The U.S. Centers for Disease Control (CDC) created a national COVID-19 Vaccine Program Playbook for state, territorial and local public health officials and their partners and issued directions for how to plan and operationalize COVID-19 vaccine programs in their jurisdictions. State health departments throughout the United States submitted comprehensive drafts of their COVID-19 vaccine distribution plan to the Centers for Disease Control and Prevention’s (CDC) on Oct. 16, 2020.1
CDC’s COVID-19 Vaccination Program Playbook
Many of the COVID-19 vaccination program initiatives described in the CDC’s playbook may overlap with routine vaccination programs already in place. For example, routine child and adult vaccination and pandemic influenza program activities can serve as a foundation for COVID-19 vaccination planning.2
The CDC’s 51-page plan calls for different phases for distributing the vaccine. Due to changing vaccine supply levels at various stages during the national COVID-19 vaccination program, the planning will be flexible but as specific as possible to accommodate a variety of scenarios. Health officials are projecting that coronavirus vaccine supplies will be limited immediately after licensure. Therefore, the first allocation of vaccine doses will target healthcare workers and populations considered to be a high risk for COVID-19 complications, such as individuals over 65 years old. As vaccine supplies increase quickly following licensure, distribution of the vaccine will be expanded to other populations that health officials consider to be at high risk and, then, to the general public.3
Vaccine Distribution Determined by Federal Government
According to the CDC’s guidelines, after a COVID-19 vaccine is approved by the U.S. Food and Drug Administration (FDA), federal officials will determine how many doses will be distributed to each state or region. States will then be responsible for distributing the doses to local vaccine providers.4
Paul Mango, Deputy Chief of Staff for Policy at the U.S. Department of Health and Human Service (HHS) said that the federal government is in the process of “actively engaging tens of thousands of provider outlets for these vaccines”.5 He added that the U.S. currently has assembled 40 million-plus vaccination kits with the bottles, needles and other items needed to administer the vaccine: “All of those are in warehouses ready to go, so that’s a big logistical task or undertaking,” Mango said.6
Vaccine Storage and Infrastructure Concerns
Depending on which COVID-19 vaccine gets approved (or if several coronavirus vaccines are approved), storage and handling of the vaccine will vary accordingly. Since Pfizer, Inc’s COVID-19 vaccine candidate, BNT162b1, needs to be stored at 94 degrees below zero, it will require special storage equipment and transportation. The company will only be shipping about 500 to 1,000 doses at a time. Moderna’s vaccine candidate will need to be stored at four degrees below zero. The concern is that many providers do not have ultra-cold freezers and the infrastructure that safe and effective storage of these vaccines require.7
Sounding a note of caution, Marcus Plescia, MD, chief medical officer at the Association of State and Territorial Health Officials said, “Everybody needs to realize it’s not going to be seamless.”8
1 Simmons-Duffin S. Facing Many Unknowns, States Rush To Plan Distribution Of COVID-19 Vaccines. NPR Oct. 16, 2020.
2 U.S. Centers for Disease Control and Prevention. COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations. Sept. 16, 2020.
4 Higgins- Dunn N. et al. States face Friday deadline from CDC to submit plans to distribute coronavirus vaccine. CNBC Oct. 16, 2020.