Following up on yesterday’s Blog Post about the Pfizer and BioNTech announcement of a vaccine with a preliminary 90% efficacy, we now turn to the challenges of distribution. I mentioned that the vaccine, which is based on a novel technology that uses synthetic mRNA to activate the immune system against the virus, needs to be kept at minus 70 degrees Celsius (-94 F) or below in order to maintain its integrity.

An outstanding article today in ProPublica (link below) highlights the fact that most states lack the resources and infrastructure to deliver the vaccine to their communities. Here are the litany of steps needed to transport and administer the vaccine:

1. Needs to be stored at temperatures of about minus 100 degrees Fahrenheit
2. Will be delivered in dry ice-packed boxes holding 1,000 to 5,000 doses
3. Doses viable for up to 10 days
4. Ice can be replenished up to three times
5. Once opened, the packages can keep the vaccine for five days
6. Packaged can’t be opened more than twice a day
7. The vaccine can also survive in a refrigerator for five days but can’t be refrozen if unused

Needing to use 1,000 doses within a few days may be feasible for large hospital systems (note that Mayo Clinic which is among the preeminent hospitals in the US does not have capacity to store this vaccine), it is impossible for physician offices to manage these requirements. According to the linked article, distribution is “especially challenging in smaller towns, rural areas and Native communities on reservations that are likely to struggle to administer that many doses quickly or to maintain them at ultracold temperatures.”

According to ProPublica, who obtained full preliminary plans for 47 states, there were clear struggles with how to handle this vaccine. Some states do not have adequate warehousing with temperature control, others cannot feasibly expect to distribute to rural communities, tribal lands or migrant workers. Other states cannot account for the large volume (1000-5000 doses) and can only manage smaller numbers.

@cdc Director Robert Redfield has said Congress will need to provide up to $6 billion but only $200 million has been allocated to this process.

Fortunately, we are not solely reliant on a single vaccine modality. In fact, I am hopeful that those efforts moving more slowly than Pfizer, such as Johnson and Johnson, will have more practical utility for the US population. This vaccine has far less stringent storage requirements and is given as a single dose, rather than two separated by 21 days. Following their efficacy data along with other efforts could lead to a multi-layered approach that would go far to bring this pandemic finally under some semblance of control.