By now, we know that there are at least two potentially highly effective Covid-19 vaccines that may soon be available on an Emergency Use Authorization from the FDA.  Fantastic news.  When that happens, these vaccines will have to be distributed and administered.  How will that work?

Let’s look at these parameters:  Logistics, Priorities, Administration Process, Labor and Cost.  I’m only going to look at this from the perspective of the United States.  But we have to understand that this is a global concern.

Logistics:  We’re told that there is a plan to use the existing network of distributors of drugs and medical supplies although, the current administration seems to lean toward distributing the vaccines to the states and allow them to handle it from there.  How has that plan worked out so far in controlling the pandemic?  The Pfizer vaccine must be stored at –70 degrees Celcius.  It is rare to find freezers currently in use in the network that will maintain this temperature.  Pfizer has developed a suitcase sized container that can be used to transport the vaccine safely but it’s good for only 10 days.  The dry ice in the container can be replaced to extend the life of the vaccine but we’re told that dry ice is in short supply and may be unavailable in rural areas.

Priorities:  We hear a lot of discussion about the right priorities for the vaccine, i.e., who will be vaccinated in what order.  Front line health care workers, residents in nursing homes and other senior facilities, those with comorbidities, workers in “essential” roles (grocery store workers, food processing plant workers, etc.), those over 65, delivery drivers, military personnel, police, racial groups disproportionately impacted, homeless and indigent people, etc.  Perhaps it’s better to identify “hot spots” and address them as a priority.  What about a random distribution based upon a birthday lottery?  What about privilege?  Do you think the wealthy and the politically connected might put themselves and their family at the front to the line?  You decide the best priority.  You can be sure that this debate will play out at every level once the vaccine becomes available.  For now it’s a philosophical discussion.  Soon it will become very real.

Administration Process:  Let’s say we decide on a priority plan.  Now the vaccine must be actually injected into arms.  And by the way, these two vaccine candidates require two dosages, one 2 weeks apart and the other 3 weeks apart.  Health care workers can be vaccinated at their place of employment.  Fairly straightforward.  But let’s look at the rest of us.  There is a plan to have the vaccine distributed to thousands of locations, using the pharmacy networks of large national chains like CVS, Walgreens, Walmart, Costco, etc.  Let’s play this out.  Once you “qualify” for vaccination based upon whatever priority scheme prevails in your area, how do you actually arrange to receive it?  Maybe you will be able to schedule an appointment through your primary care provider.  As an alternative, do you “drop in” to your local CVS and join thousands of other people battling for a parking space and a place in line?  Clearly that’s unmanageable.  To my knowledge, these pharmacies don’t have any existing mechanism to schedule an appointment for a vaccination.  So do we just continue to join the mob day after day and hope for the best?  Hope they don’t run out before we get to the front of the line?  Hope we don’t get infected while standing in line with the mob?  Some of whom will not be wearing a mask.  How will you even know which pharmacies currently have the vaccine?  And if you are supposed to receive priority due to a pre-existing condition, how do you document that?  I don’t hear anyone talking about this aspect of the delivery of the vaccine into arms.  And, did I mention, you will need two doses?

Labor:  Who will be doing all of this vaccination?  All current health care workers are actively engaged in combat with a tsunami of infected patients or with the testing of those who suspect they may be infected.  Also, every time I visit a pharmacy they all seem to be quite busy filling prescriptions, which they will need to continue doing during the vaccination effort.  So I think we can assume that there is not currently any meaningful slack in the health care workforce to perform this herculean task.  Let’s suppose that 1 person can inject 6 people per hour.  During an 8 hour work day, they can vaccinate 48 people (perhaps this is optimistic).  Do the math.  We need thousands of people to work full time for perhaps the next year or more, doing nothing but vaccinating people.  In addition to those doing the injecting, people will be needed for the administrative process to ensure that those receiving the vaccine fill out applicable paperwork and to record that they have received the first and second dosages.  Presumably, we will need a national database to record the vaccinations so that we can keep track of who has received a vaccine so that they will receive the proper second dose.  I have read the some of the vaccines will need to be mixed on-site according to very precise instructions prior to being injected.  Also, people will be needed to coordinate the vaccine supply, vaccination reservations and manage the lines of people waiting to be vaccinated.  All of these people will need to be recruited and trained (and vaccinated) at thousands of locations throughout the country.  Are you aware of any effort currently underway to recruit these people?  By the way, you will need two doses.

Cost:  We’re being told that the US government will cover the cost for the vaccine.  Ok, that’s good.  However, what about the cost for shipping and storing the vaccine (i.e. coolers, dry ice, etc.)?  What about the cost for the thousands of people identified in the previous section?  Since we will not need to pay the pharmacy for the vaccine, how will they be able to afford the additional people?  Will we need to pay something to be injected?  Again, I haven’t heard anyone talking about this.

Complicating Factors:

• All of this must play out within the context of the worst level of infection seen so far in this pandemic anywhere in the world.
• Some portion of the population will choose not to be vaccinated.  This means fewer arms need to be injected but also means that the virus will be a factor we must live with for the foreseeable future, perhaps forever.
• We don’t yet know for how long these vaccines will protect us from infection and/or disease.

Bottom line, I am optimistic that we will benefit from the coming vaccines but sadly, I think we will have to go through a lot of chaos to realize that benefit.