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Health officials to submit first drafts of vaccine distribution blueprints

Although a coronavirus vaccine probably will not be widely available until next year, states and the District are submitting their initial mass vaccination plans to the U.S. Centers for Disease Control and Prevention by Friday. (Dado Ruvic/Reuters)
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Virginia officials estimate that to provide coronavirus vaccinations to residents, they will need $2.5 million to buy equipment such as refrigerators and freezers, $3.4 million for syringes and other supplies, and more than $71 million to help communities set up and operate mass vaccination clinics.

Those estimates come from a draft of a vaccine distribution plan the state must submit to the federal Centers for Disease Control and Prevention by Friday, a requirement that all states, territories and the District must follow.

Officials in Maryland and the District have not shared their plans publicly but say they are on track to meet the deadline.

“It’s the first formal submission of how a state and territory envisions standing up and skillfully administering a national vaccination campaign,” James Blumenstock, a senior vice president at the Association of State and Territorial Health Officials, said of the plans. “It allows federal partners to get a glimpse of how the states are planning to operationalize the blueprint.”

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Experts say a vaccine probably won’t be widely available to the public until at least the middle of 2021. A limited number of vaccine doses may be available as soon as November, but those will be prioritized for certain groups, such as health-care workers.

The plans due Friday are supposed to address 15 topics, including how jurisdictions will ensure critical populations have access to vaccination sites; manage “cold chain” requirements while transporting and storing vaccines; and build public confidence in and dispel misinformation about the vaccination process.

“We do want people to understand this is in fact a draft,” D.C. Health Director LaQuandra S. Nesbitt told the D.C. Council on Wednesday. “We don’t yet have a vaccine, we don’t yet know what storage and handling requirements will be.”

District officials began discussing how to distribute a vaccine in May, and assembled a vaccine planning team in June, which meets biweekly or as needed, the health department said in written responses to emailed questions. The department also created a scientific advisory committee to counsel Nesbitt on ways to encourage vulnerable residents to trust a vaccine once it is available.

“A lot of our discussions are aimed around ensuring that there is great vaccine confidence in those groups who are the ones who should be prioritized initially,” she said at a news briefing Wednesday.

Cold-storage requirements could range from vaccines that simply need to be refrigerated or kept frozen to those that need to be kept at ultracold temperatures, according to the CDC’s 57-page playbook that was offered to states on Sept. 16.

City officials say they have drawn on lessons learned from the H1N1 pandemic of 2009, and on planning for the influenza pandemic, in drawing its blueprint.

At a scientific advisory committee meeting on Oct. 8, Nesbitt said officials are concerned that the federal government may provide vaccine allocations based on a jurisdiction’s population, instead of the number of health-care workers based there. That approach could mean there are not enough vaccines for all of the doctors, nurses and front-line health workers in the city, many of whom live in Maryland and Virginia, she said.

“We don’t quibble about testing residents from Maryland or Virginia who work here, because we can just put more money into that,” Nesbitt said during the meeting. “But I can’t put more money into buying more vaccines. It’s a controlled supply chain, so it’s not a budgetary issue, it is strictly a resource allocation issue.”

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The Maryland Department of Health began its planning meetings last spring, spokesman Charlie Gischlar said in a written response to emailed questions. The state has requested feedback from localities on its vaccine plan and asked counties and cities about their capacity to implement a plan, Montgomery Health Officer Travis Gayles said at a Montgomery County Council meeting in September.

The state is still identifying locations throughout Maryland that can provide ultracold storage capacity, Gischlar said. Gayles said at the meeting that the state focused in September on determining priority groups for the first phase of vaccine distribution, because the federal government did not provide enough specificity on that front.

Virginia plans to use existing relationships with grocery store chains and pharmacies such as Walgreens to expand vaccine availability, according to the state’s draft plan. The plan includes a map of those locations.

And the state health commissioner will partner with the private sector and local hospitals to provide vaccinations close to the initial populations that will receive the vaccine.

Local officials said they hope their plans will boost public confidence in a vaccine, which has declined after President Trump politicized the issue and clashed with scientists and the Food and Drug Administration over when a vaccine may be available and what coronavirus treatments to approve.

At Trump’s urging, the FDA gave emergency authorization in June to two malaria drugs for patients hospitalized with covid-19, despite little evidence of the drugs’ efficacy. The FDA later reversed the approval.

And in August, the agency approved convalescent plasma to help hospitalized patients after Trump pressured the agency to quickly address the pandemic. More recently, the president began pushing the agency to approve antibody treatments, erroneously calling them a “cure.”

In Maryland, half of state residents say they wouldn’t take a vaccine, according to a Goucher poll released this week. And just 35 percent of Virginians said they were “very likely” to get vaccinated, according to a survey released this week by the Virginia Hospital and Healthcare Association.

The District has yet to do polling on a potential coronavirus vaccine but is taking notes from “historical practices around influenza,” which show that people ages 18 to 34 are among the least likely to get vaccinated, Nesbitt said at the Oct. 8 meeting. Members of the scientific advisory committee urged her to begin polling and conducting focus groups among city residents.

The CDC has offered $200 million to jurisdictions for vaccine preparedness. Blumenstock, of the state health officials association, said that funding is “very much needed and greatly appreciated.”

“But,” he continued, “that will not come close to providing the financial resources to every state, municipality, and territory and tribe in this country to launch this historic and unprecedented national campaign.”

The public health community estimates that states will need $8.4 billion to distribute vaccines on a mass scale safely, Blumenstock said. Additional funding for states could come from a coronavirus relief package, if Congress and the White House can agree on one.

Michael Brice-Saddler and Julie Zauzmer contributed to this report.

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