22 United States The EconomistNovember 28th 2020
21is the temperature in ultra-freezers rarely
found outside research laboratories and
big medical centres. To deal with that,
Pfizer will be distributing the vaccine in
“thermal shippers”, special containers
packed with dry ice designed to hold be-
tween about 1,000 and 5,000 doses. (It is
now designing a smaller version to make
distribution easier.) But the dry ice must be
replenished regularly, the container can be
opened only twice a day and, once taken
out, the vaccine lasts in a regular fridge for
only five days. When ready to administer, it
must be diluted with saline, which is also
not a common step for vaccines.
People handling the Pfizer vaccine will
need extensive training, says Ms Hannan.
“This isn’t something where you can watch
the video and then you are ready to go.” She
worries that these new procedures will
come at a time when hospitals and their
staff are overwhelmed and exhausted by
the flood of patients (see next story). Be-
cause of all the intricacies involved, a fair
amount of the first supplies of Pfizer’s vac-
cine may end up being spoilt.
Moderna’s vaccine is more in line with
what vaccinators are already used to. It
must be stored at -20°C, the temperature of
standard pharmacy freezers, keeps in a reg-
ular fridge for 30 days, comes in packs of
100 doses and does not need dilution. This
vaccine, if approved, would be delivered by
McKesson, a medical distributor that al-
ready delivers vaccines nationally.
Wherever the vaccines arrive, supplies
to do the jabs must turn up at the same
time. These will be distributed by McKes-
son in pre-assembled packs of the sy-
ringes, alcohol wipes, gloves and other
items needed for each covid-19 jab. Opera-
tion Warp Speed has been stockpiling these
through the summer—to avoid a repeat of
the fiasco with personal protective equip-
ment for health workers in the spring,
when state and federal authorities were
competing with each other in a mad scram-
ble for scarce global supplies.
At present, states and the Department of
Defence, which is leading the logistics of
vaccine distribution, are focused on pre-
paring for Pfizer’s vaccine. State authorities
have been enrolling vaccination providers,
drawing up lists of health workers and oth-
ers who need to be vaccinated first, and set-
ting up systems to keep track of vaccines.
They have just started doing “dry runs”,
placing vaccine and syringe orders into the
national system and practising what they
will be doing with Pfizer’s thermal shippers
(which, for now, arrive with empty vials).
The logistics of moving vaccines
around will be complicated. The really
hard part, though, will probably be con-
vincing people to take them. America’s
plan is to make vaccination available free at
all the usual places where people get their
flu shots, such as pharmacies and doctors’surgeries. The federal government is set-
ting up a fund to cover providers’ fees for
the jab for the uninsured; health plans will
cover this fee for their members.
Many immunisation experts worry that
this “build it and they will come” approach
is naive. At the moment, surveys suggest
that anywhere between 20% and 60% of
Americans may not accept a covid-19 vac-
cine. In one survey only a third of nurses
said they would voluntarily get vaccinated.
Some people are worried that the vaccines
may not be safe, suspicious that corners
may have been cut in the rush to develop
them so quickly. Others have seen various
kinds of alarming misinformation. Mud-
dled messages from various political lead-
ers have also done their share of harm.
All vaccinators, therefore, must be well
trained to answer people’s questions about
the risks and benefits of the vaccine, poten-
tial side effects, the longevity of protection
and so on. But such training has not yet
started, partly because this sort of box-in-
sert information will be published official-
ly as part of fda’s decision on the vaccine.
In some places, such as Washington, dc,
health departments have started talking to
community leaders to get a sense of the
particular concerns of various groups. Me-dia campaigns to encourage people to get
vaccinated will be important.
All this will throw up unfamiliar chal-
lenges. Unlike many other countries,
America has a more “passive” approach to
vaccination and is not used to doing big
immunisation campaigns, says Tom Ken-
yon from Project hope, a health non-profit,
who used to lead the cdc’s global health
programme. This works for childhood vac-
cination. But covid-19 is different. Lots of
mini vaccination drives to cover specific
groups, such as frontline workers, will be
crucial, says Dr Kenyon.
This sort of groundwork, training and
campaigning is expensive. The Association
of Immunisation Managers estimates that,
all told, state and local authorities will
need $8.4bn. The cdchas put the total at
around $6bn. So far, however, states have
received only $200m for vaccination prep-
aration, and a promise of another $140m
this year. Approval of a big federal pot of
money for this has been caught up in the
political wrangling in Washington. The
Moderna vaccine, developed with Ameri-
ca’s National Institutes of Health, is a tri-
umph of American science. Failing to vac-
cinate enough people to stop the virus
would be a failure of American politics. 7“W
e as physiciansstruggle to con-
ceive of the idea of exponential
growth,” says Dan Runde, of the emergency
medicine department at University of Iowa
Hospitals and Clinics, in Iowa City.
“There’s so short a window. You go from
barely handling things, to not at all. It’s so
fast.” He recalls how Iowa had some 700 pa-
tients in hospital infected with covid-19 at
the start of November. A few weeks later, he
says, that tally had doubled. At times al-
most every icu bed is filled.
His hospital, like others, tried preparing
for such a surge. In-patients, where possi-
ble, were sent home; a dozen new icu beds
were added; some elective surgeries were
postponed. Then staff watched in alarm as
nearly one in every two covid-19 tests run
in Iowa turned out positive, foretelling a
surge in hospitalisation—and deaths. His
hospital, the state’s best-equipped, takes in
patients from far and wide when others
can’t cope. That already means an “aggres-
sive triage process”. “We’re already getting
to the line to be full. We have to start saying
no. If you’re not going to die in the next sixto 12 hours, then you have to wait,” he says.
Iowa’s hospital system is not over-
whelmed, but it could be soon, just as
wards are rapidly filling in Ohio and Penn-
sylvania. “I’m very concerned, bordering
on terrified,” says the doctor. He worries
that members of the public, and governing
politicians, don’t grasp what happensCHICAGO
Covid-19 is killing over 550 Midwesterners every dayThe virus and the heartlandView from the ICU
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US, covid-19, daily cases per million people
2020, Seven-day moving averageSource:COVIDTrackingProject1,0008006004002000
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