Distributing A Coronavirus Vaccine Will Bring Some Challenges

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NPR's Lulu Garcia-Navarro speaks with Thomas Bollyky of the Council on Foreign Relations about the challenges of distributing a coronavirus vaccine.

Transcript

LULU GARCIA-NAVARRO, HOST:

There is light at the end of the dark moment we find ourselves in - record coronavirus infections, soaring hospitalizations and deaths. But a vaccine is on the way. Pfizer and Moderna have both announced that they've developed vaccines that have a high rate of effectiveness. The first shots could be available next month, but who will get them? And because they must be kept well below freezing, how? Tom Bollyky is here to help answer those questions. He's director of the global health program at the Council on Foreign Relations, and he joins us now.

Welcome.

THOMAS BOLLYKY: Thank you for having me, Lulu.

GARCIA-NAVARRO: It is a pleasure to have you. OK. These two companies have announced promising data for their vaccines. Pfizer has asked for emergency authorization, and now the FDA will be looking at their raw data. The CDC also has to weigh in. So how long is this process supposed to take before the first vaccines can be distributed?

BOLLYKY: As of now, the committee that will assess this or give advice to the FDA will be meeting the week of December 7 - December 10 in particular. It could come very soon thereafter. So if the FDA authorizes expanded use of this - these vaccines, they'll then go to the CDC for recommendation one or two days, and then we'll be off and running.

GARCIA-NAVARRO: So do you have any concerns about the speed of the process?

BOLLYKY: I don't have concerns as of yet. We'll see what happens when the FDA does its independent review of the data. But the clinical trial results, at least as reported, are pretty spectacular. These would be among the most effective vaccines that we have. They also have a great safety profile. They're actually even safer among older populations than they are in the general population.

GARCIA-NAVARRO: All right. The Pfizer vaccine must be kept, though, at 94 below zero. That's 50 degrees cooler than other vaccines. Looking at how the government has managed the pandemic so far, do you think they're up to the challenge of distributing this vaccine widely?

BOLLYKY: I don't, at least not as of yet. And here I think there are two important things for listeners to understand. The first is even for an effective - highly effective vaccine like this, at least 3 out of 4 Americans would need to take it for this vaccine to extinguish the pandemic on its own. That's a tall order because what we're going to be doing over the next months is vaccinating adults, not children. The reason for that is we haven't done the clinical trials to support the use of either of these vaccines in children.

And here's the second thing to know. The U.S. is historically terrible at vaccinating adults. For seasonal flu, the United States has never managed to vaccinate more than half of adults for seasonal influenza in any single year. In most years, it hovers around 40%. Vaccine rates among Black or Latinx Americans, high-risk adults are even lower.

GARCIA-NAVARRO: I mean, there's a lot to dig into what you just said. So I'm going to start, actually, with kids. Where does this leave kids, then, in all this?

BOLLYKY: So kids are not likely to be able to be vaccinated until closer to the end of 2021. That's not without concern. There are roughly 75 million individuals under the age of 16 in this country. But the clinical trials, in part for speed, in part for safety, were conducted in adults first. Pfizer is just recruiting clinical trial subjects to trial this vaccine in adolescents - so 12- to 15-year-olds next. It's not going to be done for a while.

GARCIA-NAVARRO: You feel it's going to fall short - the distribution is going to fall short on the state level. Explain why that is.

BOLLYKY: So it's really for two reasons. The first is we haven't given them the resources they need to succeed. To date, the CDC has only distributed $200 million to states, territorialities and local jurisdictions for vaccine distribution. President-elect Biden has suggested that his administration will seek $25 billion to support states, but that will require congressional action and won't likely happen until February. We're going to need resources sooner.

The second reason is states and localities have struggled in the past. In H1N1, the CDC distributed vaccines to states according to the size of their population 'cause that's the easiest and most politically viable thing to do. The problem was that states didn't follow the allocation guidelines they'd gotten from the CDC. And what that meant is vaccines went to locally powerful political groups instead of frontline health workers. And we saw significant racial disparities.

GARCIA-NAVARRO: Anecdotally, I have friends and family who would do anything for a vaccine ASAP and others who say, no way am I going to be the first in line. You know, 75% of the U.S. population needs to be vaccinated - right? - in order for the vaccine to be effective.

BOLLYKY: That's right. So we do need to hit a pretty high number. That said, you know, the goal here isn't just to end the pandemic; it's to protect those who can benefit most from this vaccine. We are currently projected, between now and the end of March, to suffer another 220,000 deaths in this country. A vaccine can meaningfully alter that trajectory, but that depends on us getting it to the vulnerable populations, priority populations who can benefit from it most. And I'm concerned we're not giving the resources or taking the steps to make that happen because at the end of the day, we are going to get one shot at this. Once we lose the public's confidence, it will be very hard to win back. It's really important that we get this rollout right.

GARCIA-NAVARRO: That's Tom Bollyky of the Council on Foreign Relations.

Thank you very much.

BOLLYKY: My great pleasure. Thanks for having me. Transcript provided by NPR, Copyright NPR.