A vaccine will only work if a lot of people can get immunized. State health officials are working furiously to design outreach and distribution plans, with little clarity from the federal government.



We all talk a lot about when a vaccine for the coronavirus will be developed. But an equally important step - once it's developed, I mean, you've got to figure out how to distribute it. Later today, U.S. states have to submit their COVID vaccine distribution plans to the Centers for Disease Control. This is to show that they have worked out how they're going to get a potential vaccine to citizens in their state. NPR's Pien Huang is with us now to talk about it. Hi, Pien.


MARTIN: So you've been talking to state health officials. I mean, do they have these distribution plans? Have they worked this out?

HUANG: Yeah, in a sense. My co-reporter, Selena Simmons-Duffin, and I, we've been hearing from state departments all over the country from California to Texas, North Dakota, Michigan, Virginia, Florida. And they only had 30 days to do it. So back on September 16, the CDC gave them a playbook for vaccine distribution and said that they were to tailor it to their own states, the plans for how to get the vaccines out to their people. And they've been racing to pull it together. It's been described to me as anxiety-inducing, frustrating and also really exciting to be doing the work that will help get the vaccine out and, hopefully, help end this pandemic. I talked to Claire Hannan, who's head of the Association of Immunization Managers.

CLAIRE HANNAN: You know, it's really cramming three to six months' worth of strategic discussions with the task force, with stakeholders, into 30 days.

HUANG: She says the process, for many, has been like herding a lot of cats. In Minnesota, Kris Ehresmann is director of infectious disease at the state health department. She says the document they'll submit does address all the CDC's requirements, but it's far from final.

KRIS EHRESMANN: We've kind of described it as framing up a house. So we're going to keep adding to it, obviously, as we get more and more information. But right now, we've kind of just built a frame.

HUANG: Ehresmann says the information that still needs to be added are big keystones like which vaccines will actually be approved and how many doses will be available. But even without knowing those specifics, there is a lot of problem-solving that can be started now. Some of the vaccines may need to be stored in super cold temperatures, much colder than your home freezer. Molly Howell, immunization program manager for the state of North Dakota, says that's a logistical problem they're thinking through.

MOLLY HOWELL: So the storage container that the ultra-low cold chain vaccine comes in can maintain temperatures for up to 10 days if it's unopened. If the container is opened, then you have to kind of recharge it with dry ice every so often.

HUANG: North Dakota has bought some ultra-cold freezers and is trying to figure out how to get or make their own dry ice so they can get the vaccine out to people who live in rural communities. In Texas, the state is starting to get hospitals, doctors' offices and pharmacies registered to give out the vaccine when it is available. Decrecia Limbrick, who's assistant health department director in Houston, says they're considering all the different scenarios for vaccination down to the weather. It can get really hot and humid in Houston.

DECRECIA LIMBRICK: If we should get those hot days, we want to make sure that we maintain the integrity of the vaccine. But also, when you think about individuals potentially having to work in those conditions, just making sure that we take care of the workforce as well.

HUANG: In Virginia, Christy Gray runs the immunization division at the department of health. She says they ran a simulation to see how their plan works in different conditions.

CHRISTY GRAY: Let's just poke all kinds of holes in it. Let's take it for a ride and see how can we improve it, you know? Are there things we haven't thought of?

HUANG: Submitting these first plans to the CDC is a milestone. But Jim Blumenstock, from the Association for State and Territorial Health Officials, says it's just the very beginning.

JIM BLUMENSTOCK: Planning is just that. It's not execution. When the whistle blows and we start this campaign, it's going to be, you know, close to a year-long effort.

MARTIN: Pien, I mean, this has all got to be expensive, right? Where's the funding coming from?

HUANG: Well, Blumenstock says money is the other big missing piece to these plans. And last month, CDC Director Robert Redfield told Congress that states are going to need up to $6 billion to distribute vaccines. Yesterday, Blumenstock's organization, along with the Association of Immunization Managers, formally asked Congress for 8.4 billion. So far, the money has not been approved by Congress. And it's actually not very clear when a COVID package might get through. The election and politics are really complicating things at the moment.

MARTIN: (Laughter) Right. OK. So states are going to submit their plans. Then what happens?

HUANG: Well, the National Governors Association sent a letter to the president yesterday. It was cosigned by the heads of the NGA, Democrat Andrew Cuomo from New York and Republican Asa Hutchinson from Arkansas. And it basically said, we need to talk. We really want this vaccine campaign to roll out smoothly. But it takes a lot more than just the cost of a vaccine.

You know, states have to put up data systems to track who's getting it, to remind them to come back for second doses. They have to buy gloves and syringes and dispose of medical waste. And they also have to hire and train a lot of temporary staff to carry out that work. So the governors have asked the president for a meeting to discuss what the federal government is doing versus states and how it will all get paid for.

MARTIN: So meanwhile, the U.S. is approaching the 8 million mark for the total number of known COVID cases, which is just staggering. Can you just tell us what's happening with the virus right now?

HUANG: Yeah, absolutely. I mean, new case counts are rising across much of the country. And right now, the highest risk hot spots are in parts of the West and Midwest. You know, in North Dakota, in South Dakota, Montana and Wisconsin, the case numbers per capita are really soaring. And hospitals in these states are filling up.

A field hospital actually opened up this week at the state fair park in Milwaukee to take in overflow patients. And a month ago, the U.S. was seeing about 35,000 new cases a day. Now that number has climbed to over 50,000. The CDC reportedly told governors this week that one of the reasons for the surge in cases is because of small household gatherings, you know, groups of people coming together in homes without masks.

MARTIN: NPR's Pien Huang. Thanks for your reporting.

HUANG: Thanks for having me. Transcript provided by NPR, Copyright NPR.