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Vaccine distribution - BostonCard - 11-16-2020

Now that it looks like the COVID-19 vaccines will be very effective, comes the hard part.

https://www.nytimes.com/2020/11/14/health/covid-vaccine-distribution-plans.html

Operations and logistics are not sexy, but they will mean the difference between success and failure of the vaccine rollout.  A transition in government is not the best time to be rolling one of these things out, so that will add to the complexity.

BC


RE: Vaccine distribution - BobK - 11-16-2020

I would think a non transition could be even worse.
Let's Michigan, No NY, no California No


lex24 - lex24 - 11-16-2020

One of the many reasons the transition money should be released.  Biden is going to have to be the adult on this.  Because Trump is doing his petulant 13 year old boy act.  He’s lost, he knows it, so he’s golfing and tweeting.

Maybe Biden can make some statement about starting to work together right now on this. Who knows when the vaccine is actually going to come out but they need to start putting things in place as soon as possible. Whether the shots start on Trump’s  watch or Biden’s is irrelevant. Getting things in place is what’s important. Of course Logic doesn’t come in to play too often on this stuff. Unfortunately.


RE: Vaccine distribution - BostonCard - 11-16-2020

I would anticipate that the FDA can issue an EUA by the end of the month.

Between them, Pfizer and Moderna have 70 million doses by the end of the year, good enough for vaccinating 35 million people.  For better or for worse, that is going to have to be executed by the Trump administration.  I don't think Trump taking off for Florida for the next two months would necessarily be bad, but somebody has to actually run the government until Biden becomes president.

BC


RE: Vaccine distribution - Snorlax94 - 11-16-2020

(11-16-2020, 04:25 PM)BostonCard Wrote:  I would anticipate that the FDA can issue an EUA by the end of the month.

Between them, Pfizer and Moderna have 70 million doses by the end of the year, good enough for vaccinating 35 million people.  For better or for worse, that is going to have to be executed by the Trump administration.  I don't think Trump taking off for Florida for the next two months would necessarily be bad, but somebody has to actually run the government until Biden becomes president.

BC

BC I saw recently in an article that Pfizer planned to have 50m doses by the end of the year, but half of those earmarked for the US, or 25M divided by 2 doses per person so up to 12.5M people.

The problem is often we’ve announced how many doses have been purchased or are supposed to be ready vs how many really will be ready in total and will go to the US.

So, while the Pfizer and Moderna preliminary results are fantastic news, I don’t expect that many doses in 2020, maybe not even enough for doctors, healthcare workers, and first responders.

And, as I’ve mentioned before, I expect many many doses will just sort of disappear. Even if the US military is 1.3 million, will they also prioritize all military families? Civilians who work on bases? Defense contractors? Where there is inventory, there is always shrinkage, even more so when politicians are involved.

And the Novavax phase 3 was delayed due to manufacturing delays — they couldn’t make enough for the US phase 3 trial let alone the US or global population.

I’m very hopeful but am patient knowing it could take a little while.


RE: Vaccine distribution - BostonCard - 11-16-2020

I hadn't seen that, but thanks for the info.  It doesn't surprise me, as Pfizer's partner, BioNTech, is a German company (founded by the children of Turkish immigrants), so it makes sense that some of those doses would be earmarked for the EU/Germany.

By the end of next year, there will be multiple billions of doses of vaccine, enough (probably) to vaccinate all developed countries.  Fauci expects widespread availability of the vaccine by April, which sounds ambitious, but if you exclude the 40% of people who might refuse a vaccine, I could see it.

By the way, how's this for the power of immigrants:
As mentioned, BioNTech is a German company founded by a husband and wife team who are the children of Turkish immigrants.
Pfizer's CEO, Albert Bouria, is Greek; the company was founded in 1849 by a Charles Pfizer and Charles F. Erhart, a pair of German immigrants
Moderna was founded by Derrick Rossi, who is a Canadian, and its CEO is Stéphane Bancel, a Frenchman


BC


RE: Vaccine distribution - magnus - 11-24-2020

in today's HHS briefing,  they said the plan was to distribute the initial 6.4 million vaccines to the states on a per capita basis.  

https://time.com/5915362/covid-19-vaccine-rollout-plans/

From there,  I guess states are free to distribute based on whatever priority they deem appropriate?


RE: Vaccine distribution - Genuine Realist - 11-25-2020

(11-24-2020, 09:52 PM)magnus Wrote:  in today's HHS briefing,  they said the plan was to distribute the initial 6.4 million vaccines to the states on a per capita basis.  

https://time.com/5915362/covid-19-vaccine-rollout-plans/

From there,  I guess states are free to distribute based on whatever priority they deem appropriate?
What a can of worms. In an earlier line, I strongly opined that any racially based system was a political disaster, since there is no genetic vulnerability. Better to identify categories of employment, vulnerability, and so on. But that is actually hard to do, given life styles, part-time work, actual work style, etc. (For example, a lab assistant to a cancer researcher may technically qualify as a health worker, but faces no risk whatsoever and actually does no hands on health care, in relation to the pandemic.) 

Probably best to throw in the sponge and just do a birthday lottery, as in the movie Contagion. Simple and totally unrelated to real or phantom privilege.

(11-16-2020, 07:41 PM)BostonCard Wrote:  I hadn't seen that, but thanks for the info.  It doesn't surprise me, as Pfizer's partner, BioNTech, is a German company (founded by the children of Turkish immigrants), so it makes sense that some of those doses would be earmarked for the EU/Germany.

By the end of next year, there will be multiple billions of doses of vaccine, enough (probably) to vaccinate all developed countries.  Fauci expects widespread availability of the vaccine by April, which sounds ambitious, but if you exclude the 40% of people who might refuse a vaccine, I could see it.

By the way, how's this for the power of immigrants:
As mentioned, BioNTech is a German company founded by a husband and wife team who are the children of Turkish immigrants.
Pfizer's CEO, Albert Bouria, is Greek; the company was founded in 1849 by a Charles Pfizer and Charles F. Erhart, a pair of German immigrants
Moderna was founded by Derrick Rossi, who is a Canadian, and its CEO is Stéphane Bancel, a Frenchman
BC
Immigrant energy fuels, and has always fueled, this nation's culture and economy. Particularly so if you view the emigration of African-Americans from the Deep South to the urban North as a type of internal immigration. There's a really good book, 'The Warmth of Other Suns', by Isabel Wilkerson on that history, a career maker.


RE: Vaccine distribution - fullmetal - 11-26-2020

(11-16-2020, 12:27 PM)BostonCard Wrote:  Operations and logistics are not sexy, but they will mean the difference between success and failure of the vaccine rollout.  A transition in government is not the best time to be rolling one of these things out, so that will add to the complexity.

Thankfully, operations and logistics are well-known problems, and there is a lot of expertise available to tap.  It will be complex, but it is solvable.  I'm thinking of the collective algorithmic efficiency between Amazon, UPS, FedEx, DHL, and, of course, the USPS, among others.  Imagine the collective might that brought you overnight/same-day delivery brought to bear on this vaccine distribution problem.  At least, I'm hoping enough of the right people will be working on this.


RE: Vaccine distribution - Goose - 11-26-2020

(11-26-2020, 02:41 AM)fullmetal Wrote:  
(11-16-2020, 12:27 PM)BostonCard Wrote:  Operations and logistics are not sexy, but they will mean the difference between success and failure of the vaccine rollout.  A transition in government is not the best time to be rolling one of these things out, so that will add to the complexity.

Thankfully, operations and logistics are well-known problems, and there is a lot of expertise available to tap.  It will be complex, but it is solvable.  I'm thinking of the collective algorithmic efficiency between Amazon, UPS, FedEx, DHL, and, of course, the USPS, among others.  Imagine the collective might that brought you overnight/same-day delivery brought to bear on this vaccine distribution problem.  At least, I'm hoping enough of the right people will be working on this.
You can get overnight delivery on products stored super-cold (liquid nitrogen) right now without any problem. FedEx offers the service, and probably others do too. It is more a problem on the receiving end. If you don't have a place to store the product then you must consume it all rapidly. That is the more serious problem. If there is a shipping delay of a day or so, the product will remain cold and not be harmed. If it has to sit in somebody's stockroom for weeks there is a problem. Hospitals (of any size) can probably get storage capability easily. Doctor's offices not so much.

CVS pharmacy and the like is more where the issue is muddy. I know that our CVS pharmacy receives some vaccines in weekly sized shipments. The goal is to not store piles of it at the pharmacy. That is one reason you must make an appointment to get some of the vaccines. I also know they don't have the ability (or training) to store things at below refrigerator standards. These type of facilities are the ones with a difficult choice. Reliable daily delivery to all such facilities of super cold products is probably beyond the capacity of the delivery providers and will remain so. There are just too many of them. Weekly is certainly possible. With a properly designed shipping Dewar I would hope they could get one week storage capability even in cases where delivery is delayed (stuff happens). That is what I hope they are working hard at developing and validating.


RE: Vaccine distribution - oregontim - 11-26-2020





RE: Vaccine distribution - M T - 11-26-2020

I think it is important to get as many vaccinations done as quickly as possible.

I posted a day or two ago about the Salk and Sabin vaccination distributions in 1955 and 1962.  At that time, entire neighborhoods lined up for the vaccination, typically at a (elementary) school.

Daily deliveries could come to the counties, who would store overnight (or not) and have vaccination neighborhoods scheduled around the county.  The first neighborhoods would be for the (say) long-term care facilities, then to hospitals & other health-care workers, etc.  Eventually you would get to neighborhoods such as Stanford University or Palo Alto High School district.

This neighborhood-vaccination approach avoids the storage issue mainly (if you're willing to tell an entire neighborhood "It didn't arrive today, come back tomorrow").   It is far different from the "Drop by your pharmacy on your own schedule to get a shot" that it seems some people are thinking of (to me, that seems fraught with gross inefficiency & potentially wasted vaccine).

The neighborhood approach should work for most everyone.  You can start in the hardest hit neighborhoods.   I suppose you could even subdivide it finer (by age & comorbidity) by allocating windows (as grocery stores do).

For COVID, there is the problem of infections caused by such a program. People would stay in their cars.   The concept of neighborhood vaccination centers (such as schools) still works, but the lines will be out on the streets.  (At schools, you'd want to do this on a non-school day and non-typical-workday;  probably Saturday, maybe Sunday; or other holiday.)   Don't forget that distribution may be occurring during blizzards or sub-0 weather.

Or you could modify it for the bazillion cars in a line model.  Use stadiums or shopping centers with large parking lots and lots of access, with multiple vaccination stations scattered across the acres.  (Those without cars have to get vaccinations too, but that can be a separate process, maybe at mass transportation centers).   The problem with this is that you'll need to have a limitation so the lines aren't 24 hours long on the first day.  First letter of last name or zip code or something like that.

Some people won't be able to make any particular window, so make-ups have to be dealt with.  (One of the polio vaccination pictures was for a van that would deliver the vaccine to shut-ins.)

The same teams would be doing this day after day in possibly different locations.  If the vaccinations are done by the county, law enforcement would be available for traffic control or to deal with other problems (someone demanding the vaccination when it wasn't their neighborhood, for instance).  They would likely be very efficient at doing as many vaccinations in as short a time as possible.


RE: Vaccine distribution - Goose - 11-26-2020

(11-26-2020, 06:42 PM)M T Wrote:  I think it is important to get as many vaccinations done as quickly as possible.

I posted a day or two ago about the Salk and Sabin vaccination distributions in 1955 and 1962.  At that time, entire neighborhoods lined up for the vaccination, typically at a (elementary) school.

Daily deliveries could come to the counties, who would store overnight (or not) and have vaccination neighborhoods scheduled around the county.  The first neighborhoods would be for the (say) long-term care facilities, then to hospitals & other health-care workers, etc.  Eventually you would get to neighborhoods such as Stanford University or Palo Alto High School district.

This neighborhood-vaccination approach avoids the storage issue mainly (if you're willing to tell an entire neighborhood "It didn't arrive today, come back tomorrow").   It is far different from the "Drop by your pharmacy on your own schedule to get a shot" that it seems some people are thinking of (to me, that seems fraught with gross inefficiency & potentially wasted vaccine).

The neighborhood approach should work for most everyone.  You can start in the hardest hit neighborhoods.   I suppose you could even subdivide it finer (by age & comorbidity) by allocating windows (as grocery stores do).

For COVID, there is the problem of infections caused by such a program. People would stay in their cars.   The concept of neighborhood vaccination centers (such as schools) still works, but the lines will be out on the streets.  (At schools, you'd want to do this on a non-school day and non-typical-workday;  probably Saturday, maybe Sunday; or other holiday.)   Don't forget that distribution may be occurring during blizzards or sub-0 weather.

Or you could modify it for the bazillion cars in a line model.  Use stadiums or shopping centers with large parking lots and lots of access, with multiple vaccination stations scattered across the acres.  (Those without cars have to get vaccinations too, but that can be a separate process, maybe at mass transportation centers).   The problem with this is that you'll need to have a limitation so the lines aren't 24 hours long on the first day.  First letter of last name or zip code or something like that.

Some people won't be able to make any particular window, so make-ups have to be dealt with.  (One of the polio vaccination pictures was for a van that would deliver the vaccine to shut-ins.)

The same teams would be doing this day after day in possibly different locations.  If the vaccinations are done by the county, law enforcement would be available for traffic control or to deal with other problems (someone demanding the vaccination when it wasn't their neighborhood, for instance).  They would likely be very efficient at doing as many vaccinations in as short a time as possible.
I agree with your ideas here. Even if you had a line distanced by 6 feet apart it could work. The line could be mostly inside the school or whatever building if you are in a cold climate. It can be done. I still believe that doing the most highly positive zip codes is a good selection criteria (after health care workers and such). Go where the disease is. Why it is there and not elsewhere may be an interesting question, but getting cases down in the most infected area is best for all concerned.


RE: Vaccine distribution - Genuine Realist - 11-26-2020

(11-26-2020, 07:12 PM)Goose Wrote:  
(11-26-2020, 06:42 PM)M T Wrote:  I think it is important to get as many vaccinations done as quickly as possible.

I posted a day or two ago about the Salk and Sabin vaccination distributions in 1955 and 1962.  At that time, entire neighborhoods lined up for the vaccination, typically at a (elementary) school.

Daily deliveries could come to the counties, who would store overnight (or not) and have vaccination neighborhoods scheduled around the county.  The first neighborhoods would be for the (say) long-term care facilities, then to hospitals & other health-care workers, etc.  Eventually you would get to neighborhoods such as Stanford University or Palo Alto High School district.

This neighborhood-vaccination approach avoids the storage issue mainly (if you're willing to tell an entire neighborhood "It didn't arrive today, come back tomorrow").   It is far different from the "Drop by your pharmacy on your own schedule to get a shot" that it seems some people are thinking of (to me, that seems fraught with gross inefficiency & potentially wasted vaccine).

The neighborhood approach should work for most everyone.  You can start in the hardest hit neighborhoods.   I suppose you could even subdivide it finer (by age & comorbidity) by allocating windows (as grocery stores do).

For COVID, there is the problem of infections caused by such a program. People would stay in their cars.   The concept of neighborhood vaccination centers (such as schools) still works, but the lines will be out on the streets.  (At schools, you'd want to do this on a non-school day and non-typical-workday;  probably Saturday, maybe Sunday; or other holiday.)   Don't forget that distribution may be occurring during blizzards or sub-0 weather.

Or you could modify it for the bazillion cars in a line model.  Use stadiums or shopping centers with large parking lots and lots of access, with multiple vaccination stations scattered across the acres.  (Those without cars have to get vaccinations too, but that can be a separate process, maybe at mass transportation centers).   The problem with this is that you'll need to have a limitation so the lines aren't 24 hours long on the first day.  First letter of last name or zip code or something like that.

Some people won't be able to make any particular window, so make-ups have to be dealt with.  (One of the polio vaccination pictures was for a van that would deliver the vaccine to shut-ins.)

The same teams would be doing this day after day in possibly different locations.  If the vaccinations are done by the county, law enforcement would be available for traffic control or to deal with other problems (someone demanding the vaccination when it wasn't their neighborhood, for instance).  They would likely be very efficient at doing as many vaccinations in as short a time as possible.
I agree with your ideas here. Even if you had a line distanced by 6 feet apart it could work. The line could be mostly inside the school or whatever building if you are in a cold climate. It can be done. I still believe that doing the most highly positive zip codes is a good selection criteria (after health care workers and such). Go where the disease is. Why it is there and not elsewhere may be an interesting question, but getting cases down in the most infected area is best for all concerned.
I think you're right in principle, but I do wonder if any sort of administrative subtlety is possible given the time constraints. (This has been a problem throughout the duration of this crisis.)

So I go birthday lottery, in the interest of simplicity. The KISS principle.


RE: Vaccine distribution - Goose - 11-26-2020

(11-26-2020, 10:34 PM)Genuine Realist Wrote:  I think you're right in principle, but I do wonder if any sort of administrative subtlety is possible given the time constraints. (This has been a problem throughout the duration of this crisis.)


So I go birthday lottery, in the interest of simplicity. The KISS principle.
So can I just use my draft lottery number?


RE: Vaccine distribution - Genuine Realist - 11-26-2020

(11-26-2020, 10:46 PM)Goose Wrote:  
(11-26-2020, 10:34 PM)Genuine Realist Wrote:  I think you're right in principle, but I do wonder if any sort of administrative subtlety is possible given the time constraints. (This has been a problem throughout the duration of this crisis.)


So I go birthday lottery, in the interest of simplicity. The KISS principle.
So can I just use my draft lottery number?
Nope. It's another turn in the barrel for you.


RE: Vaccine distribution - M T - 11-27-2020

(11-26-2020, 10:34 PM)Genuine Realist Wrote:   
So I go birthday lottery, in the interest of simplicity. The KISS principle.

What's the 1st S stand for?  Surely not simple.  Nothing simple about that!!

Suppose you're the single parent of a 4yo, 6yo, and 8yo.  How many times do you wait in line with all 3?  Four times.

Or are you going to make your rules less simple?  If you go with the address line (which is more available & less sensitive - can be off driver's licenses, utility bills, etc) instead of birth date, families can go together.

With addresses, publicity of the event can be focused to the right group, everyone knows that everyone in their area is going (for instance, school could close for the day if needed, rather than 366 different absences), etc.  Businesses can expect a slowdown on their neighborhood's day.


RE: Vaccine distribution - akiddoc - 11-27-2020

(11-27-2020, 12:41 AM)M T Wrote:  
(11-26-2020, 10:34 PM)Genuine Realist Wrote:   
So I go birthday lottery, in the interest of simplicity. The KISS principle.

What's the 1st S stand for?  Surely not simple.  Nothing simple about that!!

Suppose you're the single parent of a 4yo, 6yo, and 8yo.  How many times do you wait in line with all 3?  Four times.

Or are you going to make your rules less simple?  If you go with the address line (which is more available & less sensitive - can be off driver's licenses, utility bills, etc) instead of birth date, families can go together.

With addresses, publicity of the event can be focused to the right group, everyone knows that everyone in their area is going (for instance, school could close for the day if needed, rather than 366 different absences), etc.  Businesses can expect a slowdown on their neighborhood's day.

California is talking about going by zip code. Not sure of the details.


RE: Vaccine distribution - magnus - 11-30-2020

Here's Texas' plan. 

https://gov.texas.gov/news/post/governor-abbott-dshs-announce-covid-19-vaccine-distribution-plan

Unsurprisingly,  healthcare workers are first.


RE: Vaccine distribution - Goose - 11-30-2020

What really surprises me is that this hasn't already been completely worked out months ago, at least in private. Kind of like the Republican health plan, we come to the point of distribution and now we make the plan? It is not like lots of new variables have been added. I am sure we will have enough time to make a plan, but waiting this long seems strange. Prior planning minimizes the possibilities of there being a "gotcha" that messes up the works. It is also a "generic" problem, in that vaccine distribution in an epidemic sounds like a case study the academics would love to assign to epidemiology classes.