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States face tough questions about who should get Covid-19 vaccines after the initial groups

President-elect Joe Biden has laid out his three-point plan to combat the coronavirus pandemic, which would aim to get at least 100 million Americans vaccinated in his initial 100 days in office, his pledge to sign a face mask mandate on his first day in office and efforts to get kids back to school safely.

Posted: Dec 9, 2020 11:44 AM


With the first shipments of a coronavirus vaccine poised to go out as early as this week, the plan to get the shots from the manufacturers into hospitals, assisted living homes, pharmacies and -- ultimately -- Americans' arms, is still riddled with unknowns.

States are already running into challenges when it comes to distributing the vaccine to their first priority group and that is when there are only limited distribution points and a very narrow focus of who is meant to receive the vaccine. The issues around distribution and who gets the vaccine grow even more complicated when states eventually move past their highest priority populations and start opening up more vaccination sites to vaccinate larger groups of the population.

At this point, the number of doses each state is getting in its first shipment is fluid and, in many cases, the amount is less than what states were initially told to expect, leading states to change distribution plans even as the first shipments could come as soon as the end of this week.

But the thorniest decisions still lie ahead for state officials: deciding which essential workers qualify to be vaccinated after the initial group is complete, in the face of a limited vaccine supply and the unknowns of what shipments in January through the spring of 2021 will look like.

The challenges of distributing the vaccine to the highest priority group and beyond

Although there is a general consensus among states that health care workers and long-term care facilities should receive the vaccine first, states have different approaches to who specifically within those two groups should get the vaccine first given how limited the initial supply is.

Associate Director for Global Health Policy at the Kaiser Family Foundation Josh Michaud, who has analyzed all of the state vaccination distribution plans available, said it is hard to compare how each state has chosen to go about vaccinating its population.

"Some states had very detailed plans and some states had very sort of general plans and not a whole lot of detail so it's hard to compare apples to apples in many, many cases," Michaud told CNN.

For example, states such as Alabama and Alaska are planning to vaccinate health care workers and long-term care residents at the same time, while in Pennsylvania, the vaccine will first go to health care workers before long-term care facility members.

"Things change on sort of a daily basis, so your ability to be agile and pivot is important," Dr. Amy Young, the chief clinical officer at UT Health Austin, told CNN.

"We think probably in the first round we'll be able to vaccinate our health care workers, but we don't really know that," Young said. "There are more unknowns than there are knowns."

States are starting to get an idea of how many doses they'll get in December, but it's a blank slate in January. It's easier to plan who qualifies as an essential worker in the first group to get vaccinated if officials know there are large numbers of vaccines coming in a few weeks, but that's a harder call to make when doses are limited and even more difficult when you just don't know how many doses you will have once you get to that tier, a state official said.

"It becomes just exponentially more complex as you start to expand the scope beyond a very defined early high priority population. Just thinking about how they will be prioritizing a group like essential workers, your head starts to spin about all the various ways that this could meet difficulties," Michaud told CNN.

For example, a teacher or a police officer in one state, who both fall under the essential worker group, could receive the vaccine at a different time than their counterparts in neighboring states based on how their state prioritizes each subgroup.

Poor planning for how to handle the vaccination of larger populations also creates room for serious inequalities to emerge. If robust channels aren't already built to reach more rural or harder to reach populations, then as the vaccine becomes more widely available, it will continue to go to those who are easiest to reach, not to everyone who is meant to get it.

"It is going to get more and more complicated," Michaud said. "There's so many barriers, especially when talking about reaching rural areas, disadvantaged populations."

Where does the vaccine go after it's authorized?

In most cases, the first shipments of the vaccine will be transported from Pfizer's facility in Kalamazoo, Michigan, to hospital systems and pharmacies that partnered with the federal government, which will be directly responsible for giving the vaccine to their health care workers and residents of long-term care facilities respectively.

But, as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said during CNN's Coronavirus town hall last week, "It's up to the state and local authorities in their individual way to make the decisions about the distribution, as well as the logistics of it."

So, in other states, such as Illinois, the delivery will go first to the state's strategic national stockpile, and the initial doses of the vaccine will be sent to hospitals from there.

The distribution from vaccine production company to individual hospitals and pharmacies in each state as directed by the federal government, is different for almost every state. State health department officials are coordinating with federal officials in Operation Warp Speed. However, there is no clear roadmap that explains how this process is working simultaneously in all 50 states.

Instead, states have developed individualized vaccine distribution plans that vary slightly for each individual state's demographic and geographic needs.

"I think of how we're doing vaccine allocation like this nesting doll," Alaska Chief Medical Officer Anne Zink said last week during a press briefing, when describing how she conceptualizes who is in charge of what in the distribution process. "There's all sorts of different layers."

Officials at the US Centers for Disease Control and Prevention have been in close contact with state leaders about how their distribution plans will work and challenges that could crop up state to state.

"Well-trained experts in this field of distribution have really set up an elaborate coordination and collaboration effort with the states," Operation Warp Speed's Perna said last week. "They run daily, weekly meetings. They work through detailed execution of plans."

What will distribution look like after week one?

Deacon Maddox, Operation Warp Speed chief of plans, operations and analysis, told reporters on Monday that after the initial shipment of vaccine doses goes out to states, the federal government and states receiving the vaccine doses will get into a rhythm of shipping doses out regularly.

Operation Warp Speed will communicate with Pfizer weekly to determine how many doses are ready to be shipped. That information will then go into Operation Warp Speed's data collection and tracking system, Tiberius. Once the numbers are in the tracking system, OWS will then allocate the available number of vaccine doses to the states.

"The manufacturers have up until Thursday night to let us know how much they're going to deliver. Friday morning we'll meet, we'll consider all the information. We'll make a decision, we'll publish the information, we'll allocate, we'll adjust ordering caps, and then states can order the next day, with delivery starting 24 to 48 hours later," Maddox said.

The hope is for a constant flow of vaccine as the manufacturers push it out, Maddox said.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 309223

Reported Deaths: 7153
CountyCasesDeaths
DeSoto21005250
Hinds19989411
Harrison17590303
Rankin13388277
Jackson13169243
Madison9965212
Lee9900170
Jones8319161
Forrest7554149
Lauderdale7232237
Lowndes6306144
Lamar614685
Lafayette6081118
Washington5296133
Bolivar4778130
Oktibbeha458097
Panola4461103
Pearl River4447142
Warren4310119
Marshall4302103
Pontotoc417672
Monroe4063132
Union405175
Neshoba4009176
Lincoln3892109
Hancock373785
Leflore3471124
Sunflower332090
Tate325984
Pike3226105
Scott311973
Yazoo305369
Alcorn301566
Itawamba297977
Copiah294365
Coahoma290779
Simpson290486
Tippah285368
Prentiss276659
Marion266479
Leake262473
Wayne261541
Grenada257385
Covington255380
Adams247082
Newton246161
George238947
Winston226181
Tishomingo222867
Jasper220248
Attala213673
Chickasaw205857
Holmes187272
Clay183354
Stone179733
Clarke178177
Tallahatchie176240
Calhoun165632
Yalobusha160236
Smith159734
Walthall131143
Greene129633
Lawrence126823
Noxubee126634
Montgomery125842
Perry125238
Amite121041
Carroll121026
Webster113932
Jefferson Davis105932
Tunica103425
Claiborne101430
Benton97525
Kemper95728
Humphreys94732
Franklin83123
Quitman78916
Choctaw74417
Wilkinson65329
Jefferson64928
Sharkey49817
Issaquena1686
Unassigned00

Alabama Coronavirus Cases

Cases: 522512

Reported Deaths: 10790
CountyCasesDeaths
Jefferson755371494
Mobile39129799
Madison34124500
Tuscaloosa25408444
Montgomery24059573
Shelby23225242
Baldwin20730302
Lee15638166
Calhoun14358311
Morgan14171273
Etowah13705348
Marshall12012220
Houston10416279
Elmore10024203
Limestone9862148
Cullman9509191
St. Clair9486236
Lauderdale9280233
DeKalb8762183
Talladega8127173
Walker7151276
Autauga6763106
Jackson6762110
Blount6532133
Colbert6236132
Coffee5436113
Dale4781111
Russell431239
Franklin421382
Chilton4130110
Covington4069115
Tallapoosa3922148
Escambia390374
Dallas3528150
Chambers3519122
Clarke347360
Marion3076100
Pike306676
Lawrence296395
Winston273272
Bibb256761
Marengo248561
Geneva246475
Pickens233259
Barbour227155
Hale218675
Butler213268
Fayette209660
Henry188444
Cherokee182744
Randolph177841
Monroe173140
Washington165538
Macon156548
Clay150255
Crenshaw149557
Cleburne147041
Lamar140034
Lowndes137353
Wilcox124727
Bullock122040
Conecuh109728
Perry107726
Sumter103332
Coosa99428
Greene91434
Choctaw58824
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Sunshine should bring continued warmth into your Tuesday. But going into the night, a cold front approaches. This will bring a quick round of light to moderate showers overnight and a late-season frost that could damage or kill sensitive plants.
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