Millions of Americans are counting on a Covid-19 vaccine to curb the global pandemic and return life to normal. While one or more options could be available toward the end of this year or early next, the path to delivering vaccines to 330 million people remains unclear for the local health officials expected to carry out the work.
"We haven't gotten a lot of information about how this is going to roll out," said Dr. Umair Shah, executive director of Texas' Harris County Public Health department, which includes Houston.
In a four-page memo this summer, the federal Centers for Disease Control and Prevention told health departments across the country to draft vaccination plans by Oct. 1 "to coincide with the earliest possible release of Covid-19 vaccine." But health departments that have been underfunded for decades say they currently lack the staff, money and tools to educate people about vaccines and then to distribute, administer and track hundreds of millions of doses. Nor do they know when, or if, they'll get federal aid to do that.
Dozens of doctors, nurses and health officials interviewed by Kaiser Health News and The Associated Press expressed concern about the country's readiness to conduct mass vaccinations, as well as frustration with months of inconsistent information from the federal government.
The gaps include figuring out how officials will keep track of who has gotten which doses and how they'll keep the workers who give the shots safe, with enough protective gear and syringes to do their jobs. With only about half of Americans saying they would get vaccinated, according to a poll from AP-NORC Center for Public Affairs Research, it also will be crucial to educate people about the benefits of vaccination, said Molly Howell, who manages the North Dakota Department of Health's immunization program.
The unprecedented pace of vaccine development has left many Americans skeptical about the safety of Covid-19 immunizations; others simply don't trust the federal government. "We're in a very deep-red state," said Ann Lewis, CEO of CareSouth Carolina, a group of community health centers that serve mostly low-income people in five rural counties in South Carolina. "The message that is coming out is not a message of trust and confidence in medical or scientific evidence."
The U.S. has committed more than $10 billion to develop new coronavirus vaccines but hasn't allocated money specifically for distributing and administering vaccines. And while states, territories and 154 large cities and counties received billions in congressional emergency funding, that money can be used for a variety of purposes, including testing and overtime pay.
An ongoing investigation by KHN and the AP has detailed how state and local public health departments across the US have been starved for decades, leaving them underfunded and without adequate resources to confront the coronavirus pandemic. The investigation further found that federal coronavirus funds have been slow to reach public health departments, forcing some communities to cancel non-coronavirus vaccine clinics and other essential services.
States are allowed to use some of the federal money they've already received to prepare for immunizations. But AP and KHN found that many health departments are so overwhelmed with the current costs of the pandemic - such as for testing and contact tracing - that they can''t reserve money for the vaccine work to come.
Health departments will need to hire people to administer the vaccines and systems to track them, and pay for supplies such as protective medical masks, gowns and gloves, as well as warehouses and refrigerator space. CareSouth Carolina is collaborating with the state health department on testing and the pandemic response. It used federal funding to purchase $140,000 retrofitted vans for mobile testing, which it plans to continue to use to keep vaccines cold and deliver them to residents when the time comes, said Lewis.