Who Will Get the Vaccine When?

Last Monday, the ACIP met to discuss the prioritization of distributing the soon to be approved COVID-19 vaccines. The committee, chaired by Arkansas Health Secretary Dr. Jose Romero, discussed who they would recommend being in the first group, commonly known as Tier 1a. That recommendation will now go to the CDC who will either accept it or alter it. Then the recommendation goes to the states who have the ultimate say in how the vaccines will be distributed in their states. Here’s what we know today based on several studies and assessments.

Storage of the Vaccines

To start with, there is a limited supply of vaccines available right now. There are only two vaccines that are ready for a decision from the FDA, one from Pfizer/BioNTech and one from Moderna. Both are base on mRNA technology which means they have to be stored at cold temperatures to preserve their fragile structure and the lipid nanoparticle used to deliver them into the body. Pfizer’s requirement is much more stringent than Moderna’s which could impact the distribution of that vaccine. Their vaccine requires ultra-cold temperature storage at minus 70 degrees Celsius, which is colder than winter in Antarctica. This is for long-term storage, but when the vaccine is ready for use, the vials are transferred to regular frozen storage for up to 5 days. Even then, there are some strict requirements on managing that transfer.

Moderna’s vaccine has long term storage requirements of minus 20 degrees Celsius, something you find in most freezer storage, and it can be kept in refrigerators for up to 30 days. Moderna’s can also be at room temperature for up to 12 hours compared with Pfizer at 2 hours. To show you the complexity of managing the Pfizer vaccine, you can read through the instructions from the UK’s MHRA for healthcare professionals. The Pfizer vaccine must also be transported in containers holding 975 vials compared with Moderna’s shipping containers holding 100 vials.

This means that urban areas are probably where the Pfizer vaccine will be distributed to due to these requirements. In Arkansas, that is the case with only 5 pharmacies in urban areas approved to distribute the vaccines to rural communities. Those pharmacies will break the large containers down and drive to the rural communities for vaccination events. But, once the Moderna vaccine is approved this can all change and rural health clinics and maybe even doctor’s offices could be used for distribution and vaccination.

Supply Levels

Then there’s the supply issue. Pfizer was supposed to deliver up to 100 million doses by the end of the year. However, supply chain problems reduced that volume to 50 million this year. Fortunately, Pfizer worked out the issues and shouldn’t have this problem moving forward. Once approved, Pfizer will have 6.4 million doses ready for vaccinations immediately with more doses to come from its facility in Puurs, Belgium and Kalamazoo, MI. In the months following December, Pfizer is expected to deliver more than 50 million doses a month in 2021. However, they have commitments to other countries so the bulk of the US’s vaccines will come from the Kalamazoo plant.

Moderna is expected to deliver 20 million doses this year and 50 million a month following. They will be manufactured through a partnership with Lonza, coming from Lonza’s Portsmouth, NH plant and several plants in Visp, Switzerland. The challenge is that while there may be 70 million doses ready this year, those will go to 35 million people as the vaccines require a two dose protocol. So, by the end of January we could be vaccinating up to 75 million people a month with these two vaccines. Update: It turns out the Trump administration only bought 100 million doses which severely limits the number of vaccines available in the early days. Based on that, the herd immunity timeline should be pushed out to June or July.

If you subtract from that the number who have already tested positive, we can get there sooner. Add in the AstraZeneca and Johnson & Johnson vaccines and it becomes even easier to get 70% vaccinated. But true immunity wouldn’t be reached until April at the earliest due to immunity not being achieved until a month and a half after the first dose.

Who Gets Vaccinated When?

So, who gets vaccinated first? According to the ACIP recommendation, the 21 million healthcare workers and nursing home residents/staff. Tier 1b will focus on essential workers which includes teachers, first responders, food processing workers in some states, grocery store employees, and others who have been considered essential workers depending on the states. Tier 1c would include those with high risk health conditions and adults 65 and older.

Finally, there is everyone else. With regards to priority of this group, several proposals have suggested vaccinating younger adults first since they have been the demographic with the highest infection rate. You can make your own assessment of why, but the thinking is that by vaccinating them early on it could drastically curb the pandemic and help get life back to normal sooner.

Overall, if things go as planned enough of the nation could be vaccinated that the virus is eradicated enough to get back to normal by May or June at the latest. Yes, it’s seems like a long way away, but we should start seeing improvements in numbers as early as the end of January. As the numbers drop from more people getting vaccinated, restrictions can drop.

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