There's a lot to celebrate about having safe and effective COVID-19 vaccines on the ground within less than a year of the pandemic's onset. But now that vaccine is here, much of the public is left wondering why getting doses in arms - which experts say is our ticket out of the pandemic - isn't going smoother and faster.
"We don't have enough vaccine, and that has created anxiety, it's created frustration, it's created long lines, it's created a misunderstanding about what vaccines are available and what we should be doing to make sure that everyone that wants one gets one," Tennessee Gov. Bill Lee said during a news briefing on Friday. "The fact that vaccine has been slow and limited to roll out has been a great challenge for us."
Tennessee is not alone in its struggle. Although each state was required to submit vaccine distribution plans to the U.S. Centers for Disease Control and Prevention in October, Hani Mahmassani, a professor and director of the Northwestern University Transportation Center, said the rate at which the United States is vaccinating is "quite low compared to where it needs to be."
As of Friday, more than 22.1 million doses of vaccine had been distributed across the United States, according to CDC data. But fewer than 6.7 million residents had received their first dose - nowhere near the Trump administration's promise to vaccinate 20 million people by the end of 2020.
Dr. Wafaa El-Sadr, an epidemiology professor at Columbia University, told the New York Times that the pace is concerning, especially given that the first vaccination phase should be the simplest.
"We've started out with the easiest populations, an almost captive audience: nursing homes and hospital workers - you know who they are and where to find them," she said.
With the exception of a few minor weather delays, Mahmassani said the work done by major carriers in conjunction with Operation Warp Speed - the partnership between private companies and the U.S. government to develop and deploy COVID-19 vaccines - of getting those vaccines from drug manufacturers to distribution hubs to the states has gone "as well as can be expected." But he was worried from the start about how states and localities would handle their side of the process, because those entities don't necessarily have experience in the type of mobilization effort needed to disseminate COVID-19 vaccine.
"It's been a huge, hard start to try and get a lot of vaccines out in a short period of time, and it's all time sensitive, and it's very difficult to handle as a product with a lot of moving parts," Mahmassani said. "Given how long we've known about this, I would have hoped that state and local areas would have had a more effective plan that can vaccinate people faster. But in fairness, there's also been a lot of changing information along the way."
For example, states don't know how many doses are coming and when shipments will arrive, which was compounded by the timing of the holidays.
While local governments have some experience distributing influenza vaccines, Mahmassani said there are many reasons why COVID-19 vaccines are different.
The two coronavirus vaccines now authorized for use in the United States have special storage and handling requirements. Pfizer's vaccine poses a particular challenge, because it must be kept in ultra-cold freezers that the average medical clinic and small hospital don't have, and shipments contain a minimum of 975 doses that expire quickly once thawed.
These factors greatly limit the types of settings in which the vaccine can be administered. By comparison, flu vaccines are disseminated through many more points, such as drug stores, doctors' offices, groceries and even airports.
Other challenges include a 15-minute observation period for patients after getting vaccinated and a requirement that they return in several weeks for a second dose.
"I don't think they quite realized how much it was going to take - how it's going to have to be a sustained effort of a scale that is far above ordinary," Mahmassani said. "It's also more of a concern locally because once you defrost the Pfizer vaccine, if you don't use it within a certain time period, it's gone. You lose it."
Hamilton County Health Department officials learned that lesson the hard way when on Dec. 31, the first time the department handled the Pfizer vaccine, they miscalculated the number of doses per vial. After sending eligible people in the priority groups away earlier in the day, health department staff wound up vaccinating non-eligible people in an effort not to waste any vaccine.
Mahmassani said similar issues are occurring across the country, with some locations adhering so strictly to their priority list that doses expire. A better plan would be to have a reserve list of priority people or at least people who are close in priority ready to come receive their vaccine at a moment's notice, he said.
Dr. Andrea Willis, chief medical office at BlueCross BlueShield of Tennessee, said pent-up demand for vaccine after a year in which life was upended by the pandemic, combined with the fact that COVID-19 is more widespread and deadly than other pandemics in modern history, are likely fueling frustration.
"We've been waiting on this for so long, but I do think the thought process, by making sure the most high-risk individuals are first, is very appropriate," Willis said. "I understand everybody is so anxious and excited to see a brighter day, but I do think that we can't forget that we're still fighting this, as well as trying to prevent it."
The degree at which states are getting vaccines into arms varies widely across the country.
Tennessee has fared better than all its neighboring states and as of Friday ranked 11th in the nation among states administering the most vaccines per capita, with 2,879 vaccines administered per 100,000 residents. Georgia ranked last, with only 1,122 vaccines administered per 100,000 residents.
Despite the issues, Mahmassani still thinks vaccine dissemination is better left to the states and localities that know their territories best as opposed to the federal government. In a perfect world, though, he thinks more federal resources could be used to support local governments, allowing them to deploy more vaccine stations and launch robust public information campaigns. At least some of the aid that's needed is likely to come from the nearly $9 billion COVID-19 relief package passed in December.
Willis said the situation also will improve as supplies ramp up and other vaccines become available. Johnson & Johnson and AstraZeneca both have vaccines in the final stages of clinical trials, and those could be authorized for deployment as early as next month, Willis said. Both of those vaccines have similar storage requirements, and Johnson & Johnson's vaccine requires only one dose.
She's also optimistic about Tennessee's plan to implement an online appointment system for vaccinations.
"That's consistent with the way we seek health care, for the most part, today," Willis said. "That should alleviate some of the things that we've seen so far with a lot of people waiting and then being turned away, so I think this is a good step to try to address that. But, like with everything we've seen, we probably will have to adjust."
It's also important to remember that vaccines are only one part of the public health response, Willis said.
"Public health is not just about what our public health officials do, it's also about how we can pull together," she said, adding that people still need to be taking personal responsibility for wearing face masks, social distancing and practicing good hygiene. "So this is just one tool. It's an important tool, but it's just one tool."
Contact Elizabeth Fite at firstname.lastname@example.org or follow her on Twitter @ecfite.