A 'come as you are' vaccination plan
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The uncoordinated and sluggish distribution of COVID-19 vaccines is turning into one more step in the United States’ “come as you are” pandemic response. As of Dec. 29, 2.13 million doses of the Pfizer and BioNTech’s vaccines had been administered — a fraction of the stated year-end goal. Government officials have called the early roll out “slower than we thought it would be” and admitted early distribution mistakes.

Without improvement on distribution, the advantages of the unprecedented speed of vaccine development might be squandered. The results will be measured in more infected Americans, additional lives lost, and further delay in recovering.

Operation Warp Speed is a partnership among several federal agencies including the Department of Health and Human Services and Department of Defense. A primary mission of OWS was to prepare for the delivery of 300 million doses to the American public. It reflects the federal part of getting a vaccine distributed throughout the country.

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However, in a sense, that is the easiest part of the distribution process. The larger challenge is the last tactical mile — the distribution that must occur at the state, local, tribal and territorial levels. If failure occurs there, the rest of the efforts will have been for naught.

To understand the planning shortfalls and slow execution, one must look at the system that has been developed for vaccine distribution. OWS only planned for moving vaccines from manufacturing plants in the United States to local distribution points, at which point state, local, territorial and tribal authorities become responsible for further distribution and administering the vaccine through a mix of public and private industry vendors.

This requires a centralized federal system with accurate, real-time information on vaccine availability that must be seamlessly integrated with perhaps thousands of highly decentralized local systems that include hospitals, outpatient clinics, pharmacies, long term care facilities, doctors’ offices, Indian Health Services, public health clinics, mobile units, and federal entity sites.

This may work for reaching the prioritized health workers and first responders followed by those with comorbidities and living in congregate settings — about 15 percent of the population. However, such a decentralized approach likely will prove challenging once the general population starts to be vaccinated.

Already several state governors have raised concerns about unnecessary delays, shorting of deliveries and an inability to get accurate information on the status of anticipated deliveries. The story of a Michigan doctor making a 140-mile trek to deliver vaccines from a hospital to rural health care workers illustrates the distribution challenges ahead.

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The magnitude of the problem will only increase unless a streamlined process to vaccinate the remaining 85 percent of the population is identified. Clinics, pharmacies and doctors’ offices likely won’t be able to provide the necessary throughput and the vaccination timelines will stretch out for months more.

The uncertainty of relying on state, local, tribal and territorial authorities for vaccine distribution also will be exacerbated by 20 years of underfunding of their public health capacities. These shortfalls have already been evident in the COVID-19 testing and contact tracing initiatives that were undertaken within local communities — and those needed to reach only a fraction of the population. The decision by Congress to not fund state and local governments as part of the latest COVID-19 relief package will likely only worsen the situation.

Finally, there’s been a failure to communicate to Americans what they should expect about when and how they will get vaccinated. Much effort has gone into convincing the public the vaccine is safe and effective, and those efforts seem to be bearing fruit as polling suggests that more people have expressed a willingness to get the vaccine once their turn comes up. Now the message needs to shift to when and where the general population are likely to be able to obtain a vaccine.

A “come as you are” approach may not ensure that every person desiring to get vaccinated can do so as soon as possible. Stringent planning, timely execution and clear communications will be key to the success of the COVID-19 vaccination program and ultimately to the broader recovery.

Daniel M. Gerstein is an adjunct professor at American University. He formerly served as the undersecretary (acting) and deputy undersecretary in the Science and Technology Directorate of the Department of Homeland Security from 2011-2014.