtful planning.
Federal, state, and local public health officials must be in the driver’s seat. The CDC should be given the space to lead this national-level effort without interference. It has the history, experience, and expertise to do so. Public health professionals at the local and state level should also take charge in their jurisdictions. Public health officials have led efforts to protect the public and effectively contain the spread of West Nile virus, Ebola, Zika, and numerous other recent infectious diseases. The job of the CDC and its local and state counterparts is to keep our country healthy and safe.
More Americans will be vaccinated if the effort is led by an unbiased, trusted entity. Any new vaccine brings other anxieties, like doubts directly related to the vaccine and concerns about who will get it first. Our leaders must focus on the science and emphasize that vaccines protect more people than those who are vaccinated. The military is capable of bolstering massive mobilization efforts, but its involvement should complement, not replace, the leading role of health professionals. Doing otherwise will cause distrust and dissuade participation, putting us all at higher risk.
Vaccine distribution cannot be first come, first served. There won’t initially be enough vaccines for everyone. Priority must be given to those at the highest risk of contracting Covid-19, including older Americans, those with preexisting conditions, frontline health care providers, and first responders. Special attention is necessary to reach communities of color that have been hardest hit by Covid-19 to ensure that access is guaranteed, legitimate concerns are addressed, and trust is built.
A strong plan requires multipartner involvement. The vaccination process needs proactive support from multiple sectors. Without coordination and collaboration between elected officials and health experts, we risk a misinformed public. Clinicians who don’t normally give vaccinations — pharmacists, emergency medical technicians, paramedics, and nursing and medical students — will need to be authorized and trained to do it. There must be close coordination with the manufacturing sector to produce enough medical supplies, the economic sector to ensure adequate funding to cover vaccine administration, e.g. doctors and nurses clinical time, and the public safety sector to assist in operations and logistics. State and local governments will need to work with their communities and local businesses to convert unconventional spaces like workplaces, churches, schools, and grocery stores into vaccine sites.
Efficient plans require sufficient resources. The Covid-19 pandemic has exposed how chronically underfunded our country’s public health systems are. Medical professionals have had to reuse N95 masks and medical gowns amid the ongoing shortage, and the U.S. has faced numerous problems with accessible Covid-19 testing. Public health and health care organizations will need additional personnel, vaccine supplies, biomedical hazard wastebaskets, refrigeration facilities, resources for communication campaigns, and overtime pay for frontline workers. These require adequate funding for public health workers and for other mobilized government agencies.
Prepare for the unexpected but expect to be flexible. The only way to reap the benefits of a vaccine distribution plan is to see it in action. Vaccines and supplies will need to be redistributed quickly. This will only be possible if there is flexibility and coordination across all sectors. Public health professionals must be given the support they need to enact this plan even as it evolves.
Effective and frequent communication is essential. Mass vaccination strategies are inherently complex and likely need readjusting. That makes them vulnerable to confusion, misinformation, and misunderstanding that can undermine their credibility. Clear and consistent communication from trusted health and medical leaders is essential to success in addressing these issues and the success of the vaccination program.
These are unprecedented times. But we have the know-how for carrying out effective public health initiatives in this country, led by the CDC, and would be wise to review these capacities now. Doing so is the best way to ensure that the Covid-19 vaccines are delivered safely and equitably across the United States.
John Auerbach is the president and CEO of Trust for America’s Health, former associate director at the Centers for Disease Control and Prevention, and former commissioner of public health for the Commonwealth of Massachusetts. David L. Lakey, an infectious disease physician, is vice chancellor for health affairs and chief medical officer at the University of Texas System, former commissioner of the Texas Department of State Health Services, and a board member of Trust for America’s Health.
How would the preparation work precisely for those vaccines that require subsequent booster shots of the exactly same kind?
Stockpile enough for the first shot plus boosters or just exhaust all for the first shot and worry about manufacturing and distributing boosters for later?
Take care of just the US recipients and save enough for their boosters or distribute the remaining fist shots to outside of US?
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