The Challenges of Vaccine Distribution in California
By Cassandra Drumond
With the anticipated roll out of vaccines now available in California, there are many questions such as who should receive them first, if there is a distribution problem, what the current challenges are, why it seems to be rolling out so slowly, and why some groups are hesitant.
Here to answer some of those questions are Dr. William Schaffner, professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee. He was commissioned in the US Public Health Service as an Epidemic Intelligence Service Officer with the Centers for Disease Control and Prevention in Atlanta for two years. Dr. Schaffner now is the medical director of National Foundation for Infectious Diseases. Schaffner explains: “There have been a number of triumphs out there, but there have also been a number of bottle necks as well, both at the national and the local level. Nationally, there has been uncertainty on vaccine shipments. Locally, there are a number of places the vaccine is distributed. The first challenge came with the Pfizer vaccine, which requires a really deep freeze in order to keep it intact, which meant it could only be distributed to certain large medical centers, where there were appropriate freezers and personnel who were trained to handle. There are twenty million doses of the Pfizer and Moderna vaccine, but only five million have been administered so far.”
Dr. Robert M. Wachter, Chair of the Department of Medicine at the University of California, San Francisco adds: “I’m not surprised that we are not doing very well. The only parts of COVID we have done well on is the discovery of the vaccine, but not the other parts such as the roll out of PPE, the rollout of testing and the logistical, sociological and political parts we have not done well on. It could have been predicted that this vaccine would be more complex than the flu vaccine. We would have greatly benefitted from a thoughtful national plan that included the last part—getting the vaccine to people at local levels. There was no national plan at the last mile, it was handed off to each state and then to local governments, most of which were inventing as they go. There was a lot of wiggle room. In trying to get the vaccine to those who need it the most, we have created something more complex that we cannot handle. I believe in a well-meaning effort to distribute the vaccine to people who need it the most first, paying attention to issues such as health equity, and making sure that groups that seem to have been most affected, particularly communities of color, were prioritized, we created something more complex than we are capable of handling. In terms of who gets the vaccine first, it does make sense that grocery store workers, first responders, and other groups get it first. But how is Walgreens going to figure out that you are a grocery store clerk or a preschool teacher or that you have a pre-existing condition? The answer is always ‘we’ll figure it out’ which is not a good answer. We have not prepared very well. We didn’t appreciate the complexity. We’ve been able to administer 30% of the total vaccines that have been distributed. That represents millions of people who should have received it by now. Some of those people will now go on to get sick, go to the hospital or even die.
Dr. Wachter on whether the first dose is effective in the short-term, before waiting for the second dosage: “Nobody that I know is advocating for a single dose. The studies have all used two doses. Of the bottlenecks that is arising was the fact that the allocation plan will give out first doses now and will withhold the second dose until you come around. It is guaranteed for the 2nd dose to be administered after three weeks, which then you are 95% protected and creates that more durable immunity. We want to get as many first doses out as possible because ten days after your first shot, you are up to 80% protected.”
Public health officials are advising whether vaccinated or not, continue to wear a mask, stay 6 feet apart and practice frequent hand washing.