Vaccine distribution - Printable Version
+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: Vaccine distribution (/thread-20889.html)
+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: Vaccine distribution (/thread-20889.html)
RE: Vaccine distribution - M T - 12-06-2020
(12-05-2020, 09:48 PM)Goose Wrote:(12-05-2020, 06:52 PM)M T Wrote: The first week's vaccinations should be easy.Compared to what? No activity you haven't done before is ever "easy". Plenty of things that you never imagined can go wrong. The Health Care Workers should be easier than the general public, but that doesn't mean "easy". Figuring out who "qualifies" is perhaps an important part of the problem, but people in LTCF will probably receive their vaccines in that facility. How that will be made to happen isn't trivial.
All this stuff can be done, and if properly planned, properly resourced, and properly validated can go very well. We will soon see to what extent it has been. We can't afford anything but a "good" performance, because the performance we have managed up to now in containing this disease is horrid, IMHO.
Past performance does not guarantee future performance!
What I meant by easy is that the set of people is known to the state(s). Almost all of them will be easy to find (patients at a LTCF; health care workers and 1st responders includ many at LTCFs or known facilities (hospitals, clinics, fire stations, etc.)) and at a place that one could give injections.
As for "compared to what", I meant as compared to any further attempt at giving shots to those that might benefit the most (those most at risk if the get COVID, as well as those most at risk of getting COVID, as well as those most at risk of spreading COVID (except children, who are not going to get the vaccinations))
RE: Vaccine distribution - dabigv13 - 12-06-2020
https://www.washingtonpost.com/business/2020/12/05/operation-warp-speed-coronavirus-vaccine-shortfall/
More details here. It does seem to be the case that they are holding shots in reserve for 2nd doses and not giving everything at hand as a first dose.
Quote:Operation Warp Speed officials said that, within 24 hours of the Pfizer vaccine winning clearance, the government would begin releasing 6.4 million doses, in two stages: enough for the first shot, followed three weeks later by enough for the second shot. Once the Moderna vaccine is authorized, perhaps a week after Pfizer’s, 12.5 million doses would begin to be released, under a similar schedule.
I am curious how the raw material shortage problems are being fixed; the two leading candidates are very similar to each other, as well as being novel. To my eye this would seem to be a potential problem as there may not be a robust supply chain for these raw materials in existence, and if both companies are drawing from the same well, makes that even worse.
Can they scale the production as rapidly as they have promised? They are talking about supply chain problems now and they are producing at a miniscule level compared to their predictions for a month from now.
In any case, let's hope the modified nucleotide and lipid vaccine encasement supply chain is more robust than that for nitrile gloves. Several sizes nearly out now, staff advised to try and fit into mediums last week. Maybe OWS bought them all but I doubt it.
‐------
On a more hopeful note, this article on the science behind the mRNA vaccines is very good.
https://www.washingtonpost.com/health/2020/12/06/covid-vaccine-messenger-rna/
Basic science research over decades has accumulated the building blocks to make this all possible. When I was in medical school I did some lab research with RNAi, a different sort of RNA therapeutic than the mRNA vaccine tech, in treatment of head and neck cancer. Didn't really work out too well (an experience that made me lament the shitty facilities and support at USC compared to Stanford). A lot of the difficulty was transporting the RNAi safely into the cells because of how fragile RNA is. Basically every lab surface is potentially crawling with RNAse begging to degrade your therapeutics, and the cells themselves are trying to as well. The lipofection process of getting the therapeutic into the cells (similar to how the mRNA vaccines work, transported in lipid vectors) is not simple either, even in a controlled lab setting. This is why the mRNA vaccines require the freezers other vaccines don't, to slow any enzymatic degradation, but even so making them as stable as they are is a great feat, especially Moderna's.
I imagine a lot of the advances made for these vaccines could in turn spur new advances in a lot of other clinical applications. Let's hope it works as safely and effectively in the real world as the clinical trials have indicated thus far.
RE: Vaccine distribution - BostonCard - 12-06-2020
I’m having flashbacks to residency when large and extra large gloves were hard to come by because the nurses would put out medium size gloves that fit them well.
BC
RE: Vaccine distribution - fullmetal - 12-07-2020
(12-06-2020, 12:22 PM)BostonCard Wrote: I’m having flashbacks to residency when large and extra large gloves were hard to come by because the nurses would put out medium size gloves that fit them well.
Gotta know where the supply rooms are and grab a (presumably overstocked) box to take back to your station :)
RE: Vaccine distribution - dabigv13 - 12-07-2020
https://www.nytimes.com/live/2020/12/07/world/covid-19-coronavirus/trump-administration-officials-passed-when-pfizer-offered-in-late-summer-to-sell-the-us-more-vaccine-doses
Not optimal. Pfizer is supposed to deliver 20m by end of December and then ramp up. If we are only getting 100 million from them, and 100 million from Moderna, that's 100m total Americans that can be vaccinated because both vaccines require two doses. Prior reporting indicated the US had bought 100million from Pfizer and had an option for an additional 500m. Seems now from this report that option will only be available in perhaps June.
Don't think the mRNA vaccines will even cover all the HCPs and elderly with comorbidities, and we could well run out of vaccines to give in the Spring unless more is sourced, or other vaccines are approved.
We better hope that the other vaccines are safe and efficacious and also can be produced very quickly.
RE: Vaccine distribution - BostonCard - 12-07-2020
Between Moderna itself and Lonza (manufacturing on behalf of Moderna), they are looking at 400 million doses of vaccine a year, of which 100 million are committed to the US, 100 million to the EU, and 50 million each to Canada and Japan.
The game changer would be approval of one of the antigen-based or viral vector vaccines. Then manufacturing will be into the billions.
BC
RE: Vaccine distribution - Goose - 12-07-2020
FWIW, the "option" scam is one that contractors and the government use all the time to make things look much better than they actually are. I am speaking from bitter experience. Usually the terms of the option are such that either side can get out of it very easily by (correctly) claiming that some of the agreed-upon terms have not been met. For that reason, contractors can agree to options that require them to do things they actually may not be able to do because they know they won't actually have to do so. I don't know if this is the case here, but one should never assume that a government "option" in a contract means much, no matter what they tell you.
RE: Vaccine distribution - dabigv13 - 12-07-2020
More details here-
https://www.washingtonpost.com/health/2020/12/07/pfizer-vaccine-doses-trump/
The plan the government is selling to the public is that by the summer, most people will be able to get shots or have gotten shots.
But in actuality, that plan depends on several other vaccines quickly finishing clinical trials that demonstrate safety and efficacy, and then being able to quickly produce hundreds of millions of vaccines in a few months. No sure thing. This is all being done for the very first time, and the company with the first vaccine to market, Pfizer, already had to downgrade their initial production estimates, though they say they will make it up.
RE: Vaccine distribution - dabigv13 - 12-07-2020
https://www.statnews.com/2020/12/07/pledge-to-vaccinate-20-million-against-covid19-in-december-seems-unrealistic/
STAT News has been critical during the pandemic. This on the "last mile" of the initial vaccine distribution is very informative. I am extremely skeptical that 20m people will be getting shots in arms this month.
RE: Vaccine distribution - Goose - 12-07-2020
(12-07-2020, 09:04 PM)dabigv13 Wrote: https://www.statnews.com/2020/12/07/pledge-to-vaccinate-20-million-against-covid19-in-december-seems-unrealistic/
STAT News has been critical during the pandemic. This on the "last mile" of the initial vaccine distribution is very informative. I am extremely skeptical that 20m people will be getting shots in arms this month.
I share your skepticism. Based on this link, it is even more of a cluster**** that I had feared. The "last mile" folks are not ready and haven't walked through this process. Some of the problems they are talking about are just the "level 1" set of issues. Granted, sometimes internet reports are not "typical", but I have no reason to believe we are in better shape locally than these folks were.
Given all the problems we have experienced with all levels of the government's response to this pandemic, one would have hoped lots of people would have ensured we didn't mess up our only way out of it. Not looking good ATM. Let's see how the UK does.
RE: Vaccine distribution - OutsiderFan - 12-08-2020
Someone please correct if they are not facts:
- The Biden Transition has seen no vaccine distribution plan being worked on by the federal government now.
- The New York Times reports the Fed government passed on ordering more Pfizer vaccine doses when asked if it wanted more, other countries did order them, and the U.S. will be at the bottom of the pecking order as a result.
My assumptions:
- The Fed government never had a plan to distributive vaccines and has been planning to leave it up to the states.
- The Fed government also passed on ordering other vaccines beyond Pfizer's, because why would they if the states are expected to be responsible.
- Scott Atlas was never a strong proponent of mass vaccination, as he wanted his own herd immunity method to kill millions.
- Pfizer offered states a certain amount of free doses, but required the Fed government to order more that had to be bought, because why on Earth would any company try selling to 50 different people when it can just sell to one (FEMA), and the states have no money anyway. FEMA passed on ordering after orders from someone*.
* This could warrant an investigation and lead to criminal charges of some sort. Why wasn't more Pfizer vaccine ordered when offered?
The Biden Transition is formulating a vaccine distribution plan, but it doesn't have access to the government machinery to make the planning connections needed to execute. Instead of working with the Fed government to put those connections in place before new admin, nothing is happening, and on day 1 of new admin, those connections will have to start being made. But what difference does it make if the vaccine doses needed aren't going to be on hand?
So the Trillion Dollar question now becomes: Did the government order any additional vaccines beyond Pfizer's when offered them?
RE: Vaccine distribution - dabigv13 - 12-08-2020
I think most of your assumptions are not really supported by the facts. And the US has orders with other vaccine companies. I linked a newsweek article from November that went through what has been purchased a few posts ago. What the recent reporting has made clear is the hundreds of millions of doses we had options on will not be reality until the summer at best.
Operation Warp Speed seems pretty useless I will say. The main thing they did was throw a ton of money at drug companies but when they had a promising vaccine candidate they could have bought more of, they didn't. It seems this will lead to a several month delay or replacement with a likely less effective vaccine.
It also seems they are doing nothing to help coordinate vaccine distribution locally beyond dropping off the boxes of vaccines.
I do think they are dropping a big mess in Biden's lap. Let's see how things look in a couple weeks, will be more clear by then.
RE: Vaccine distribution - OutsiderFan - 12-08-2020
On the topic of who has claimed and ordered vaccines, Laurie Garrett just shared this today. There is a big delta between purchased and available to be purchased for the United States:
[twitter]https://twitter.com/Laurie_Garrett/status/1336314235396235267/photo/1[/twitter]
RE: Vaccine distribution - BostonCard - 12-08-2020
(12-08-2020, 10:09 AM)dabigv13 Wrote: Operation Warp Speed seems pretty useless I will say. The main thing they did was throw a ton of money at drug companies but when they had a promising vaccine candidate they could have bought more of, they didn't. It seems this will lead to a several month delay or replacement with a likely less effective vaccine.
I'm not sure this is quite right. Pfizer opted not to participate in Warp Speed for vaccine development. And for smaller companies like Moderna or Novavax, Warp Speed was a source of funding for an accelerated development program that they would not have been able to undertake without partnering with a large pharma company (as BioNTech did). The second thing it allowed was manufacturing development at risk. Normally, manufacturing scale-up would happen in conjunction with clinical scale-up. You wouldn't develop large-scale manufacturing until you were well into the phase 3 trial because so many things can go wrong. Warp Speed shifted the risk of building a large manufacturing facility for a failed vaccine from the company to the government.
I'm not sure why the government declined the Pfizer option. It could be because they were not part of Warp Speed, or it could be because they already ad more than enough vaccine ordered up to cover everyone from Warp Speed participants (though of course, timing is an issue). But the government did seem to miss a chance to order more vaccine from the frontrunner.
As to distribution, although the cold chain is much more logistically challenging, the "last mile", getting vaccine into deltoid, is something that we do have a lot of experience with using annual flu shots. About 40% of the country's population gets an annual influenza vaccine over the course of about 4 months (October through January). COVID-19 vaccination is more complicated (cold storage requirement, two doses required), but this is not something entirely new.
BC
RE: Vaccine distribution - dabigv13 - 12-08-2020
Right, they threw a bunch of money at the drug companies. Which is great and a no brainer when the potential costs are dwarfed by the possible benefits.
But then when you have a vaccine, which in July did not have phase 3 trials completed but was still obviously a frontrunner with Moderna in terms of likelihood of being to market much sooner than others and with promising early trial data, and you've already thrown billions of dollars at less promising, less far along candidates, why would you not throw a few more billions to secure 100million more doses from Pfizer?
It is dumb. Height of pennywise, pound foolishness. If they did it simply because they weren't a part of Operation Warp Speed, even dumber.
-----
Flu vaccination is an entirely different animal than this. In March there could be 4 or more different vaccines all requiring different dose intervals and storage protocols. They will all be limited in doses, and none will be swappable with others. We need to identify who needs them, and can't waste the precious doses we have. This will be a singularly difficult vaccination campaign. And from what I see on the ground, there is very little coordination from the feds, the state, and the healthcare orgs that will be doing the shots.
RE: Vaccine distribution - Goose - 12-08-2020
(12-08-2020, 10:36 AM)BostonCard Wrote: As to distribution, although the cold chain is much more logistically challenging, the "last mile", getting vaccine into deltoid, is something that we do have a lot of experience with using annual flu shots. About 40% of the country's population gets an annual influenza vaccine over the course of about 4 months (October through January). COVID-19 vaccination is more complicated (cold storage requirement, two doses required), but this is not something entirely new.The storage requirement isn't entirely new, but it does place a major constraint on administration. The effective shelf life of the vaccines is much shorter than the shelf life of the flu vaccine. Even more importantly, flu vaccine isn't a "limited resource", at least not usually. You can get pretty much all you want. That is a critical difference. We can't allow any significant quantity of this vaccine to expire and not get used. We also need to vaccinate more than 40% of the population to stop this thing. As BC has pointed out, if we get vaccines that are technologically more similar to flu vaccines we can manufacture oceans of it easily and store it in refrigerators for 9-12 months. Unfortunately we aren't there yet.
BC
I just looked on the web for results of trials of the Sinovac vaccine. Lost of phase 1 and 2 stuff early on and then something approaching silence. Any insight on this board on where this vaccine actually stands? I know there is lots of concern about its genesis, but it would be nice to know if it actually is safe and actually effective. At a minimum, we need to know if we can "count" people who have received it as relatively safe from spreading COVID-19.
RE: Vaccine distribution - teejers1 - 12-08-2020
(12-08-2020, 09:44 AM)OutsiderFan Wrote: Someone please correct if they are not facts:
- The Biden Transition has seen no vaccine distribution plan being worked on by the federal government now.
- The New York Times reports the Fed government passed on ordering more Pfizer vaccine doses when asked if it wanted more, other countries did order them, and the U.S. will be at the bottom of the pecking order as a result.
My assumptions:
- The Fed government never had a plan to distributive vaccines and has been planning to leave it up to the states.
- The Fed government also passed on ordering other vaccines beyond Pfizer's, because why would they if the states are expected to be responsible.
- Scott Atlas was never a strong proponent of mass vaccination, as he wanted his own herd immunity method to kill millions.
- Pfizer offered states a certain amount of free doses, but required the Fed government to order more that had to be bought, because why on Earth would any company try selling to 50 different people when it can just sell to one (FEMA), and the states have no money anyway. FEMA passed on ordering after orders from someone*.
* This could warrant an investigation and lead to criminal charges of some sort. Why wasn't more Pfizer vaccine ordered when offered?
The Biden Transition is formulating a vaccine distribution plan, but it doesn't have access to the government machinery to make the planning connections needed to execute. Instead of working with the Fed government to put those connections in place before new admin, nothing is happening, and on day 1 of new admin, those connections will have to start being made. But what difference does it make if the vaccine doses needed aren't going to be on hand?
So the Trillion Dollar question now becomes: Did the government order any additional vaccines beyond Pfizer's when offered them?
Evidently the democratic process of electing (and not re-electing) presidents, very likely due to pandemic response, is insufficient for some - I'd say several - on this board. We must have criminal prosecutions!!
The guy is WAY too old to have dated your girlfriends/wives/significant others, thus, that can't be the motivation . . .
I've never understood the
RE: Vaccine distribution - dabigv13 - 12-08-2020
Trump is almost certainly a criminal who has mismanaged the pandemic, but I don't think he will have committed any crimes related to the pandemic. But I'm always surprised by what his crew can pull off.
Regarding the SinoVac vaccine, I don't know that I'd trust any data from them, but I presume it will behave similar to the other adenovirus vaccines such as the Oxford/AZ vaccine, which BC nicely summarized in another post. Then again it seems dose timing and dose quantity may be important for these types of vaccines, which again are novel, and it seems they didn't do as much in early clinical trials to figure that out as they could have. So maybe if different adenovirus vaccines have different dose quantities or schedules, they may behave differently. But the vaccines themselves will be very similar in design.
RE: Vaccine distribution - Goose - 12-08-2020
(12-08-2020, 11:29 AM)dabigv13 Wrote: Regarding the SinoVac vaccine, I don't know that I'd trust any data from them, but I presume it will behave similar to the other adenovirus vaccines such as the Oxford/AZ vaccine, which BC nicely summarized in another post. Then again it seems dose timing and dose quantity may be important for these types of vaccines, which again are novel, and it seems they didn't do as much in early clinical trials to figure that out as they could have. So maybe if different adenovirus vaccines have different dose quantities or schedules, they may behave differently. But the vaccines themselves will be very similar in design.
For sure I wouldn't trust anything coming directly out of China. I probably wouldn't trust anything from Indonesia either, for somewhat different reasons. There is an EUA in Indonesia at the moment. I am hoping for something more reliable. Turkey is supposedly doing a trial, but I don't see any results. I did find this, FWIW;
https://learningenglish.voanews.com/a/turkey-brazil-to-use-chinese-covid-19-vaccine/5686367.html
It is certainly possible to design an adenovirus vaccine that turns out to work poorly, so I wouldn't necessarily put too much stock in the technological roots of the vaccine. We need the results of clinical trials that we trust. Maybe Brazil's?
RE: Vaccine distribution - M T - 12-08-2020
(12-07-2020, 09:04 PM)dabigv13 Wrote: https://www.statnews.com/2020/12/07/pledge-to-vaccinate-20-million-against-covid19-in-december-seems-unrealistic/
STAT News has been critical during the pandemic. This on the "last mile" of the initial vaccine distribution is very informative. I am extremely skeptical that 20m people will be getting shots in arms this month.
Well, when STAT News bases everything on its own falsehood, it can say whatever it wants. The article is based on this falsehood as the lead sentence of its second paragraph "Leaders of Operation Warp Speed have repeatedly said they are on track to vaccinate 20 million people in December..." (Note the links are to news sources, not OWS sources.)
What OWS has repeatedly said is that they are working to distribute 40M doses of vaccine in December to 64 jurisdictions. The federal government is not choosing who gets the vaccine and who doesn't and in what order. That is up to the 50 states, 8 territories, 6 major cities that are getting the shipments. The federal government is not administering the shots. That is up to the 64 jurisdictions to do.
To claim that OWS said that they were going to vaccinate 20M people or even 1 person is disingenuous or, perhaps depending upon how literal you take the news source, fake news. They even (nearly) accurately quote one of the sources "Moncef Slaoui, head of Operation Warp Speed, said in a briefing last week he was confident “we will be able to distribute … enough vaccine to immunize 20 million people in the U.S. in December.” where OWS is NOT saying that they will vaccinate 20 million people in December.
The actual statement (9:52 in the video) starts with "... fortunately the investments we have made in scaling up and starting to stockpile manufacturing of the vaccine allow us to feel confident that we will be able to distribute … enough vaccine to immunize 20 million people in the U.S. in December. That's forty million doses.”
Dr. Slaoui's comment should be read carefully. It is accurate but I believe it is TOO easy to be misunderstood. He does NOT say that 20M people will be vaccinated in December. He does NOT say that these doses will go ONLY to 20M people. This is like saying "We fell confident we will distribute enough vaccine to fill an Olympic-sized pool." As I've said before, I expect (close to) 40M doses will be shipped, and they will all be used as first doses. I will be disappointed if only 20M first doses ship in December with 20M (of that first 40M) held back until January for distribution.
Slaoui's use of "enough vaccine to immunize 20 million people" apparently is intended to allow speaking uniformly across different vaccines where some will require only one dose. I looked hard to see if they distinguished whether 40M doses will BE DISTRIBUTED in December or BE ALLOCATED. If allocated, then 20M ship now and 20M later (only 20M first doses administered). If distributed, then 40M doses ship in December (40M first doses administrated (not necessarily in December)). It wasn't 100% clear to me. I currently believe it is DISTRIBUTED (what Slaoui said).
As for the 64 jurisdictions, they were required to submit their draft "microplan" for distribution in November, with final versions about a week before the Dec. 10 (Pfizer) and Dec 17 (Moderna) EUA meetings.
As I understand it, shipments will be once a week. The state locks in how much gets sent to which location on, say, Saturday. The shipment happens on Sunday. It arrives on Monday. Once it arrives, it is up to the jurisdiction to put shots in arms.
I don't know what the states have done for ramping up the vaccinations.
For those who thing OWS isn't worthwhile, I rather disappointed in that view. In the Nov 24 briefing, start listening at the 42:00 minute mark for the Secretary's run down of what the Federal government has done and what is up to the states to do (I believe he indicated a half-trillion dollars will have been distributed to the states for their part).