Vaccine distribution challenges include regional approach, insufficient supply

By Mark Hart
78th District
Representative
    Developing and delivering a COVID-19 vaccine became a priority for our nation in the early days of the pandemic. It became obvious that a vaccine would be a necessary part of addressing the virus as public health officials and medical providers developed a better understanding of how it spread from person to person.
    To address that need, the Trump administration created Operation Warp Speed, a program that leveraged public funding to spur private development of not only a vaccine, but also advancements in treatment and testing. While the program was formalized in mid-May of 2020, nearly $1.5 billion was allocated in March and April as the Trump administration set a goal of producing and delivering safe, effective vaccines by January of 2021. It was an ambitious goal, but within reach because medical researchers had already accomplished a great deal in developing vaccines using the mRNA platform. From what I understand, mRNA research began over a decade ago and vaccines using the technology have been tested for four infectious diseases: rabies, influenza, CMV, and Zika.
    Operation Warp Speed was successful in creating vaccines, but now the devil is in the details when it comes to how they will be distributed. In Kentucky, the virus distribution plan is divided into groups and began in mid-December with health care providers and long-term care workers. More flexibility was given to those administering the vaccine earlier this month and now we are seeing teachers and Kentuckians over the age of 70 vaccinated. However, with hundreds of thousands of Kentuckians waiting for their first dose, the demand is outpacing the available supply and the current distribution plan makes the vaccine difficult to access for our state’s rural residents.
    The first challenge is supply. Moderna and Pfizer, the two companies with vaccines approved by the Food and Drug Administration, have not met the goals they initially set for manufacturing. At the same time, far more people are getting vaccinated than we expected, proving early concerns that folks would hesitate completely wrong. The federal government decides how many doses each state is eligible to receive. States then use that number to determine how many to order. The federal approach has been relatively conservative as administrators dealt with manufacturing shortages and wanted to avoid the problems that happened with the H1N1 vaccine about ten years ago. The inconsistent supply leads to a lot of stops and starts as providers open and close registration based on what they are told they will receive. Unfortunately, some who registered for vaccine clinics had their appointments postponed after the providers received fewer doses.
    Of course, how we distribute the vaccine in Kentucky plays a big role in making the vaccine accessible. Until now, most vaccines have been available through public health departments, CVS, and Walgreens. The Governor announced in mid-January that Kroger will join the group, offering drive through regional clinics starting February 1. While it is good to have additional providers, we do not expect to see an increase in our supply so that means the vaccine is carved out of another provider’s amount. Think of supply like a pie, the more people who split the pie, the smaller each piece gets.
    I have grave concerns that the increased emphasis on the regional distribution model and the shortage in supply are adding up to a lack of access for Kentuckians in rural areas. Take my district for example. I represent all of Harrison and Pendleton counties and a portion of Scott County. My constituents are at the same risk of getting COVID as those in urban areas; we even had the first diagnosed case in the state. As I write this update, some of my constituents must drive almost an hour to get the vaccine. Combine that drive with the fact they may end up waiting in line for hours and folks get discouraged from even trying. This is a very real issue.
    In reality, a great deal of the supply issue is unavoidable and Kentucky and other states are going to have to find a way to make it work. After all, leadership is about being prepared enough to make a plan and flexible enough to change it. The solution may be in how we approach distribution. This is a temporary situation, so maybe it is appropriate to try temporary solutions like pop up clinics, rotating supplies among local health departments, or mobile vaccination clinics. Perhaps using technology to create a searchable database can help with accessibility?
    I am told we will see improvements in the weeks to come as vaccines made by Johnson and Johnson and other manufacturers are approved for use. Until then, I will continue to work to make them available at our local health departments. After all, these folks know their community’s needs better than anyone.
    We will reconvene on February 2. In the meantime, I can be reached during the week from 8:30 a.m. until 4:30 p.m. (EST) through the toll-free message line at 1-800-372-7181. You can also contact me via e-mail at Mark.Hart@lrc.ky.gov.