Experts explain: How do we inoculate 300M people against COVID?

By Physician Sense
Published August 3, 2020

Key Takeaways

The United States is a nation of about 328 million people. Assuming Operation Warp Speed yields a safe, effective COVID-19 vaccine, how do we administer it to so many millions?

With this question in mind, we turned to 2 experts: Shobha Swaminathan, MD, principal investigator at Rutgers New Jersey Medical School Clinical Research Center and associate professor of medicine, and epidemiologist Brenda F. Seals, PhD, a public health professor at The College of New Jersey. According to Swaminathan and Seals, vaccinating against COVID-19 presents several challenges, including logistics, public-private partnerships, and public health education

Both said in the beginning, likely we’ll see vaccines administered in 3 waves. The first wave likely will include healthcare workers and first responders, as well as other essential workers who can’t work remotely. Wave 2 likely will cover at-risk populations, such as people over the age of 65 and those with underlying health conditions. Finally, wave 3 likely will cover the general public.

“If a vaccine comes out in the last quarter of 2020, then in the first quarter of 2021, you would hope it would be available to the general public,” Seals says. “But I do assume that there’s going to be politics involved, that is that there are certain states that are not a priority for the president and that those states would receive the vaccine later.”

A new inoculation approach

Vaccine distribution will look different from previous mass-inoculation efforts, both experts say. Previous large-scale vaccinations, such as smallpox and polio, were largely public initiatives where people came in droves to schools and other municipal buildings to get vaccinated. COVID-19, as a disease largely spread by proximity, nullifies this approach. COVID-19 vaccination, Swaminathan and Seals say, will be about meeting people where they’re at.

“There are inequities in the healthcare system,” Swaminathan says. “Certain populations have better access to healthcare than others. In rural communities, the clinics can be miles away from where people live. We have to look at a true partnership between public health and the community where you try to develop ways to offer these vaccines that are tailored to the community at the local level.”

We’re more likely to see a public-private hybrid approach to inoculation. Seals, who worked at the CDC then at Temple University’s Center for Emergency Preparedness after 9/11, says that the federal government will likely oversee vaccination efforts, but injections will be a coordinated effort.

“I would assume that the federal government would do what it could to facilitate the first line,” Seals says. “That will happen through physicians’ offices, pharmacies, and hospitals.”

What history teaches us

History offers some important insights for distributing an effective COVID-19 vaccine, and, hopefully, eradicating the virus. Polio and smallpox are two examples of the public health challenge of mass-scale inoculation. Granted, these are two drastically different viruses, but there may be valuable logistical lessons to be drawn from their elimination.

According to the WHO, 2020 marks the 40th anniversary of the eradication of smallpox. While Dr. Edward Jenner developed a proto-vaccine in the late 1700s, the disease’s global rein wouldn’t end until 1980. Ending it required major international collaboration. Well after the ‘60s, the virus remained endemic in Africa and Asia.

From a historical perspective, smallpox is remarkable because it was the first disease to be fought on a global scale, the WHO says. While the WHO’s eradication program began in 1959, it didn’t gain traction until 1967 when nations came together to confront that pandemic. The global health community coalesced around vaccination campaigns, prevention, and surveillance measures, the WHO says. Technological breakthroughs also aided the campaign’s success, the CDC says, including a freeze-dried vaccine as well as the bifurcated needle.

Polio has a similar story. This deadly virus dates to 1580 BCE in Egypt, according to the Polio Global Eradication Initiative. The emergence of international trade would circulate the virus through modern history. However, the disease went relatively unnoticed in the US until 1894, when the first documented outbreak occurred. Today, polio cases have been cut by 99%, and as of this week, there were 85 confirmed cases globally in 6 countries this year, the organization’s data show. 

While Jonas Salk developed a polio vaccine in 1954, its creation and deployment wouldn’t have been possible without charity, according to the Smithsonian Institute. For example, a Rockefeller University researcher identified polio as a virus. The March of Dimes helped fund the development of Salk’s and Albert Sabin’s vaccines. Whereas Salk’s vaccine used an inert virus, Sabin’s used a live but weakened version of the virus, which had the added benefit of conferring immunity to others, according to the Smithsonian Institute. The Sabin vaccine became the vaccination of choice abroad whereas the Salk vaccine was more widely used in the US.   Finally, Rotary International raised funds to immunize children internationally.

“We have had great successes with some vaccines,” Seals says. “Polio is one of the big ones in my lifetime. It was such an urgent desire on the part of the federal government that they vaccinated almost everyone within a 2-year period across the United States. That was 60 years ago. So, we can do this.”

Public health education

We can do it, but will people understand the importance of the vaccine? They will, Swaminathan says, if physicians and public officials explain the precautions to monitor the vaccine safety and efficacy. Complicating the issue is the dis- and misinformation that persists around the widely discredited notion that vaccines are linked to autism. Furthermore, if approved for widespread use, the Moderna vaccine would be a first-of-its kind mRNA vaccine, which makes some non-anti-vaxxers uneasy. 

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