The First Americans Are Being Vaccinated. Now, the Hard Part

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The next few weeks will also be a trial run for the computer systems states plan to use to track and schedule vaccinations. Ideally, people showing up for vaccinations will be notified of their eligibility and sign up ahead of time through systems tied to state vaccination registries. Doing that would mean fewer paper forms onsite, and less manual labor for local staff who have been asked to report updated vaccination tallies daily. That will allow states and the Centers for Disease Control and Prevention to monitor the progress of allocating doses. In addition to electronic notifications, people receiving vaccinations will also receive a physical card with the date of their immunization and a reminder to come back for a second dose in three or four weeks, depending on which vaccine they have received.

Those notification and tracking features are a major improvement over those in place during past immunization campaigns like for H1N1 in 2009, says Rebecca Coyle, executive director of the American Immunization Registry Association, which advocates for improving vaccine IT systems. But new systems are bound to have kinks, especially at scale. The next few weeks will be a test for those systems, starting with hospital systems that have extensive experience with vaccine record-keeping. “The easy data capture will happen first,” Coyle says, “My assumption is that there will be opportunities for improvement.”

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One disadvantage of not sending people to their usual doctors for shots may be keeping track of those people in the long term, well beyond the second dose, says Hemi Tewarson, a senior scholar at the Duke-Margolis Center for Health Policy who has been reviewing state vaccination plans. That long term surveillance is necessary to build trust in a vaccine. “There’s so much focus on getting the shot into people’s arms that states haven’t had time to think about this piece,” Tewarson says.

In Teton County, Wyoming, home to 23,000 people spread sparsely across 4,200 square miles, the regional hospital received an initial tray with 975 doses of the Pfizer vaccine, according to the state health department. Earlier this year, hospital staff ignored guidance from the CDC to purchase a freezer capable of storing the vaccine. “Luckily they did it, and we’re very happy they did,” says Jodie Pond, the county health director. As a result, the hospital is now a storage point for Pfizer vaccines for much of the western half of the state.

The vaccine is “coming in dribs and drabs” for now, she says, but the county is prepared for a larger campaign across the sprawling territory, where it makes sense to go mobile. Earlier this fall, officials used the annual flu vaccine as a test drive. They rented an RV and took the vaccination effort around the region. The RV’s kitchen table, Pond reasoned, would be nice for people when the Covid-19 vaccines were being administered in the midst of a Wyoming winter. They’ll record the data from the vaccinations when they get back to the office, due to limited internet access out in the field.

Pond was also considering another need: law enforcement backup. Security has been tight around shipments by air and truck, and for local distribution that will be true as well, especially if the supply of vaccines is limited or uneven. In Teton County, some nurses recalled pushing and shoving in lines for the H1N1 vaccine, when production issues resulted in shortages. “It’s human nature when there’s scarcity. People want what they can’t have,” she says. The county health department has been receiving calls from people asking how they can get in line. She assures them they’ll be notified when it’s their turn, once the pecking order has been settled—and no, calling won’t boost their priority. But she’s happy to see the interest. For now her primary concern is getting out the word that these vaccines are safe and well tested. When the time comes, she wants everyone to get the shot.

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