Up next in fighting COVID-19: The challenges of rolling out vaccines 


December 3, 2020

James English of Washoe county, Nevada, is one of the hundreds of local public health directors across the US who will be tasked with distributing a vaccine. Photograph: Maggie Starbard/The Guardian


James English has a problem. It’s actually a problem many Americans have wanted him to have for many months now. 

English is the regional operations chief and health branch director for COVID-19 in Washoe County, Nevada. He is one of hundreds upon hundreds of local public health directors across the U.S. who will eventually help distribute COVID-19 vaccines. 

The challenges in rolling out one or more vaccines, once approved, are breathtaking, immense, and complicated — and they will cost money.  

Two – and possibly three – vaccines could soon be ready for public distribution. But how to safely and effectively distribute the vaccines in a nation with more than 300 million people? “My understanding is we could have a vaccine on site within a month or less….It may not be approved, but that is what I’m hearing and preparing for,” English recently told The Guardian. 

But even if the vaccines are determined to be safe and effective and approved for immediate use, much needs to be done in order to make safe distribution possible.  

One challenge is public education. Simply put, it is one thing to have an effective vaccine. It is quite another thing to have people actually vaccinated. “This is our best way out of this pandemic, so we want to recommend and encourage our community members to take the vaccine,” said Dr. Umair Shah, Executive Director of the Harris County health department in Texas. “What would be the worst is a vaccine that’s safe, a vaccine that’s effective, a vaccine that’s distributed, and vaccine systems now about to get vaccines in the arms of people – and people just don’t take it.” 

Another challenge with the vaccine is the specific conditions in which they must be transported and distributed. The leading vaccine candidates requires storage at -94°F (-70°C) which most pharmacies cannot accommodate since no other approved drug has needed a freezer that cold. One vaccine candidate, Pfizer, has developed a reusable shipping container that can hold 975 doses for 10 days using dry ice. The case cannot be opened more than twice a day for more than a minute per opening which means that healthcare workers must take out the right number of vaccines only twice a day to not risk damaging the other doses. English was able to purchase a freezer cold enough for the vaccine but the “vaccine still must be transported on dry ice from any location away from his deep freezer, and properly diluted before people receive a shot in the arm.” Once thawed, vials only last five days and can only be used for six hours after being diluted.

An ultra-cold freezer where vaccines can be stored. Photograph: Maggie Starbard/The Guardian

Yet another challenge facing the nation’s health care system is that most vaccines under development require two doses per person in order to be effective — which means that additional support will be needed for administration and record-keeping. “The Pfizer candidate also requires a second shot called a booster 28 days later,” The Guardian reports. “State health authorities advised English to give out all the doses he receives, and not keep any for the booster.” Since he won’t keep any for the booster, his department is expecting a new shipment of vaccines one day prior to the time for administering the booster shots, giving them a short time to coordinate and schedule the second round. 

Even if the U.S. is able to overcome these challenges, there remain other obstacles regarding distribution. Large institutions such as universities and airports will be needed to distribute the vaccine to their students and employees because local health care centers will not have the capacity to handle it on their own. Similar to the creation of COVID-19 testing centers, spaces like stadiums, theaters, and other large areas should be used as vaccination centers to help the community fight against COVID. But what about remote communities? As reported by NBC News,  American Indians and Alaska Natives have already experienced health care disparities due to “federal government’s chronic underfunding of tribal and urban health care systems, despite legal and treaty obligations to do so. Due to the pandemic, these tribal economies have collapsed, with the disease preventing any potential recovery from occurring, which is leading tribal leaders to question what a distribution plan will look like.  

For successful distribution and implementation of vaccines across the country, state and local governments will need to add additional support to their healthcare systems. Since the most likely vaccine candidates require two doses, the existing immunization registries would need to be expanded so people can go to any place for their second shot. Companies like Apple, Google, Oracle, and others are being called upon to provide their services for effective tracking and to help develop a universal system for reminding people about their second dose.  

Last but certainly not least: we can’t pull this off without adequate funding, and that’s where Congress comes in. Back in Nevada, English has $74,000 allotted for vaccine distribution planning – but these dollars and other funds he has for contact tracing provided under the CARES Act will expire on Dec. 31. Pharmacies and doctors’ offices can be used for convenient administration of the vaccine, but will need additional resources in order to purchase proper refrigeration and hire and train workers. 

Despite facing these challenges, English and his department are approaching these questions with optimism and believe that they can pull off their distribution plan. We’re counting on thousands of public health officials across the country to succeed. Congress must do its part too.