The New York Times - USA (2020-11-15)

8 N THE NEW YORK TIMES, SUNDAY, NOVEMBER 15, 2020

Tracking an OutbreakStopping the Spread

for further funding are caught up
in the stalemate between House
Democrats and the Trump admin-
istration over the coronavirus
stimulus bill.
“There’s a lot of anxiety,” said
Rebecca Coyle, executive director
of the American Immunization
Registry Association, which has
been helping states prepare. “I
don’t think we are ready today.”
Congress has allocated $10 bil-
lion to Operation Warp Speed, the
federal effort subsidizing vaccine
companies’ clinical trials and
manufacturing costs. Dr. Mandy
K. Cohen, the secretary of health
and human services in North Car-
olina, said her state had received
just $6 million for distributing and
promoting the shot. She expects
$3 million more by the end of the
year and called the money “a
down payment” for what is likely
to be $30 million worth of work
over the first year of vaccine dis-
tribution.
Dr. Nirav Shah, director of the
Maine Center for Disease Control
and Prevention, said that more
than anything, insufficient fund-
ing would slow the rate of vaccina-
tion, particularly among disad-
vantaged populations that are
harder to reach.
“The speed at which we vacci-
nate the population in Maine is di-
rectly dependent on the funding,”
he said. “We will still get the job
done, but it will take longer if I
can’t train the people to give it.”
There are myriad other costs
too — including, Dr. Shah noted,
paying for secure convoys to
transport the vaccine once it gets
to states. “We can’t just throw it
into Bob’s pickup truck and drive
it down the road.”
One official working on distri-
bution plans at the C.D.C., who did
not have authorization to speak
publicly, said the slow drip of
money had made it difficult for
states to carry out plans and to
hire for vaccine-related jobs.
“It’s unfortunate and inefficient
to do it this way,” the official said.
Preliminary plans that almost
every state has shared with the
C.D.C. offer a glimpse of urgent
preparations for a mass vaccina-
tion campaign larger than the
United States has ever seen. Al-
though the vaccine will be avail-
able to only a very small slice of
Americans at first, probably start-
ing with health care workers, ac-
cess could expand rapidly over
the first half of 2021.
Michigan is enlisting pharma-
cies to tell their customers with
chronic conditions — like diabe-
tes, asthma and high blood pres-
sure — about the vaccine, as they
will be prioritized to get it. Tennes-
see is recruiting more than 1,
volunteer doctors and nurses to
help administer the vaccine ini-
tially. Nebraska is making plans to
promote it on gas station video
screens and in robocalls. New
Hampshire — the only state with-
out an online immunization regis-
try — is scrambling to build one to
track which residents have re-
ceived the shot and to report the
information to the C.D.C.
The first vaccine that is likely to
be authorized by the Food and

Drug Administration, made by

Pfizer, comes with especially

daunting logistical challenges, in-

cluding the fact that every recipi-

ent will need a booster shot three

weeks after the initial dose. Keep-

ing track of which people need the

follow-up dose, and getting them

to return for it, are among the

steepest hurdles public health of-

ficials face. So is a requirement

that providers report, for every

dose administered, demographic

and other data to their state

within 24 hours; states, in turn,

will quickly report it to the C.D.C.

A new federal platform, called

the Immunization Gateway, aims

to connect state vaccine registries

so they can share information

with one another — for example, if

someone gets an initial coronavi-

rus vaccine in New York and then

goes to Florida for the winter, a

doctor there can look up that per-

son’s first dose information in or-

der to give the correct second

dose. But most registries have not

yet connected to the platform. Be-

tween that and another new fed-

eral platform to track vaccines,

public health officials are haunted

by the spectacular crash of

HealthCare.gov, the federal online

insurance marketplace set up un-

der the Affordable Care Act, when

it went live in 2013 after being fin-

ished in a rush.

“A month before the vaccine is

about to become available is not

the time to think about making

systems across 3,000 health de-

partments in 50 states interoper-

able,” said Lori Freeman, chief ex-

ecutive of the National Associa-

tion of County and City Health Of-

ficials. “It just doesn’t work.”

Addressing Americans’ wari-

ness toward the vaccine — recent

polls show that between a third

and half of Americans would be re-

luctant to get it — is also hard,

some state officials said, given

that none has been approved yet

and comprehensive safety data

from the ongoing clinical trials

has not been released.

“We don’t really have the safety

studies available to quote from,”

said Dr. Jennifer Dillaha, the Ar-

kansas state epidemiologist and

medical director for immuniza-

tions. “What we’re trying to do is

develop relationships with people

and organizations that can help us

with messaging when the time

comes.”

Other unknowns include how

many doses of vaccine each state

will initially receive, which groups

will the C.D.C. will recommend to

get it first and even whether

states need to worry about build-

ing the ultracold storage capacity

needed for the Pfizer vaccine.

The C.D.C. has told states and

localities not to buy ultracold

freezers for now, since the Pfizer

vaccine will be shipped in coolers

with dry ice that can keep it viable

for up to 15 days with re-icing; it

can then last five additional days

in a conventional freezer. But

many academic medical centers

and other hospitals that can afford

it are acquiring colder freezers

anyway, setting up a have and

have-not scenario.

Record-keeping requirements

will also be an overwhelming task,

officials said. The C.D.C. wants to

track, in real time, the age, sex,

race and ethnicity of everyone

who is vaccinated — states usu-

ally provide such data quarterly,

at best — so it can analyze how

well the vaccination campaign is

going among different demo-

graphic groups day by day and

make adjustments if certain popu-

lations or regions have low vacci-

nation rates. The C.D.C., which

holds frequent planning calls with

state and local health officials, is

also still working on persuading

states to hand over the personal

data of their citizens. The agency

has requested each vaccine recipi-

ent’s name, date of birth, address,

race, ethnicity and certain medi-

cal history.

As soon as the F.D.A. approves a

vaccine, the C.D.C.’s Advisory

Committee on Immunization

Practices will meet to issue rec-

ommendations, already in the

works, on how it should be distrib-

uted. It will almost certainly say

that health care workers should

be the group with the highest pri-

ority for vaccination, followed by

essential service workers, people

with high-risk medical conditions

and those older than 65.

But states will be allowed flexi-

bility within those guidelines;

Maryland, for example, plans to

include its prison and jail popula-

tions in its “Phase 1” priority

group. State officials also have to

figure out whom to focus on within

priority populations if they get

less vaccine than they need.

During the C.D.C. advisory

committee’s meeting last month,

some members said they wanted

to ensure that information about

any safety problems would be

made public quickly. Until now,

the F.D.A. and the C.D.C. have

maintained one data system for

patients or providers to report bad

reactions to vaccines. They plan

to supplement that system with a

smartphone-based tool that

checks in with individuals who

have been vaccinated to see

whether they have had any health

problems.

The C.D.C. advisory group has

also stressed the importance of a

campaign to persuade the public

to take the vaccine, noting that

messages were likely to be more

effective if they came from com-

munity leaders than from the fed-

eral government. North Carolina

says its campaign will use “pho-

tos, video, and personal testimony

of celebrities, leaders of histori-

cally marginalized populations,

and other trusted messengers re-

ceiving vaccine as early adopt-

ers.”

To ease the burden on health de-

partments, the federal govern-

ment is contracting with CVS and

Walgreens pharmacies to vacci-

nate residents of nursing homes

and other long-term-care centers

around the country. But it could be

difficult to reach those in isolated

regions, and some might opt out of

the program. Last week, the ad-

ministration announced the fed-

eral government would contract

with pharmacies to provide the

vaccine generally, as they do with

flu shots, once supplies of it in-

crease next year.

Christine Finley, the immuniza-

tion program manager at the Ver-

mont Department of Health, said

her focus right now was enrolling

hospitals to provide the first doses

to health care workers and pre-

paring a communications strat-

egy.

“There are so many questions

we’ve received,” she said, “and so

much interest, with the disease

rate soaring — people saying, ‘We

need a vaccine, now.’ ”

States Are Unprepared for the Logistics, and Cost, of Distributing Shots

ROBYN BECK/AGENCE FRANCE-PRESSE — GETTY IMAGES

PFIZER/VIA REUTERS

Above, lining up for tests at Dodger Stadium in Los Angeles this

summer. Supplies of the vaccine will be available to only a few at

first, so states and cities must decide who will be first in line.

A VACCINE

Federal funds have

largely been reserved

for drugmakers.

From Page 1

Salvador Dali (1904-1989)

Le Mur des Lamentations (The Western Wall), 1975

Oil and gouache on canvas

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Leon Benrimon

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The Daredevil, 1962

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