By Surabhi Dangi-Garimella, Ph.D.

Despite the initial stumbles, it looks like the wheels of the vaccination mobile have stabilized a bit in the U.S. Plans remain fluid on prioritizing who receives the vaccines developed to tackle the 2019 coronavirus disease (COVID-19) pandemic that has gripped the U.S. and the world, and states are revising their plans as they go as more data and vaccine doses become available.

Phased Approach and Where States Stand

The initial plans for vaccine distribution were developed when the first emergency use approval (EUA) by the FDA was visible on the horizon—the Pfizer-BioNTech COVID-19 Vaccine received an EUA on December 11, 2020, for the prevention of COVID-19 among those 16 years and older. The initial plans for the Phase 1a vaccination used guidelines laid out by a CDC Advisory Committee, which did warn that demand for the vaccine would far outstrip supply. The committee recommended that Phase 1a should include health care personnel and residents and staff of long-term care facilities.

EUA of a second vaccine, the Moderna COVID-19 Vaccine, on December 18, 2020, eased up the vaccine supply a little and an updated guideline emerged from the Advisory Committee on January 1, 2021. The committee recommended opening up Phase 1b of the COVID-19 vaccination plan for persons 75 years and older and for non-health care frontline essential workers (first responders; corrections officers; food and agricultural workers; postal, manufacturing, grocery store, and public transit workers; teachers and other school staff; and childcare workers) and Phase 1c for those in the 65-74 age group and in the 16-65 age group with a medical condition that puts them in the high-risk category.

The question is, how strictly have states been following these recommendations? According to the Kaiser Family Foundation, as of January 11, 2021:

  • Phase 1a: All 50 states and Washington, D.C. have been vaccinating health care workers and staff and residents at long-term care facilities, per the Phase 1a recommendation, but some went ahead and started vaccinating additional non-health care responders such as police and fire personnel, childcare staff, older adults, the homeless, and prisoners
  • Phase 1b: While 44 states expanded their vaccination reach per the CDC guidelines, 30 states accommodated additional age groups and started vaccinating those over 65 (recommendation is 75 years and older); Alaska went even lower (55 years and older). Interestingly, Washington state included those in the 50-69 age group living in multigenerational households. Some states restricted who would qualify as a non-health care essential worker; others included high-risk younger individuals in this phase.
  • Phase 1c: 16 of 33 states that implemented Phase 1c of the CDC guideline diverged from the recommendations; 6 widened the age group and 4 restricted who qualifies as an essential worker  

Logistical Challenges Are Causing Delays

Rollout efforts have witnessed significant challenges, from lags in distribution networks to limited staff that can administer the vaccines (since the pandemic continues to rage and hospitals continue to  influx of COVID-19 patients). In some places, the demand is so high that supply is not able to keep up and counties are running out of their vaccine stock.

State restrictions have created another stumbling block for delivery of the shots. In New York, for example, Gov. Andrew Cuomo was forced to ease eligibility restrictions after thousands of vaccine doses were under threat of being discarded—he partially opened up Phase 1b that allowed those 75 and older to receive the vaccines.

A commonly reported challenge in the clinic is the vial size—Moderna’s vaccine is packaged as 10 doses per vial, and the doses have to be used within six hours of the vial being punctured. Efficient use of the doses therefore needs careful planning, which can be thrown into disarray when folks don’t keep their appointments or decide against being vaccinated at the last minute—this is being reported, especially among health care workers. The federal government—then led by the Trump administration—left the on-the-ground planning of vaccine administration on overburdened hospitals and health officials who are simultaneously treating COVID-19 patients.

However, vaccine administration might ease up once it is opened up to the broader public, aided by agreements made by the federal government with pharmacy chains like Walgreens and CVS.

Plan by the Biden Government

Prior to his inauguration on January 20, 2020, President Joe Biden’s Transition Team shared a comprehensive national strategy for pandemic preparedness and response. This includes:

  • Using contract authorities, including the Defense Production Act, purchase of additional FDA-approved vaccines, and prioritizing supplies of glass vials, syringes, needles, etc. that can cause bottlenecks
  • Get maximum doses out into the community and not hold too many back—rather, monitor supply to ensure the booster shots are received on time
  • Encourage states to move through the priority groups more quickly, while ensuring that essential health workers and seniors receive their shots
  • Ensuring a quick, effective, and equitable vaccine supply for high-risk as well as hard-to-reach communities
  • Expand vaccination sites to include pharmacies and retail stores, community and rural health clinics, physician offices, urgent care centers, and mobile clinics
  • Compensate providers and states for the cost of administering vaccines
  • Expand the community-based healthcare workforce to improve vaccination efforts

While the plan seems solid, implementation and outcomes remain in the future. Announcing the deployment of FEMA and the National Guard to support the vaccination plan, President Biden said, “We didn’t get into all of this overnight, we won’t get out of it overnight either. But we will get through it.”

Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brought her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.