Georgia submits vaccine distribution plan to CDC

The Georgia Department of Public Health submitted its COVID-19 vaccine distribution plan to the Centers for Disease Control and Prevention on Friday, laying the groundwork for an extraordinary undertaking to vaccinate millions of people across the state.

The 56-page plan touches on everything from ordering and tracking the vaccine to meeting cold-storage requirements. It also outlines a strategy of making the vaccine available at not only healthcare settings but non-traditional places like churches and workplaces.

Even so, the plan lacks specifics. It doesn’t state exactly where all the vaccination sites will be. And it’s not clear how waivers will be granted for people who can’t afford the fees that clinics might charge for administering the shots.

With vaccine supplies expected to be extremely limited in the initial months, it’s unknown how many doses will Georgia get. Experts say it’s not a simple population calculation, and a vaccine won’t be done on a first-come, first-served basis.

DPH emphasized the plan is still considered a first draft. The CDC will need to review it, and many details will need to be ironed out over the coming weeks. States across the country had to race to create their distribution plans by Friday, the deadline set by the federal government in August.

No one knows yet when, or even if, a vaccine will become available. Some experts have estimated that, for the general public, it will be the middle of next year at the earliest. It’s possible that a limited number of vaccines may be available by the end of the year for health care workers.

The country has never had such an urgent demand to produce so many vaccine doses so quickly.

Every year, a flu vaccine is given to well over 100 million Americans. But COVID-19 inoculations will be more complex because of the challenges of storage, delivery and tracking multiple vaccines with different requirements, said Julie Swann, a North Carolina State University professor who in 2009 served as a senior adviser to the CDC on the national distribution for the H1N1 flu vaccine.

Jack Krost participates in Phase 3 of the COVID-19 vaccine trial at Emory University’s Hope Clinic. He’s with Laura Clegg, clinical research nurse at the Hope Clinic.

Credit: Jack Kearse

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Credit: Jack Kearse

Two leading vaccine candidates, by Moderna and Pfizer, use a new RNA technology and require ultra-low temperature storage. This will require a supply chain that can keep vaccines in tightly controlled temperatures from the moment they are made, to the moment that they are administered. Pfizer has devised “thermal boxes” that, unopened, can keep a batch of vaccines frozen for up to 10 days; once opened, though, they have to be replenished with dry ice within 24 hours.

Along with temperature-controlled facilities, there also will be a need for monitoring capabilities and trained staff. Because vaccines will be very valuable, security will be needed to prevent tampering and theft.

Another challenge: A vaccine will likely require two doses. That means doubling production and persuading people to return for the second shot. If multiple vaccines are available at the same time, health care providers will need to make sure that someone getting the first dose gets a second dose of the same vaccine.

The state plan noted many pharmacies and hospitals have systems they use for patient notifications for appointments and for a medication pick up, and that they could use these same systems for second dose reminders to patients.

There also are questions about the cost of the vaccine for the public. While the vaccines will arrive at clinics at no charge, the government is not going to pay for the vaccines to be administered. To make money, clinics may still charge patients an administrative fee, which will have a limit of $43.86 for a two-dose vaccine. The plan notes that clinics “must” waive the fee for those who can’t afford it, but it doesn’t say what that means, or how patients will know to ask for waivers. More than 1 million Georgians live below the poverty level.