Research | Can We Make Vaccine Rollout Faster?

Introduction

As the number of cases and deaths rapidly rose in March 2020, pharmaceutical companies had furiously scrambled to find the vaccine and/or drug that will help us all return to normalcy. Near the end of 2020, two companies came up on top with their mRNA vaccine: Pfizer and Moderna. With both publicly stating that their vaccine had a >90% efficacy in their trials, hope, medically and economically, significantly increased for the upcoming year; reopening, finally, became a possibility in the relatively near future.

Of course, initially, skeptics had their doubts about these vaccines as they were incredibly fast-paced in their development and have never been made this quick previously. In fact, for Influenza, scientists took decades of research on the virus itself, and only after completing this process was the vaccine developed as a preventative tool.

However, now, the central issue does not lie in the vaccine's efficacy but its distribution speed. While Operation Warp Speed had unequivocally accelerated the production and development of the vaccine, distribution was its major shortfall.

Rollout

In December of 2020, Pfizer stated they have fulfilled every shipment that the government has requested, and millions of doses were merely sitting in a federal warehouse. This declaration was in response to former Health and Human Services Secretary Alex Azar's public comments that essentially blamed the distribution issues because of the "production challenges" that Pfizer was facing early on in the process. With considerable uncertainty, many had turned to the states to see their viewpoint on the entire situation. As previously stated by NPR, "Washington Gov. Jay Inslee says the Centers for Disease Control and Prevention has told his state that its vaccine allocation 'will be cut by 40 percent next week — and that all states are seeing similar cuts.' The federal government did not give an explanation, he said. 'This is disruptive and frustrating,' Inslee added. 'We need accurate, predictable numbers to plan and ensure on-the-ground success.'" The situation was alarmingly confusing for many of our leaders as no one had an honest answer to why specific actions were taking place.

Furthermore, Washington state was not the only victim of this unstable situation because Idaho, early on, too, was told that the number of doses allotted to their state was going to reduce from 17,550 to 9,750. The goal at the end of 2020 was for 20 million vaccinated, but with only 2.8 million administered by December 31st, severe logistical barriers had prevented the vaccine from getting in everyone's hands. Even today, March 28th 2021, the vaccine has only widely been available for those with pre-existing conditions. Though this is a vital demographic and an important step in the right direction, herd immunity won’t be achieved until a majority of the United States’ population receives the vaccine.

Sadly, countless have been denied access because medical facilities simply do not have enough vaccines supplied to adequately compensate the immense demand. While large manufacturers of vaccines and the federal government have pointed fingers at each other, innocent people are still dying, which then begs why this is the case?

Why Are We in This Situation?

At the end of 2020, significant issues in the vaccination rollout process, such as the 42 people in Boone County, W.VA who were supposed to receive the vaccine but instead received experimental monoclonal antibody treatment, needed to be addressed along with the lack of personnel in administering many of these vaccines. Dr. Ashish Jha, the dean of Brown's University School of Public Health, previously voiced this concern as well: "We've taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people's arms." With considerable uncertainty, the citizens, who are being adversely affected by this complex process, are trying to pinpoint the problem.

Federal officials, part of Trump's Operation Warp Speed program, had denied blame for the rollout speed, stating that their job was to "ensure that vaccines are made available." With the blame game virtually counterproductive to the public's well-being, many health institutions found that the task of managing the pandemic (testing, contact tracing, disease control, etc.) and administering vaccines to the general public was far too arduous to accomplish effectively.

Throughout the process, Pfizer, Moderna, and other global vaccine providers have asked the public to be patient as the distribution of this scale has never been done before. In fact, concerning previous vaccine distribution, the current pace of rollout is not that shocking. Furthermore, this vaccine is unique in that it uses a particular type of molecule: mRNA. Not only is it hard to manufacture these molecules in immense quantities, but it is also challenging to store due to the necessary freezing temperature requirements. For these reasons, some argue that the media is inflating the issue.

Regardless, with this extraordinary miscommunication between partnering organizations, storage issues, and lack of infrastructure for distribution of this scale, it is no surprise that America and other leading nations are facing problems to place these vaccines in every single person’s hands. However, there is always room to improve, and some states, people, and institutions have demonstrated this in the past.

How Do We Improve?

On a larger scale, we must create a lasting cohesion between the state and the federal government. Like the wartime mobilization periods of America in the 20th century, we must instill a sense of urgency and national effort in the process. By setting goals to keep all clinics open from 6 am to 6 pm on the weekends, providing additional staff for vaccine centers, and establishing more mass vaccine sites, the federal government could efficiently speed up the process in several states.

Some believe the one issue that could be hindering the distribution speed has been the hesitancy among the citizens to take the vaccine because of the spread of misinformation on social media about "certain" adverse effects some are experiencing. One intriguing method to solve this issue, developed by the Vanderbilt University Medical Center, is an educational program that occurs for 4-6 weeks before delivery. This program will include information in the form of videos, Q&As, and social media outlets. If more states can provide such programs to their citizens and broadcast them on cable television, people will be more ready to take the vaccine. Furthermore, more states should consider sending health care workers and professionals to many communities as an outreach to provide information on the vaccine and reduce hesitancy.

Another substantial issue, that many point to for the lack of progress in many states, is funding. In December, US lawmakers approved $8.7 billion solely for vaccine distribution. Because many medical clinics, hospitals, and pharmacies were "stretched thin" from the influx of COVID patients, they needed additional funds to take on vaccinations. Many of these medical clinics didn't have adequate staff for administering vaccines to the point where they had to ask retired medical professionals for help.

In addition, as of March 11th, 2021 President Biden signed the American Rescue Plan Act that promised to provide $7.5 billion in funds towards vaccine distribution and administration. This attempts to enable states in purchasing additional methods for vaccination, hiring more workers, and contacting communities of color who are disproportionately affected by this pandemic.

With the FDA’s approval of J&J's vaccine, their vaccines have helped solve the previous shortage in supply. In combination with training for administering the vaccines, an increase in vaccines' supply can only help to get it in more citizens' hands. Furthermore, J&J's vaccine doesn't need ultra-cold storage, which will help speed up the process and bypass any dry ice packaging needed for Pfizer and Moderna's vaccines. Though states are still unsure exactly when shipments come and how large shipments are, supply predictability continues to improve over time.

Case Study: Israel and West Virginia

From the Start, Israel has been the most efficient country for vaccine rollout, a helpful case study for most American and European countries. Its vaccine distribution started on December 19th, 2020, giving priority to the high-risk demographics: those over the age of 60, pre-existing conditions, and health workers. As of January 8th, Israel had vaccinated ⅛ of the population and has continued to excel in vaccine distribution compared to the US that had vaccinated 1/55th of the population (6 million of the 330 million people in the US have been vaccinated). But what has Israel truly been doing that the US and other leading countries haven't?

The main actions that Israel has stressed are planning, having large information campaigns, and receiving the people's trust. Dr. Boaz Lev, chair of the advisory committee for epidemic control and COVID Vaccines at Israel's Ministry of Health, tells CNBC that it's all about "a good flow of vaccines, a good flow of people… with a good administrative background so that you can register them and they know when to come for their next jab. So there's a variety of things involving planning ahead basically, and having it rolled out so it flows."

Of course, this takes extraordinary planning, and Israeli officials understand this. Lev tells CNBC that logistics are the backbone of this effort, and for this process to be successful, a combination of planning and establishing correct stepping stones is vital.

Though some of Israel's success can be attributed to its small geography and population, its health care system has always been tight-knit regarding communication. The health system requires every citizen to belong to one of the four health care maintenance organizations (HMOs), and through these HMOs, people are provided the vaccine. Because of excellent logistics, efficient planning, and cohesive communication, these vaccines have been administered to 60% of Israel’s population, 50% of which have received both doses.

Another interesting case study that may be more applicable for the American health infrastructure is what West Virginia has done for vaccine distribution progress. Unlike most states that chose the federal plan, partnering with immense chain pharmacies such as Walgreens and CVS for vaccine distribution, West Virginia felt, because of its tucked-away communities (those far away from big-chain pharmacies), it would be better to use a network of independent pharmacies. In combination with 200 long-term care facilities, this network enabled West Virginia to complete the first round of vaccinations by the end of December.

Furthermore, West Virginia is using the National Guard to aid in its vaccine operations. With their experience, Jim Kranz has said that "they are logistical experts," and he believes they don't need written plans to distribute vaccines effectively. Though it is pretty counter-intuitive, officials have opted to meet in-person rather than over Zoom because of increased productivity and work level. Agreements over simply categorizing vaccines would take a more extended period on Zoom when compared to meeting other officials face-to-face.

Though relatively trivial, many large cities and states in America have promised vaccines and then rescinded their statement because they ended up not having enough vaccines. However, West Virginia has opted only to provide appointments to select citizens when they have the vaccines in their hands to build trust between the people and the government.

West Virginia has had minor problems in the past but its only significant barrier is supply, which J&J's additional vaccines can solve.

Conclusion

Of course, over time, the US and other countries will solve current logistical and informational issues. Still, as a collective, to truly contain the number of lives lost and place the vaccine in people's hands, we must listen to our experts and follow the path of successful countries. To achieve President Biden's mission of having everyone fully vaccinated by the end of May, we need to provide information to the public, set up mass-vaccination sites, and provide funding to hospitals/healthcare centers to surpass these issues. By purchasing an additional 200 million doses and increasing the minimum weekly vaccine shipments from 8.6 to ten million, the President has attempted to solve one problem: supply. But with the help of Biden’s $7.5 billion in funding, prominent city officials may no longer need to scamper to find shipments for doses or clinics ready to administer them. However, the infrastructure to support distribution has not yet been made readily available for people who want to take the vaccine. The fact of the matter is that at this very moment, the commoner doesn't have the vaccine in his/her hands. The solution? Resources, Guidelines, Coordination, and correct information. Continual improvement is necessary at every step.