That work has largely fallen to states, which have traditionally organized vaccination campaigns, such as during the 2009 swine-flu pandemic. But this year, they are already strained from months of fighting COVID-19, and they haven’t had the money or resources to fully plan the biggest and most complicated pieces ahead of time. Congress waited until December to pass $8 billion for vaccine distribution, even though local and state officials had been pleading for funding for months. “States can’t make a contract or plan for anything or hire someone until they have that money on hand,” says Kelly Moore, the deputy director of the Immunization Action Coalition. That work is happening only now, as vaccines are already being distributed.
Florida might serve as a cautionary tale about trying to vaccinate large numbers of people without advance planning. The state is currently offering vaccines to seniors over 65, in addition to the federally recommended priority groups of health-care workers and long-term-care residents. But it delegated the logistics to counties, which came up with a host of different plans that ran into a host of different problems: long lines of seniors waiting overnight in some counties, confusing registration sites and outright scams in others. Without better coordination, these scenes could soon play out across the country.
On the most basic level, scale creates new challenges. And the first coronavirus vaccines require very particular storage conditions and skill to administer, adding to the difficulty. Exactly how community vaccination centers solve these problems will vary state by state, city by city. Ballad Health, a hospital system in eastern Tennessee and southwestern Virginia, is working with local health departments to open five community vaccination centers for the elderly, three in Tennessee and two in Virginia. The centers are in buildings near a hospital with ultracold storage, so doses can be quickly thawed and transported. Jamie Swift, the chief infection prevention officer at Ballad Health, says her team has had to plan for everything: staffing phone lines, traffic flow, even just having enough chairs available for seniors waiting for their vaccine.
The hospital drew on experience in vaccinating their own staff and local doctors, but planning for the community is more complicated. In hospitals, “it was a very controlled population. These are our employees. This is who’s eligible. You have to get your badge to get in … end of story,” Swift says. With the community vaccination clinics, the hospital is expecting more questions and more time for each person.
As more vaccines become available, doctors’ offices and pharmacies are expected to offer the COVID-19 vaccines as well. The sheer number of people getting vaccines will create more errors in handling and scheduling and other logistics. “The bigger this gets, the more sites that get involved, the less control,” Toner says.