Who will get the coronavirus vaccine first? : Short Wave Developing a safe and effective coronavirus vaccine will be crucial to getting the pandemic under control. Also important, distributing it throughout the country once it's been approved. NPR science reporter Pien Huang tells us which high risk groups will get it first, how the vaccine will be distributed (including some challenges), and who's footing the bill for all of this.

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Who Gets The Vaccine First? And How Will They Get It?

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Who Gets The Vaccine First? And How Will They Get It?

Who Gets The Vaccine First? And How Will They Get It?

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You're listening to SHORT WAVE from NPR.

Maddie Sofia here with NPR science reporter Pien Huang. Hiya, Pien.


SOFIA: So this last week or so was pretty busy in terms of coronavirus coverage.

HUANG: Yeah, it was super busy. Biden was announced as the next president-elect.


WOLF BLITZER: Winning the White House and denying President Trump...

HUANG: A couple days later, he announces COVID-19 transition advisory board.


JOE BIDEN: We'll follow the science. We'll follow the science. Let me say that again.

SOFIA: Meanwhile, in the backdrop of all of this, case numbers are exploding all over the country.


RACHEL MADDOW: It's not a Midwest story or an East Coast story or a Southern state story. It's all over.

HUANG: There was also some news about preliminary results from the Pfizer vaccine trials that looked pretty promising.


LAKSHMI SINGH, BYLINE: Pfizer says early results show its experimental vaccine is 90% effective at preventing...

HUANG: We know that an effective vaccine is critical to controlling this pandemic. But it's not just about finding a vaccine that works. Getting that vaccine out to the public is just as important.

SOFIA: For sure. Even the most effective, safest coronavirus vaccine won't work to curb the spread of the virus unless a large number of people get immunized.

HUANG: Exactly. And that's going to take wicked logistics.

SOFIA: So today on the show, coronavirus vaccine distribution - what we know and don't about how a vaccine will make its way across the country. I'm Maddie Sofia. And you're listening to SHORT WAVE from NPR.


SOFIA: OK, Pien, let's start with the actual vaccine part of this. What do we know about how close scientists are to having a safe and effective vaccine ready?

HUANG: Well, right now, there are four vaccines that are in the final phase of clinical study here in the U.S. The Food and Drug Administration is the agency that's going to evaluate them to make sure they're safe and effective. And then they're going to approve or give emergency authorization for them to be given out to the public. But so far, that hasn't happened for any of them yet.


HUANG: That said, last week, there was promising news about one of those vaccines made by the drug company Pfizer. And it's early, but it looks like it could be pretty effective.

SOFIA: Right. But like we talked about last week on the show, the FDA needs a couple more weeks of follow-up to make sure that those results hold and that there are also no bad side effects.

HUANG: Exactly. So officials from Operation Warp Speed - that's the government's project to fast track COVID vaccines - they say they think that an authorization could come as early as December.

SOFIA: OK, so if the FDA authorizes a vaccine, what happens?

HUANG: Well, lots of things need to happen. And some of those things have already been happening. So even though vaccines haven't been authorized, big batches of them are already being produced...

SOFIA: Right.

HUANG: ...Which is really unusual, especially at this scale, because it's very possible that some of these vaccines getting made won't actually be authorized and will essentially get thrown out.

SOFIA: Right. That's kind of part of the strategy to make sure that if a vaccine does get authorized for use, we already have a bunch of it ready to go.

HUANG: And Operation Warp Speed wants every state to be ready to start distributing COVID-19 vaccines as soon as the FDA OKs one and the CDC recommends it - like, within 24 hours of that happening.

SOFIA: Right.

HUANG: So states have really been scrambling to make plans for how to actually get the vaccine into people's arms on the local level.

SOFIA: OK, got it. So public health folks all around the country are busy right now. So what about what's in these distribution plans, Pien? Like, once a vaccine is ready, what do we know about who's going to get it first?

HUANG: So the CDC is going to set national guidelines around that vaccine, like, who should get it first. And to do that, CDC relies on its Advisory Committee on Immunization Practices, or ACIP. This is a group that makes recommendations on every vaccine. And states are free to take their advice or leave it. But most, if not all, are expected to fully take ACIP's advice. That said, those official recommendations aren't coming until a vaccine gets FDA signoff. But we do have some clues into their thinking. The group has been holding public meetings virtually every month. And there's been general consensus that health care workers should get first dibs given their high risk of exposure and the fact that they're needed to keep the health system running. Here's Dr. Jose Romero, who chairs ACIP. He spoke with NPR earlier this month.


JOSE ROMERO: I think there is overall universal agreement that a first tier or first phase of the vaccine should be administered to health care providers. And that's health care providers writ large. And by that, I mean it's not just the doctors and nurses that are interacting with these patients but also the support personnel that help deal with them - so respiratory technologists, emergency responders.

SOFIA: OK, that makes total sense to me. But what about other essential workers? They're certainly at higher risk, right?

HUANG: Yeah, absolutely. I mean, that's another of the groups that the committee discussed. And it's a big one. You know, it's estimated to be 87 million workers. These are people who work at grocery stores. These are bus drivers, police officers, other people who keep the wheels of society turning. And, you know, the committees also talked about prioritizing other groups, like people with high-risk medical conditions and those aged 65 or older.

SOFIA: OK. So, Pien, if the idea is to get to people who are at the highest risk of getting the coronavirus and dying of it, have there been conversations in there about addressing the vast racial disparities we're seeing with the coronavirus?

HUANG: Yeah, there have actually been a lot. There was a recent study by the National Academies, which was sponsored by CDC and the National Institutes of Health. And they say that the reason minority groups have been disproportionately affected by sickness and death is basically systemic racism.

SOFIA: Sure.

HUANG: They're saying that groups with poor access to health care tend to have more underlying conditions. Workers in low-wage jobs or people who live in crowded situations are more likely to be exposed to the virus. So they say that prioritizing people at high risk of COVID also addresses these underlying disparities. And they also want states and communities to make every effort to reach groups that are socially vulnerable, you know, groups that are poor, that don't have easy access to health care, to make sure they can get vaccinated, too.

SOFIA: OK, makes sense. So I know this is all hypothetical at this point, but if we get vaccines to all the groups that we just talked about, how much time would pass until everyone else had access?

HUANG: So if you're under 65 and you're pretty healthy and you can work from home, you're probably last in line to get a vaccine. Operation Warp Speed officials said last week that if a vaccine or, even better, a couple of vaccines are authorized in December, they expect it to be widely available by the middle of next year, so think summer 2021. But that's very optimistic. Other estimates say it could be much longer.

SOFIA: So how will the vaccine physically get to us, Pien? Like, what do those logistics look like? I've read that the military has something to do with this.

HUANG: Yeah. So the military is in charge of coordinating logistics, but they're not actually expected to be physically moving doses or injecting any vaccines into people. For that, the government has partnered with private companies that will move big boxes of vaccines from storage facilities out to pharmacies and hospitals and places where people will get them. But there is a really interesting logistical hurdle that we should talk about.


HUANG: The two COVID vaccines that are furthest along in development have to be stored in really cold temperatures, especially the Pfizer vaccine. That needs to be kept at least -70 degrees Celsius...

SOFIA: Right.

HUANG: ...Which is close to the temperature of dry ice.

SOFIA: Yeah, I mean, that sounds like kind of a supply chain nightmare, right? Trying to keep those cold enough as we ship them around the country. Plus, I know from grad school those ultra-cold freezers are, like, at least $10,000 a pop.

HUANG: The CDC had told states to hold off on buying a bunch of ultra-cold freezers. They don't think that it's necessary, but states are starting to think they're going to have to have a few lying around. Those cold storage requirements could be especially tricky in rural communities or places with extreme temperatures. I talked with Molly Howell. She's the immunization program manager for the state of North Dakota. And she says it's a logistical problem that they're really thinking through.

MOLLY HOWELL: So the storage container that the ultra-low cold-chain vaccine comes in can maintain temperatures for up to 10 days if it's unopened. If the container is opened, then you have to kind of recharge it with dry ice every so often.

SOFIA: So, Pien, I mean, moving this much vaccine this quickly has to be really expensive, right? Like, where is the funding coming from? Who's going to pay to get this vaccine out to the public?

HUANG: Well, the federal government says that they're footing the cost of the vaccine itself and also the cost of getting it delivered to hospitals or other designated vaccine sites.


HUANG: And they also say that providers will be able to bill insurance companies for the costs of giving out a vaccine. But Claire Hannan, head of the Association of Immunization Managers - she says there's a lot of other costs that need to be covered.

CLAIRE HANNAN: You have to build an online enrollment program for the providers to enroll. You have to have training materials to educate them. At public health facilities, you have to hire vaccinators, and you have to pay them before that - you can bill for admin costs.

HUANG: Health departments also have to stand up data systems to sign up providers to track who's getting what vaccine. And they also have to roll out campaigns, so people know when it's their turn for a vaccine and where to get them. So a group representing state health officials sent a letter to Congress asking for $8.4 billion for vaccine distribution to states. But actually, additional money for vaccine distribution hasn't been approved yet by Congress. And it's actually not clear when a COVID package might get through. So who exactly is going to pay for this? How much the states will have to bear themselves - that's an open question. And it's going to be a really important one going forward.

SOFIA: So, Pien, you're telling me, it sounds like, the money is going to be complicated at best and a total disaster at worst.

HUANG: Yeah, that sounds about right.

SOFIA: All right, Pien. We appreciate you. Come back soon and keep us updated.

HUANG: Appreciate you, too. Thanks, Maddie.

SOFIA: This episode was produced by Brit Hanson, fact-checked by Ariela Zebede (ph) and edited by Viet Le. I'm Maddie Sofia. Thanks for listening to SHORT WAVE from NPR.


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