Friday, September 18, 2020

This is not the "October Surprise" You Are Looking For

The surprise would be if it actually happened.

Considering how complex the distribution of a vaccine will be (if one is safe and approved) and the fact at least one vaccine requires two doses (so will that be only 50 million doses?):

Here’s how it would work: Medical offices, clinics, hospitals, pharmacies and other groups that want to vaccinate people for COVID-19 need to first enroll in the U.S. COVID-19 vaccination program They’ll sign an agreement with the CDC and prove they have the space, the necessary equipment and properly trained staff to administer the shots.

Because the requirements for storing, handling and administering the shots are so challenging, the government will prioritize getting vaccine to sites that can reach large numbers of priority populations and vaccinate lots of people quickly, CDC documents show.

When a vaccine becomes available, a vaccination site will request doses through a state agency, usually its department of public health. That’s how it was generally done during the 2009 nH1N1 influenza pandemic, said Julie Swann, a professor of industrial and systems engineering at North Carolina State University who was a science adviser to the CDC at the time.

The department of health would confirm the site was OK’d to distribute the vaccine. At that point, if vaccine supplies are limited, the state could determine how much vaccine to allocate to that specific site, perhaps less than was requested.

Next, the order will be electronically transmitted to the CDC. The CDC also could decide how many doses to allocated to a given site if vaccine supplies are limited, Moore said.

The CDC will then transmit the order to itscontracted partner McKesson, the largest pharmaceutical distribution and technology company in the United States. It already has distribution centers across the country and is building more for COVID-19.

Vaccine orders will be shipped within 24 hours of approval depending on supply, the CDC’s planning documents say.

And then there's the storage question:

Here’s where things diverge a bit. Moderna’s candidate vaccine has to be stored at minus 4 degrees Fahrenheit, but Pfizer’s requires it be stored at minus 94. If either of them are among the first vaccines available, that 90-degree difference means they must be distributed differently.

The Moderna vaccine will be stored either at the manufacturing plant or at a McKesson distribution center. When an order comes in, McKesson will ship it directly to the medical facility that ordered it, said Moore.

The Moderna vaccine comes as a frozen liquid in a 10-dose vial and contains no preservatives. It can be stored in a freezer or in its shipping container if it's replenished with dry ice, CDC documents show. It can be stored for up to two weeks at normal refrigerator temperatures (36 to 46 degrees) according to data provided by the Immunization Action Coalition. Once at room temperature it must be used within six hours.

After the vial has been punctured to take out the first dose, it is good for six hours and then must be thrown away. Because vaccine will be in short supply, especially at first, clinical sites will need to schedule patients so none is wasted.

To be effective, the Moderna requires two doses of vaccine given 28 days apart. It must be the same vaccine both times.

State Departments of Health?  Need I even mention how underfunded that department is in Texas?  Second most populous state in the union?  Hello?  Is this thing on?  Cases in Texas, just for one, peaked in July, and fell to the lowest point since that peak in on September 7.  They have risen steadily since then, as schools opened to classroom attendance across the state.

50 million doses (or 100 million) is 1 million per state (or 2 million).  Some states, clearly, don't have populations that reach 1 million; some have cities far larger than that.  Who gets the vaccine?  What states is it distributed to, and how?  Do we follow the Jared Kushner model and leave it to the free market?  (I wish I were morbidly joking.)  Such questions need to be worked out, and they won't be without politics coming into play.  Politics is not known to speed up a complicated process, let us all note.  It would be a great thing if a vaccine was available, but the distribution won't happen this year, and even if it does, access will be severely limited.  And the ones limited out will not be best pleased.

It will be limited enough I'm still not going back to restaurants or movie theaters any time soon.  I don't think I'll be alone in that.

Never mind:  it's not even coming in 2020.

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