State officials plead for more info on vaccine distribution plans

Governors and state health officials scrambling to develop comprehensive coronavirus vaccine distribution plans are pleading with the Trump administration for more clarity and more funding.

State and local officials sent drafts of their plans to the Centers for Disease Control and Prevention (CDC) last week, just 30 days after the administration released its initial COVID-19 vaccination playbook.

The task of setting up a comprehensive distribution system is daunting, especially since no vaccine for the novel coronavirus has been cleared by the Food and Drug Administration (FDA) and clinical trials of two of the four leading candidates have been paused because of safety concerns. 

Until a vaccine is authorized or approved by the FDA, officials won’t know which populations the vaccine will be most effective in, storage requirements, dosage requirements and other variables. States also don’t know how many doses of the initial vaccine they will receive.

Public health officials say they are used to planning without knowing the full picture but are urging Congress to provide $8.4 billion in additional funding.

“It’s one thing to write a strong plan. It’s quite another to implement the plan. And right now the plans … are just wish lists. Without additional resources and funding, we won’t be able to successfully implement them,” said Claire Hannan, executive director of the National Association of Immunization Managers. 

President Trump has tied his reelection message to promising a vaccine by Nov. 3, and the CDC told states to prepare for a vaccine rollout by Nov. 1, raising concerns that political pressure could undermine the science. 

While the vaccine manufacturers and federal health officials have since indicated that timeline is unrealistic, state officials said they have to be ready to go whenever a vaccine is authorized.

“Our approach is, let’s be ready, irrespective of when the first vaccines received approval or authorization,” said Nirav Shah, director of the Maine Center for Disease Control and Prevention. 

“Certainly the more lead time that we have, the better able we will be on day one, but for us it’s less about a date that we’ve circled on our calendar, it’s more about knowing that we have a certain discrete checklist … in place,” Shah said.

The CDC’s Advisory Committee on Immunization Practices will recommend a plan for initial vaccination, but states will ultimately have the final say. Most plans are expected to prioritize the first doses for vulnerable populations, health providers for COVID-19 patients and first responders. 

The Trump administration has delegated much of the responsibility of preparing to states, but the federal government will provide the actual vaccine and syringes. States will be responsible for other supplies, like bandages, gloves and needle disposal containers.

Federal officials said the U.S. has already assembled at least 40 million vaccination kits with the bottles, needles and other items needed for the shots.

“All of those are in warehouses ready to go, so that’s a big logistical task or undertaking,” Paul Mango, deputy chief of staff for policy in the Department of Health and Human Services, told reporters recently.

Supplies like needles and syringes will be automatically ordered in amounts to match vaccine orders.

State officials argue that a successful distribution plan will require a level of coordination with the federal government that has been missing through much of the pandemic.

Inequalities and delays in obtaining personal protective equipment, testing components and the experimental COVID-19 drug remdesivir have made officials skeptical. 

New York Gov. Andrew Cuomo (D) and Arkansas Gov. Asa Hutchinson (R), the bipartisan leaders of the National Governors Association, last week asked for a meeting with the White House to discuss specific concerns about funding for the administration of a vaccine, allocation and supply chain, and communication and information requirements.

“States cannot do this on their own. Period,” Cuomo said. 

“This is a massive undertaking. This is a larger operational undertaking than anything we have done under COVID to date. This is a more complicated undertaking and task. And we need the federal government to be a competent partner with this state and with every state,” Cuomo added.

So far, the CDC has distributed only $200 million to states and territories for vaccination efforts, but the Association of State and Territorial Health Officials said it was “merely a down payment.”

The CDC itself has also told Congress it urgently needs more funding for the vaccination effort, a figure CDC Director Robert Redfield put at $6 billion last month.

But despite the pleas, new funding does not appear to be coming.

States “do not have a need for additional funding for the rollout of the vaccine program, they actually have received funding for this, they have plenty of resources to manage the vaccine distribution program,” HHS Secretary Alex Azar said Monday at a Milken Institute event.

“There’s plenty of funding available to meet all their needs,” Azar added.