{"id":267417,"date":"2020-09-02T06:45:19","date_gmt":"2020-09-02T10:45:19","guid":{"rendered":"https:\/\/canadianinquirer.net\/v1\/?p=267417"},"modified":"2020-09-02T06:45:19","modified_gmt":"2020-09-02T10:45:19","slug":"health-officials-worry-nations-not-ready-for-covid-19-vaccine","status":"publish","type":"post","link":"https:\/\/canadianinquirer.net\/v1\/2020\/09\/02\/health-officials-worry-nations-not-ready-for-covid-19-vaccine\/","title":{"rendered":"Health Officials Worry Nation\u2019s Not Ready for COVID-19 Vaccine"},"content":{"rendered":"
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But health departments that have been underfunded for decades say they currently lack the staff, money and tools to educate people about vaccines and then to distribute, administer and track hundreds of millions of doses. Nor do they know when, or if, they\u2019ll get federal aid to do that. (Pixabay photo)<\/figcaption><\/figure>\n

Millions of Americans are counting on a COVID-19 vaccine to curb the global pandemic and return life to normal.<\/p>\n

While one or more options could be available toward the end of this year<\/a> or early next, the path to delivering vaccines to 330 million people remains unclear for the local health officials expected to carry out the work.<\/p>\n

\u201cWe haven\u2019t gotten a lot of information about how this is going to roll out,\u201d said Dr. Umair Shah, executive director of Texas\u2019 Harris County Public Health department, which includes Houston.<\/p>\n

In a four-page memo<\/a> this summer, the federal Centers for Disease Control and Prevention told health departments across the country to draft vaccination plans by Oct. 1 \u201cto coincide with the earliest possible release of COVID-19 vaccine.\u201d<\/p>\n

But health departments<\/a> that have been underfunded for decades<\/a> say they currently lack the staff, money and tools to educate people about vaccines and then to distribute, administer and track hundreds of millions of doses. Nor do they know when, or if, they\u2019ll get federal aid to do that.<\/p>\n

Dozens of doctors, nurses and health officials interviewed by KHN and The Associated Press expressed concern about the country\u2019s readiness to conduct mass vaccinations, as well as frustration with months of inconsistent information from the federal government.<\/p>\n

The gaps include figuring out how officials will keep track of who has gotten which doses and how they\u2019ll keep the workers who give the shots safe, with enough protective gear and syringes to do their jobs.<\/p>\n

With only about half<\/a> of Americans saying they would get vaccinated, according to a poll from AP-NORC Center for Public Affairs Research, it also will be crucial to educate people about the benefits of vaccination, said Molly Howell, who manages the North Dakota Department of Health\u2019s immunization program.<\/p>\n

The unprecedented pace of vaccine development has left many Americans skeptical about the safety of COVID-19 immunizations; others simply don\u2019t trust the federal government.<\/p>\n

\u201cWe\u2019re in a very deep-red state,\u201d said Ann Lewis, CEO of CareSouth Carolina, a group of community health centers that serve mostly low-income people in five rural counties in South Carolina. \u201cThe message that is coming out is not a message of trust and confidence in medical or scientific evidence.\u201d<\/p>\n

Paying for the Rollout\u00a0<\/strong><\/p>\n

The U.S. has committed more than $10 billion to develop new coronavirus vaccines<\/a> but hasn\u2019t allocated money specifically for distributing and administering vaccines.<\/p>\n

And while states, territories and 154 large cities and counties received billions in congressional emergency funding, that money can be used for a variety of purposes, including testing and overtime pay.<\/p>\n

An ongoing investigation by KHN and the AP has detailed how state and local public health departments across the U.S. have been starved for decades, leaving them underfunded and without adequate resources<\/a> to confront the coronavirus pandemic. The investigation further found that federal coronavirus funds have been slow to reach<\/a> public health departments, forcing some communities to cancel non-coronavirus vaccine clinics and other essential services.<\/p>\n

States are allowed to use some of the federal money they\u2019ve already received to prepare for immunizations. But KHN and the AP found that many health departments are so overwhelmed with the current costs of the pandemic \u2014 such as testing and contact tracing \u2014 that they can\u2019t reserve money for the vaccine work to come. Health departments will need to hire people to administer the vaccines and systems to track them, and pay for supplies such as protective medical masks, gowns and gloves, as well as warehouses and refrigerator space.<\/p>\n

CareSouth Carolina is collaborating with the state health department on testing and the pandemic response. They used federal funding to purchase $140,000 retrofitted vans for mobile testing that they plan to continue to use to keep vaccines cold and deliver them to residents when the time comes, said Lewis.<\/p>\n

But most vaccine costs will be new.<\/p>\n

Pima County, Arizona, for example, is already at least $30 million short of what health officials need to fight the pandemic, let alone plan for vaccines, said Dr. Francisco Garcia, deputy county administrator and chief medical officer.<\/p>\n

Some federal funds will expire soon. The $150 billion that states and local governments received from a fund in the CARES Act, for example, covers only expenses made through the end of the year<\/a>, said Gretchen Musicant, health commissioner in Minneapolis. That\u2019s a problem, given vaccine distribution may not have even begun.<\/p>\n

Although public health officials say they need more money, Congress left Washington for its summer recess without passing a new pandemic relief bill that would include additional funding for vaccine distribution.<\/p>\n

\u201cStates are anxious to receive those funds as soon as possible, so they can do what they need to be prepared,\u201d said Dr. Kelly Moore, associate director of immunization education at the Immunization Action Coalition, a national vaccine education and advocacy organization based in St. Paul, Minnesota. \u201cWe can\u2019t assume they can take existing funding and attempt the largest vaccination campaign in history.\u201d<\/p>\n

What\u2019s the Plan?<\/strong><\/p>\n

Then there\u2019s the basic question of scale. The federally funded Vaccines for Children program immunizes 40 million children each year<\/a>. In 2009 and 2010, the CDC scaled up to vaccinate 81 million people<\/a> against pandemic H1N1 influenza. And last winter, the country distributed 175 million vaccines for seasonal influenza vaccine<\/a>, according to the CDC.<\/p>\n

But for the U.S. to reach herd immunity against the coronavirus, most experts say, the nation would likely need to vaccinate roughly 70% of Americans<\/a>, which translates to 200 million people and \u2014 because the first vaccines will require two doses to be effective \u2014 400 million shots.<\/p>\n

Although the CDC has overseen immunization campaigns in the past, the Trump administration created a new program, Operation Warp Speed, to facilitate vaccine development and distribution. In August, the administration announced that McKesson Corp.<\/a>, which distributed H1N1 vaccines during that pandemic, will also distribute COVID-19 vaccines to doctors\u2019 offices and clinics.<\/p>\n

\u201cWith few exceptions, our commercial distribution partners will be responsible for handling all the vaccines,\u201d Operation Warp Speed\u2019s Paul Mango said in an email.<\/p>\n

\u201cWe\u2019re not going to have 300 million doses all at once,\u201d said Mango, deputy chief of staff for policy at the Health and Human Services Department, despite earlier government pledges to have that many doses ready by the new year. \u201cWe believe we are maximizing our probability of success of having tens of millions of doses<\/a> of vaccines by January 2021, which is our goal.\u201d<\/p>\n

Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said it will take time for the vaccines to be widespread enough for life to return to what\u2019s considered normal. \u201cWe have to be prepared to deal with this virus in the absence of significant vaccine-induced immunity for a period of maybe a year or longer,\u201d Adalja said in August.<\/p>\n

In preliminary guidance<\/a> for state vaccine managers, the CDC said doses will be distributed free of charge from a central location. Health departments\u2019 local vaccination plans may be reviewed by both the CDC and Operation Warp Speed.<\/p>\n

The CDC has vetted state and federal vaccination plans in five locations: North Dakota, Florida, California, Minnesota and Philadelphia. No actual vaccines were distributed during the \u201cmicroplanning\u201d sessions, which focused on how to get vaccines to people in places as different as urban Philadelphia, where pharmacies abound, and rural North Dakota, which has few chain drugstores but many clinics run by the federal Indian Health Service, said Kris Ehresmann, who directs infectious disease control at the Minnesota Department of Health.<\/p>\n

Those planning sessions have made Ehresmann feel more confident about who\u2019s in charge of distributing vaccines. \u201cWe are getting more specific guidance from CDC on planning now,\u201d she said. \u201cWe feel better about the process, though there are still a lot of unknowns.\u201d<\/p>\n

Outdated Technology Could Hamper Response<\/strong><\/p>\n

Still, many public health departments will struggle to adequately track who has been vaccinated and when, because a lack of funding in recent decades has left them in the technological dark ages, said Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials.<\/p>\n

In Mississippi, for example, health officials still rely on faxes, said the state\u2019s health officer, Dr. Thomas Dobbs. \u201cYou can\u2019t manually handle 1,200 faxes a day and expect anything efficient to happen,\u201d he said.<\/p>\n

When COVID-19 vaccines become available, health providers will need to track where and when patients receive their vaccines, said Moore, the medical director of Tennessee\u2019s immunization plan during the H1N1 influenza pandemic in 2009 and 2010. And with many different shots in the works, they will need to know exactly which one each patient got, she said.<\/p>\n

People will need to receive their second COVID-19 dose 21 or 28 days after the first, so health providers will need to remind patients to receive their second shot, Moore said, and ensure that the second dose is the same brand as the first.<\/p>\n

The CDC will require vaccinators to provide \u201cdose-level accounting<\/a> and reporting\u201d for immunizations, so that the agency knows where every dose of COVID-19 vaccine is \u201cat any point in time,\u201d Moore said. Although \u201cthe sophistication of these systems has improved dramatically\u201d in the past decade, she said, \u201cmany states will still face major challenges meeting data tracking and reporting expectations.\u201d<\/p>\n

The CDC is developing an app called the Vaccine Administration Monitoring System for health departments whose data systems don\u2019t meet standards for COVID-19 response, said Claire Hannan, executive director of the Association of Immunization Managers, a nonprofit based in Rockville, Maryland.<\/p>\n

\u201cThose standards haven\u2019t been released,\u201d Hannan said, \u201cso health departments are waiting to invest in necessary IT enhancements.\u201d The CDC needs to release standards and data expectations as quickly as possible, she added.<\/p>\n

Meanwhile, health departments are dealing with what Minnesota\u2019s Ehresmann described as \u201clegacy\u201d vaccine registries, sometimes dating to the late 1980s.<\/p>\n

A Historic Task<\/strong><\/p>\n

Overwhelmed public health teams<\/a> are already working long hours to test patients and trace their contacts, a time-consuming process that will need to continue even after vaccines become available.<\/p>\n

When vaccines are ready, health departments will need more staffers to identify people at high risk for COVID-19, who should get the vaccine first, Moore said. Public health staff also will be needed to educate the public about the importance of vaccines and to administer shots, she said, as well as monitor patients and report serious side effects.<\/p>\n

At an August meeting about vaccine distribution<\/a>, Dr. Ngozi Ezike, director of Illinois\u2019 health department, said her state will need to recruit additional health professionals to administer the shots, including nursing students, medical students, dentists, dental hygienists and even veterinarians. Such vaccinators will need medical-grade masks, gowns and gloves to keep those workers safe as they handle needles amid the contagious coronavirus.<\/p>\n

Many health officials say they feel burned by the country\u2019s struggle to provide hospitals with ventilators last spring, when states found themselves bidding against one another<\/a> for a limited supply. Those concerns are amplified by the country\u2019s continuing difficulties providing enough testing kits<\/a>; supplying health workers with personal protective equipment<\/a>; allocating drugs such as remdesivir<\/a>; and recruiting contact tracers<\/a> \u2014 who track down everyone with whom people diagnosed with COVID-19 have been in contact.<\/p>\n

Although Ehresmann said she\u2019s concerned Minnesota could run out of syringes, she said the CDC has assured her they will provide them.<\/p>\n

Given that vaccines are far more complex than personal protective equipment and other medical supplies \u2014 one vaccine candidate must be stored at minus 94 degrees Fahrenheit<\/a> \u2014 Plescia said people should be prepared for shortages, delays and mix-ups.<\/p>\n

\u201cIt\u2019s probably going to be even worse than the problems with testing and PPE,\u201d Plescia said.<\/p>\n

Associated Press writer Michelle R. Smith and KHN Midwest correspondent Lauren Weber contributed to this report.<\/em><\/p>\n

This story is a collaboration between The Associated Press and KHN.<\/em><\/p>\n

Subscribe<\/a> to KHN’s free Morning Briefing.<\/p>\n

KHN<\/a>\u00a0(Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.<\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

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