A first look at state vaccine distribution protocols

A coronavirus vaccine will likely receive emergency approval from the federal government sometime in the next month or two, but getting millions of doses to New Yorkers will be easier said than done.

Production has already begun on hundreds of thousands of vaccines, but there will not be anywhere near enough doses for U.S. residents until sometime next year at the earliest. Supplies will have to be rationed, with front-line health care workers, and people who live and work in nursing homes getting the vaccines first, according to draft distribution plans the state submitted to the federal government over the weekend.

The 96-page document outlines how the state will approach key questions surrounding the prioritization of vaccines based on criteria like occupation, age and geography. It also details the logistical challenges of storing the vaccine at subzero temperatures and the messaging issues around ensuring public confidence in the vaccine itself. “I believe this is going to be the hardest operational challenge that we have faced since COVID began,” Gov. Andrew Cuomo told reporters on Monday. “Administering a vaccine is going to make testing look simple.”

A lot remains up in the air, as was noted in the draft plan. The federal government has yet to provide details on how it will determine the state-by-state distribution of vaccines. Any federal approval of a vaccine before the Nov. 3 election will stir up concerns that President Donald Trump meddled in the regulatory process. Funding remains a big issue for cash-strapped states like New York.

Yet, the draft plans from the state are the most detailed explanation of what New Yorkers should expect during the distribution process. Here are five things you need to know.

There are five phases to distribution

The state developed a matrix to determine the distribution of a vaccine based on the vulnerability of different groups and their potential exposure to the coronavirus. Health care workers, the most vulnerable nursing home residents and people who work in long-term care facilities will be able to receive the vaccine first. Then comes essential workers like first responders, police, teachers, grocery store clerks, other people in congregate settings, and people with severe comorbidities. More people over 65 years old and people with additional health conditions will follow in the next phase. The fourth phase includes other essential workers. Everyone else comes in the fifth and final stage.

Factors like geography will also determine distribution

Other factors mean some people will get vaccinated before others. “Once the vaccine is first approved for use, New York State will use up-to-date data to determine which geographic areas of the state may derive a greater public health benefit to receiving early vaccine,” according to the draft plan. Nursing homes experiencing high numbers of infections could also get priority access to the vaccine. The state is also considering the use of vaccines as a tool in addressing local outbreaks.

It is hard to keep vaccines from spoiling

The state’s plans are all about getting two doses of the vaccine for each person from the manufacturing hubs to about 20 million people across the state. That can be really hard when you have to do it at scale with a vaccine that will likely require two doses administered weeks apart.

The state anticipates using all sorts of venues to actually give the vaccine to people, including large-scale temporary facilities like the testing sites it has set up in the past few months, as well as existing locations like pharmacies. Current plans state that any entity that wants to get involved will have to register with the state Department of Health. “Capacity to store and handle vaccines across the full cold-chain spectrum will be assessed as part of the provider enrollment process,” according to the state plan. “The state will identify strategically located facilities that can host state-operated vaccination sites and build necessary infrastructure.”

None of this will be easy, but there is at least one source of convenience: “The vaccine may be shipped in a flat ‘pizza box-like’ container with dry ice that would not need recharge until the 10-day mark,” according to the state plan.

The state is centralizing control

The state expects the Centers for Disease Control and Prevention to use McKesson Corp. to distribute a vaccine being developed by Moderna. Another vaccine being developed through the multibillion-dollar federal effort Operation Warp Speed, however, could be directly shipped to hospitals and other users. The extent to which this could cut the state out of the distribution process remains to be seen, but the state explicitly says in the draft plan that it intends to be the ultimate decider of who gets the vaccine. “To ensure coordinated and efficient statewide distribution and administration, all localities and entities in New York State will be required to follow the state’s guidance and protocols for COVID-19 vaccination,” the plan reads. A task force named by the governor will not only judge the safety of any federally approved vaccine, but will also advise the state on its legal authority to block the distribution of a vaccine it deems unsafe. 

Pay attention to the task forces

Cuomo has already named two task forces to help the state with its distribution strategy. The first is called the Clinical Advisory Task Force, which consists of seven public health experts. “The Task Force will advise on the vaccine safety profile, legal authority to withhold vaccine, and clinical best practices if New York State must withhold or pause distribution of the vaccine. The group will also advise New York State as to the implications of a vaccine being released under an FDA (Emergency Use Authorization).” 

The second task force is called the Vaccine Distribution and Implementation Task Force, which will “advise the setup and operation of the state’s COVID-19 vaccination program.” Additional task forces could be set up in the future, according to the draft plan, which could help the Cuomo administration make good on assurances that it will address outstanding concerns about how racial inequities could limit public confidence and access to future vaccines. The draft plans do envision a public relations campaign, but it remains unclear who among communities of color will have direct say on state distribution plans moving forward. “New York State will continue to work closely with partners across the state who can assist in addressing health equity issues and ensure that access to health care and vaccines is not a barrier for COVID-19 treatment strategies,” reads the draft. “Health care providers, community-based organizations, and religious and community leaders will continue to assist New York State to achieve these goals and will be represented across the various stakeholder groups.”

Correction: An earlier version of this story incorrectly stated the number of people on the state Clinical Advisory Task Force.