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The launch of the coronavirus vaccine in the United States had a slow start, as states struggle with logistical challenges.
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Public health experts fear that the next round of vaccinations, for the elderly and essential workers, will be even more chaotic.
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Several state health departments have told Business Insider that they are still working out the logistics of who will be vaccinated next and how that process will happen.
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It is not clear whether individuals will need consultations. But the distribution of vaccines on a first-come, first-served basis can cause long lines and health risks.
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The news came in a press release last weekend: Elderly residents of Lee County, Fla., Could receive coronavirus vaccines on a first-come, first-served basis.
In the hours and days that followed, hundreds of people aged 65 and over lined up outside vaccination sites. Some endured temperatures as low as 47 degrees Fahrenheit while camping overnight. Most sites reach capacity before 7 am every day – two hours before opening.
It was a preview of what a broader vaccine implementation would look like without adequate preparation and communication.
In most states, vaccines are currently being distributed first to health professionals and residents of long-term care facilities. These are among the easiest groups to vaccinate: Health workers get vaccinations at their workplace, so it is not difficult to check your eligibility or instruct them where to appear. Meanwhile, CVS and Walgreens are traveling to individual facilities to vaccinate nursing home residents.
But the next round of vaccinations is likely to be more difficult to administer.
“It is going to get a lot uglier,” Dr. Ashish Jha, dean of the Brown University School of Public Health, told Business Insider.
The Centers for Disease Control and Prevention recommended that states prioritize key frontline workers and people aged 75 and over in their next vaccination phase. This category is much larger than the previous one, with an estimated 49 million people. The initial groups totaled just 24 million people. Furthermore, the status of “essential worker” can be difficult to define and can vary from state to state.
Many state health departments, including those in Colorado, Connecticut, Indiana, Maryland, New Jersey, Pennsylvania, Vermont and Virginia, told Business Insider that they are still evaluating the logistics of who will be vaccinated next, how individuals will be prioritized, and which locations will help with immunizations. Some departments said they hope to finalize the parameters in the next few days or weeks.
This timeline is very slow, said Jha.
“We are not months away from vaccinating 80-year-olds,” he said. “Hopefully, we’re weeks away from vaccinating 80-year-olds. I don’t understand how we’re going to do that, and nobody else does.”
Vaccination of essential workers presents new challenges
For the most part, state health departments say vaccines will be available in some combination of local hospitals, health departments, pharmacies, doctors’ offices and health centers qualified by the federal government. The federal government has partnered with major pharmacy chains such as CVS, Walgreens and Walmart.
Vermont said it is forming its own partnerships with pharmacies and already has relationships with local hospitals, but gave no further details. Illinois said it would work with pharmacies and also deploy mobile vaccination teams in vulnerable communities. Texas said the decisions and procedures would be left to each of the 50 individual local health departments.
It is not yet clear whether people will have to make appointments to get vaccinated in these or other states, or whether we will see more queues. The Colorado health department told Business Insider that consultations may be available “in some cases”.
“I’m not seeing uniformly concise and clear communication on how to get the vaccine as it is being launched in a more public forum outside, say, hospital staff,” said Marissa Levine, professor of public health at the University of Southern Africa. Florida, told Business Insider. “People need to know how to get the vaccine, when to get it and who should get it, and then how these decisions are being made.”
Having people in line, she added, “seems like a very dangerous way to do that.” Coronavirus hospitalizations reached peak levels – more than 120,000 a day – in the United States, and the country reported its highest number of daily deaths on Wednesday: more than 3,700. Encouraging vulnerable groups to meet in lines can fuel transmission.
It is also unclear what type of identification states will require to verify that people are in priority vaccine groups. Health officials in Lee County, for example, asked health professionals to provide a copy of their identification badge or an updated paycheck.
“If you are a nurse or pharmacist at CVS, how do you check if someone is a public transport worker?” Jha said. “Do you need a letter from the HR department? Can anyone forge a letter?”
He added that states are “overwhelmed” to solve these problems on their own.
Vaccination sites remain in the dark
According to the CDC, states should have enough vaccines to start vaccinating essential workers and people over 75 in January, and then completing those vaccinations in February.
But even the big healthcare systems aren’t sure how it will go down. In a statement to Business Insider, Kaiser Permanente, one of the country’s largest health systems, said it is working with state officials, but acknowledged that “we still don’t know how each state will approach this process”.
Three major primary care networks recently told Business Insider that they do not know when to expect vaccines for their own healthcare professionals, let alone patients. They also don’t know how many doses are coming or what to tell patients who call to ask when they can get their injections.
“We are not receiving much information from state health departments, pharmacies or hospitals right now about when we are going to commit,” Dr. Jason Lane, an infectious disease physician at ChenMed, a Miami-based primary care company, said.
Dr. Emily Maxson, medical director at Aledade, a chain of independent medical practices, said the vaccine distribution plan so far is “completely a mystery to frontline providers”.
‘A complete mess of a national launch’
The United States has sent about 12.4 million doses of the vaccine so far, but less than 2.8 million people received injections on Wednesday morning, according to the CDC. Data delays mean that the real number could be higher: Bloomberg’s tracker suggests that nearly 3.5 million Americans have been vaccinated by Friday.
In any case, this is nowhere near the Trump administration’s goal of vaccinating 20 million people by the end of 2020.
In a press release on Wednesday, Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, attributed the slow rate of vaccinations to the Christmas holiday and confusion over how many doses were available.
“We knew that vaccines were coming in December,” said Jha. “This is not a surprise – and you would have thought that the entire infrastructure, all the planning, the data infrastructure, everything would have been set up months ago so that on the day the vaccine was authorized, it could have been shipped and could have started to go into people’s arms. “
The patchwork nature of the deployment, however, placed the burden on the already overburdened state health departments.
Local authorities were tasked with coordinating vaccination schedules and, at the same time, facing a tsunami of sick patients. Many health departments do not have the funding to hire enough staff to administer doses in large batches. Others have no experience transferring thousands of doses of local deposits into the arms of individuals – what experts call the “last mile” challenge.
“Vaccines on the shelves are doing nothing while thousands of Americans are dying,” said Jha. “This is a scam. This is the most ridiculous example of our country’s incredible ability to be innovative in the production of the vaccine, but of our government’s inability to help get it to people.”
The recently approved coronavirus relief package gives states about $ 8 billion to help with these vaccine delivery problems. President-elect Joe Biden said he would need even more funding from Congress to achieve his goal of vaccinating 100 million people in his first 100 days in office.
“The Trump team is delivering a complete mess of a national launch,” said Jha. “The Biden team is going to have a lot of hard work ahead of them.”
Shelby Livingston contributed reporting.
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