States ramp up for biggest vaccination effort in US history

With a COVID-19 vaccine drawing closer, public health officials across the country 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.

Posted: Nov 12, 2020 12:35 PM

With a COVID-19 vaccine drawing closer, public health officials across the country 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 push could begin as early as next month, when federal officials say the first vaccine may be authorized for emergency use and immediately deployed to high-risk groups, such as health care workers.

“The cavalry is coming,” Dr. Anthony Fauci said Thursday on ABC’s “Good Morning America.” He said he hopes shots will be available to all Americans in April, May and June.

Pfizer also boosted hopes this week, saying early data suggests its vaccine is 90% effective. But the good news came in one of the grimmest weeks of the pandemic so far. Deaths, hospitalizations and new infections are surging across the U.S. — and turning up the pressure to get the vaccine effort right.

In Philadelphia, the health department is counting how many health care workers and others would be among the first in line. In Louisiana, officials are planning a remote exercise this week to play out different scenarios exploring how the process might unfold.

“If you get 10,000 doses, what are you going to do, versus 100,000 doses?” said Dr. Frank Welch, director of Louisiana’s immunization program.

State and local officials are also planning for the likelihood that the first shipments will not be enough to cover everyone in high-priority groups.

Similar preparations are happening at the federal level. Welch listened in last week on a “war gaming” session by the U.S. Department of Health and Human Services.

For the vaccination effort to get off the ground, state officials have been readying systems to track supplies and who has been vaccinated. That information will be fed into a national network and will be critical in giving federal health officials an up-to-date picture of vaccinations around the country.

Providers such as pharmacies and doctor’s offices will also need to be able to look up records, so people do not have to return to the same place for their second shot. More than one vaccine could also become available, and doses cannot be mixed and matched.

“We not only have to bring people back for a second dose, but need to make sure that we have very good records of which vaccine they received the first time,” said Dr. Jinlene Chan of Maryland’s health department.

States already have immunization registries, which will be used for COVID-19.

To better understand whether at-risk groups are getting vaccinated, the CDC wanted providers to report the race and ethnicity of the people they vaccinate. But pharmacies and other providers that do not always collect that information objected.

“We have to be careful not to put too many administrative burdens on providers that are already stressed,” said Mitchel Rothholz of the American Pharmacists Association, an industry group.

He said providers have been told they will have the option to leave that information out.

Providers will also have to report vaccination information daily, which will be an adjustment for those that typically enter data weekly or every couple of weeks, state officials said.

To help people find doses in their area, the CDC wants to put information on a vaccine finder website, which will be updated each day with the latest inventory.

Supplying that inventory information might be a staffing strain for some providers, including a hospital in Utah that said it only has one person who currently enters the information, said Jon Reid, who manages state’s immunization registry.

“And they don’t do it every day. They do it whenever,” Reid said. State officials in Utah plan to update the inventory, rather than having each provider enter it, he said.

States are also working to expand the number of pharmacies, doctor’s offices and other providers that can administer COVID-19 vaccines, to ensure shots are conveniently available.

But enrollment can be time-consuming, Reid said, because providers often need help filling out forms, getting technical systems working and going through inspections to ensure they can meet storage requirements. The Pfizer vaccine needs to be kept at minus 70 degrees Celsius (minus 94 F).

Given the hurdles, Reid does not expect smaller pharmacies to become COVID-19 vaccine providers.

Because of the likely need for two doses given three or four weeks apart, the Centers for Disease Control and Prevention is considering ways of helping Americans remember the second shot, including issuing cards that people would get with their first shot, akin to the polio immunization cards many older Americans remember carrying.

Many people will likely need additional prodding.

In a rural part of South Carolina, one community health center is planning multiple reminders, including text messages and calls from health workers.

Still, “there will still be some that slip through the cracks,” said Ann Lewis, CEO of CareSouth Carolina, which runs the health centers.

Distributing doses is another issue. The Pfizer vaccine, which could be the first to get the green light, comes in shipments of nearly 1,000 doses.

“A minimum of 1,000 doses makes it very difficult to get smaller facilities vaccinated,” said Rich Lakin, director of Utah’s immunization program.

Shipments might go to a hospital that is easily accessible to health care workers from multiple sites, Lakin said.

“They may have to drive to that hospital to get the vaccine,” he said.

In North Dakota, providers receiving fewer than 1,000 doses will have them shipped to a state warehouse that can maintain the ultra-cold storage.

“We’ll break them down into the smaller quantities and then drive them to the provider,” said Molly Howell, the state’s immunization director.

State and local health departments will break up and redistribute shipments of other vaccines, which are expected to require orders of at least 100 doses, for smaller providers that do not need that many. But even if distribution goes smoothly, officials worry people will not want the shots.

“If there’s going to be any real challenge, to be honest with you, it’s going to be convincing folks to get the vaccine,” said Patrick Peer, who runs the Good Neighbor Community Health Center in Columbus, Nebraska.

So far, states have received far less money than they say they need for vaccine distribution, and it’s unclear if any more federal help is coming. Public health groups estimate that an additional $8.4 billion is needed to pay for staff, data systems and outreach and supply costs.

In rural Minnesota this fall, masked nurses in traffic vests reached into cars to give passengers flu shots. The drive-thru clinic was a way to social distance in the pandemic, but it also served as a test run for someday administering a COVID-19 vaccine.

Carlton County has purchased mobile vaccination stations to prepare for similar mass clinics for the coronavirus. But county health officials are also suddenly dealing with a spike in cases, and many questions remain unanswered, including when a vaccine might arrive and how many doses there will be

“It’s all kind of up in the air,” said Jenny Barta, a public health nurse specialist.

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Illinois Coronavirus Cases

(Widget updates once daily at 7 p.m. CT)

Cases: 1612129

Reported Deaths: 27216
CountyCasesDeaths
Cook61543610987
DuPage1042681360
Will876561092
Lake773641061
Kane66108852
Winnebago39170545
Madison38345578
St. Clair35140571
McHenry33177317
Peoria26076363
Champaign25967184
Sangamon24718273
McLean22003208
Tazewell19833326
Rock Island17919348
Kankakee16856235
Kendall15537107
Macon14565244
LaSalle14539278
Vermilion13343190
Adams12733148
DeKalb11729129
Williamson11528160
Whiteside7944176
Jackson774389
Boone762782
Coles7404113
Ogle718087
Grundy704582
Franklin693999
Clinton683798
Knox6715166
Marion6581138
Macoupin6525100
Henry625674
Effingham612882
Jefferson6116132
Livingston574196
Woodford556191
Stephenson549789
Randolph532197
Monroe510199
Christian496380
Fulton491570
Morgan488996
Logan478474
Montgomery470476
Lee460658
Bureau429188
Perry416671
Saline414064
Fayette403459
Iroquois396973
McDonough356656
Jersey324253
Shelby317343
Crawford307930
Douglas307636
Lawrence303431
Union297347
Wayne276057
White267730
Richland264455
Hancock258834
Pike258056
Clark253538
Cass252228
Bond244824
Clay242247
Edgar237545
Ford235956
Warren227161
Carroll226537
Johnson214925
Moultrie212931
Jo Daviess207226
Washington206627
Wabash202616
Greene200939
Mason200351
Massac200144
De Witt196830
Piatt192114
Mercer191234
Cumberland179825
Menard160812
Jasper153418
Marshall135621
Hamilton129821
Brown10228
Pulaski99211
Schuyler9748
Edwards96815
Stark77227
Gallatin7557
Scott6975
Alexander68111
Henderson66114
Calhoun6452
Hardin56414
Putnam5464
Pope4945
Unassigned1812432
Out of IL60

Indiana Coronavirus Cases

(Widget updates once daily at 8 p.m. ET)

Cases: 947918

Reported Deaths: 15377
CountyCasesDeaths
Marion1291181990
Lake635721103
Allen53899761
Hamilton44082449
St. Joseph42122590
Elkhart33803491
Vanderburgh30574449
Tippecanoe26915251
Johnson23727418
Hendricks22410342
Porter21832347
Clark17562231
Madison17492385
Vigo16302285
Monroe14545191
LaPorte14389239
Delaware14183222
Howard13971273
Kosciusko11498135
Hancock10935166
Warrick10737178
Bartholomew10635170
Floyd10514208
Wayne10077226
Grant9213204
Morgan8928160
Boone8463111
Dubois7791123
Dearborn769490
Henry7691133
Noble7466101
Marshall7409128
Cass7219118
Lawrence7026153
Shelby6647111
Jackson661386
Gibson6190107
Harrison609386
Huntington604495
Montgomery5853105
DeKalb581091
Knox5535104
Miami548888
Putnam543268
Clinton537465
Whitley529354
Steuben501768
Wabash488692
Jasper483861
Jefferson474492
Ripley457777
Adams446068
Daviess4231108
Scott409165
Clay394957
White393858
Greene393392
Wells389884
Decatur388797
Fayette378578
Posey362341
Jennings356056
Washington334747
LaGrange325175
Spencer321136
Fountain318455
Randolph317190
Sullivan309449
Owen287064
Starke282864
Fulton280454
Orange277859
Jay257038
Perry254152
Carroll245229
Franklin242838
Rush237030
Vermillion235050
Parke221420
Tipton212055
Pike211740
Blackford170534
Pulaski168551
Crawford147318
Newton145845
Benton143916
Brown135846
Martin130217
Switzerland126910
Warren115616
Union98511
Ohio80511
Unassigned0482