Medically Necessary: Winter storm delays, FEMA vaccination sites, Supply chain for superspreaders

Good afternoon. Medically Necessary is a newsletter by Matt Blois about the health care supply chain — how we get drugs, devices and medical supplies to health care providers and patients.

A massive winter storm is slowing the distribution of COVID-19 vaccines across much of the U.S.

Mass vaccinations canceled: The storm forced cancellations of vaccination clinics in Missouri through Friday.

Vaccine shipments delayed: The Centers for Disease Control and Prevention expects the storm to cause widespread delays in COVID-19 vaccine shipments, a spokesperson told Politico.

• The Biden administration expects delayed shipments to arrive this week, probably about one or two days late, according to a report from McClatchy.
• The CDC says patients who missed a second dose of the vaccine because of the storm shouldn’t worry. The agency’s guidelines say it is OK to get the second dose of a vaccine up to six weeks after the first. Normally, patients would receive a second dose after three or four weeks.

Power outages threaten vaccines: The public health department in Harris County, Texas nearly lost thousands of doses of the COVID-19 vaccine after a storage facility lost power, according to a report from ABC News. The county distributed most of the vaccine and was able to find more storage for the remainder.

More vaccine sites: The Biden administration aims to open 100 federally operated vaccination sites to speed up the vaccination campaign. The Federal Emergency Management Agency opened the first two sites in California this week.

• The federal sites in California are opening days after local vaccination clinics ran out of doses and closed, according to the LA Times.
• Both sites will focus on historically marginalized communities. They can administer up to 6,000 shots per day.
• Additional sites are slated to open in Texas and New York in the coming weeks. The Department of Defense, which is assisting FEMA, expects the next sites to be up by Wednesday.
• The Biden administration is far from achieving its initial goal of 100 sites before the end of February.

A different approach: Some epidemiologists argue that the COVID-19 vaccine campaign should focus on those who spread it most — comparatively young people. A supply chain focused on young superspreaders would look dramatically different from the current system.

The rationale: Vaccinating the people who are most responsible for spreading the coronavirus is the fastest way to stop the pandemic. Some researchers argue this approach would indirectly offer more protection to the most vulnerable people.

• “One of the lessons from … past pandemics is that vaccinating the likely asymptomatic spreaders early can avert multiple infections with others,” a group of public health scholars from Johns Hopkins University and the University of Southern California wrote in The Conversation last fall.

The superspreaders: A recent paper in Science, using cell phone locations and coronavirus infection data, estimated that people ages 20 to 49 were responsible for 65% of COVID-19 infections in the U.S. last fall.

• “Interventions among adults aged 20-49, such as mass vaccination with transmission-blocking vaccines, could bring resurgent COVID-19 epidemics under control and avert deaths,” the authors from the Imperial College COVID-19 response team write.

How would it work? In many ways, targeting that age group could be logistically easier than shipping small batches of vaccines to hospitals, doctors’ offices or community health clinics. 

• “If you want to tackle the 20 to 49s in terms of supply chain, then the best places are universities, community colleges, educational settings where 20-year-olds will be,” University of South Florida epidemiologist Edwin Michael told FreightWaves. “You have a captive population. It’s easy to reach.” 

Michael also imagined shipping vaccines to large workplaces with thousands of employees, such as meat processing plants, where the coronavirus spreads easily. That would make it possible to inoculate many people at once, and companies would be motivated to cooperate.

• “They will make really good partners, they would want to keep their workforce safe,” he said. 

Why isn’t it happening? A panel at the CDC — the Advisory Committee on Immunization Practices — originally recommended vaccinating essential workers early on. That category would have included many young people with lots of exposure to the virus.

Julia Raifman, a health researcher at Boston University, said that when the vaccine rollout got off to a slow start, many states abandoned or changed policies that had put young, essential workers first. Instead, they opened up eligibility to older people who were more vulnerable to the virus.

• “Despite ACIP talking about essential worker priority, many states have thrown that out entirely or limited it dramatically, ignoring issues about transmission,” University of Denver bioethicist Govind Persad said at a February webinar hosted by The American Journal of Bioethics. “I’ve been struck and disappointed to see states throw out those categories.”

The dream: What would happen if the U.S. set up vaccination clinics in front of bars? Sign me up.

Wishful thinking is a section of the newsletter where I give experts one wish to improve the health care supply chain. Send your wishes to [email protected].  

“I would have nationalized it … . Have the U.S. military go into different physical locations in large cities and just have full day dosing.” 

— Mark Sawicki, CEO of cold chain logistics company Cryoport Systems

Background: The federal government’s primary objective in the vaccine rollout is delivering doses to the states. Once the doses arrived, it’s up to the states to get those shots into arms.

• The distribution process has always been mostly centralized. States order new vaccines using a national vaccine ordering system called VTrckS. 
• The logistics company McKesson is responsible for distributing all of Moderna’s vaccines, while Pfizer ships its vaccines directly to vaccine administration sites.

 A slow start: With a limited supply and little assistance from the federal government, many states struggled to get doses out quickly in the first weeks of the vaccine rollout. Distribution has since accelerated.

Signs of change? The U.S. opened its first federally operated vaccination sites this week. The Biden administration has plans to open 100 sites total. 

Even with those sites, county health departments and retail pharmacies will be responsible for doling out the vast majority of shots.

• The myth of ‘good’ and ‘bad’ Covid vaccines: Why false perceptions overlook facts, and could breed resentment — STAT
• People With Intellectual Disabilities Are Often Overlooked In Pandemic Response — NPR
• Anti-Immigrant Hate Snarls the South’s Vaccine Rollout — The Daily Beast
• The Vulnerable Can Wait. Vaccinate the Super-Spreaders First — WIRED
• Walmart’s Covid-19 Vaccine Rollout Heads to Small Towns — The Wall Street Journal

Thanks for reading. Please send an email to [email protected] if you have questions, praise or grievances. If this email was forwarded to you, sign up here.

Matt Blois