The Vaccine Rollout

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Nancy Messonnier, MD

Director
National Center for Immunization and Respiratory Diseases (NCIRD)
at the Centers for Disease Control and Prevention (CDC)

​ The Forum Welcomes New Senate Participants​​Sen. Matt Huffman
President of the Senate
(Ohio) ​Sen. Ty Masterson
President of the Senate
(Kansas)

Polling: How is your state doing on vaccinations?

The session began with polling questions on how senators rated the success of their state’s vaccine rollout. The majority reported being dissatisfied with how the process has worked thus far. They cited a variety of obstacles, with a major focus on lack of supply and the logistical challenges of administering the vaccines — especially to populations such as rural residents and the elderly — and disproportionately affected populations. When queried about how the federal government could best help the states, most respondents indicated the highest need with supply chain logistics and technical support activities.

​Obstacles

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​Federal Support

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Federal Help for the States

Nancy Messonnier, MD, the Director of the National Center for Immunization and Respiratory Diseases (NCIRD) responded to these issues, noting, “Collectively, we face immense responsibility for the COVID vaccine program, and our success depends on pulling together across states, communities, and government entities.” Dr. Messonnier is leading the CDC’s effort on the COVID-19 vaccine program in the areas of distribution, administration, implementation, safety, and access.

​ “Collectively, we face immense responsibility for the vaccine rollout, and our success depends on pulling together across states, communities, and government entities.”— Dr. Nancy Messonnier, MD

“We see great positive momentum in the vaccine rollout. It is impressive that a new and unknown vaccine was developed so quickly, was launched over the year-end holidays, and is now seeing rapid escalation in administration,” Dr. Messonnier reported. The CDC tracks vaccine doses from the time they leave the warehouse through to being administered. The regularly updated COVID Data Tracker reports that 59.3 million doses have been delivered to the states and 41.2 million doses have been administered, with 30 million people receiving one or more doses (as of Feb 8, 2021).

​COVID-19 Integrated County ViewsThe CDC’s COVID Data Tracker includes a county view of key data, updated daily. Click the map to learn more.​

Prioritizing Vaccine Distribution

Prioritizing which populations should get the vaccines first was a job assigned to the Advisory Committee on Immunization Practices (ACIP), a committee within the CDC comprised of outside experts with no conflicts of interest. The ACIP, in consultation with the World Health Organization, Johns Hopkins University, and the National Academy of Medicine, set the priorities for COVID vaccine administration.

• Phase 1a: health care personnel and long-term care facility residents

• Phase 1b: people aged 75 years and older and non–health care frontline essential workers

• Phase 1c: people aged 65–74 years, people aged 16–64 years with high-risk medical conditions, and essential workers not included in Phase 1b

Dr. Messonnier noted that as many as 50% of working-age US adults fit in the “essential worker” category, making vaccine allocation a challenging decision. However, she said, the new administration is committed to greater transparency including more accurate forecasting of supplies, which may help allocation decisions.

​Vaccine Distribution
By StatesThe ACIP’s recommendations are subject to interpretation by the states. For an up-to-date report on how each state is prioritizing vaccine distribution, see State Health Facts (courtesy Kaiser Family Foundation).

Best Practices

The CDC engages regularly with state leaders to do a “deep dive,” examining key barriers and identifying best practices for vaccine programs, Dr. Messonnier reported. These assessments have examined the prioritization process, vaccination planning, reaching priority populations, ensuring equity especially for disproportionately affected populations, and building public confidence.

Some of the promising practices identified include using graphical tools to help people understand the prioritization schema, and engaging multi-party stakeholder strategies to establish awareness, educate the public, and ensure unified action for a successful vaccine program.

A major challenge for the states is how to reach prioritized groups, such as elderly people who may not have the technical skill or access to use online portals, or people with comorbid conditions. Effective practices for outreach to seniors have included using traditional mail and phone call approaches, and by word-of-mouth during door-to-door distribution of hand sanitizers along with educational materials about the vaccines. Vaccination strategies have included transportation support and the deployment of mobile clinics.

Equitable distribution of vaccines is enhanced by the development of social vulnerability assessments based on multi-layer mapping to identify hot spots of COVID incidence in order to direct vaccines and strike teams to those areas.

The Vaccinate with Confidence challenge is being met by training existing community health teams on how to educate populations in hard-hit areas as they make regular public contact.

CDC Technical Assistance and Resources

The CDC offers significant resources to address the needs of the states and to help jurisdictions execute best practices for vaccine programs. States can benefit from consultations with experienced CDC strike teams to assess local barriers to vaccine administration and develop local strategies to overcome them. The CDC has developed extensive toolkits and communication resources for medical clinics, long-term care facilities, and community based organizations, including information technology and data support, tools for communications to priority populations to increase vaccine confidence and for leveraging public-private partnerships.

​Access the CDC’s Extensive Free Resources:Directory of State and Territorial Health OfficialsTechnical AssistanceVaccination Communication ToolkitRecipient Education ToolkitLong-Term Care Facility ToolkitCOVID-19 Vaccination Toolkits — Additional resources, including Toolkits for Special Populations and Clinical TrainingIf the Senate Presidents’ Forum can help you locate or access additional information, please contact us.

The success of COVID containment will require coordinated and concerted efforts of the CDC, the states and counties, and many stakeholder groups, Dr. Messonnier pointed out. “We need high vaccination coverage in every corner of every community to stop the pandemic,” she concluded.

​ “We need high vaccination coverage in every corner
of every community to stop the pandemic.”— Dr. Nancy Messonnier, MD

Discussion

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Moderated by

Tom Finneran

Tom Finneran: You mentioned “positive momentum” in moving the vaccine program forward. What is giving you this confidence?

Dr. Messonnier: Public opinion polls in September and October showed a low acceptance of the vaccine, but today there is a groundswell of support. People are excited and eager to get their turn for vaccination. Now, there is a greater sense of “we’re all in this together.” Clinicians also are more comfortable with the vaccine, and we are seeing better operationalization of aspects like the requirement for cold chain maintenance. We are getting more familiar with supply chain issues, recognizing that we need to retain some vaccine in the pipeline in order to ensure supply.

​Today there is a groundswell of support [for the vaccine]. Now there is a greater sense of “we’re all in this together.”

Josh Brown (National Vice President, Pfizer): Dr. Messonnier has been at the center of the vaccine rollout and has done a great job of keeping the momentum growing.

Pharmaceutical companies have been working on the vaccine for less than a year. It is unprecedented to have a vaccine developed, fully tested, approved and into arms in such a short time. However, the states still face urgent issues including: when will we get more vaccine, what’s the hold-up, and what are the potential impacts of variants and mutations.

Pfizer is working to address these concerns. The company had initially committed to 100 million doses by the end of the first quarter, plus another 100 million doses by the end of June. By working together with other manufacturers, that timeframe has been accelerated. Last week, 30 million doses were shipped, and an exponential 40% increase in the supply is expected in the next few weeks, with an anticipated 120 million doses delivered by the end of March and 200 million doses by the end of May. Furthermore, Pfizer is working to provide more predictability about supply projections.

​States can benefit from consultations with experienced CDC strike teams to assess local barriers to vaccine administration and develop local strategies to overcome them.

Tom Finneran: Some states like West Virginia and the Dakotas have had very successful vaccine rollouts. What can be learned from their experiences?

Dr. Messonnier: Every state is very different and faces unique challenges; however, West Virginia and the Dakotas had some strategies in common that other states could replicate. They brought a lot of stakeholders to the table early on to develop a cohesive plan and consistent messaging. They ensured that everyone was on message for advocacy and communication.

Gerard Dehrmann (Senior Vice President Public Affairs & State and Local Government Relations, Walmart Stores): Walmart is working with the CDC and Health and Human Services (HHS), and our Walmart pharmacies are preferred providers in 22 states. The pharmacies have embraced a “Show up and sign up” strategy and, to date, have administered 100,000 vaccine doses.

The company uses every communication channel to address frequently asked questions and overcome vaccine hesitancy. One lesson learned is the importance of ensuring that the message is delivered by people who have earned their constituents’ confidence and trust, such as local aldermen or clergy from the same neighborhood — “People who look like your clients.”

​ An important step in overcoming vaccine hesitancy is to have messages of confidence conveyed by one’s neighbors and trusted members of the community.

Walmart engages with many different stakeholder groups for vaccine outreach. We work with payers and insurers to ensure that elderly people are informed and signed up to get the vaccines, and we sponsor events with teachers, veterans, and clergy who are messengers in getting the word out and who are bringing people together to get vaccinated.

Daniel J. Wahby (Senior Director, State Government Affairs, Eli Lilly): The work the CDC is doing to get people vaccinated is so critical, but until everyone is vaccinated, many people are still at risk of getting COVID-19 or already have the infection. Lilly is among the companies whose monoclonal antibody therapies have been granted Emergency Use Authorization (EUA) by the FDA for the treatment of mild to moderate COVID-19 in high-risk patients. What is the role of treatment in ending the pandemic?

Dr. Messonnier: The CDC website for the National Institutes of Health provides Treatment Guidelines for the treatment of patients with COVID-19. It is imperative for patients to receive appropriate care in order to combat the risk and spread of infection. Even after receiving vaccination, people need to double-down on the safety precautions: wear a mask, wash your hands, and maintain social distance.

Sen. Robert Stivers (President of the Senate, KY): Who could have imagined that all of our economy and our educational system would be dependent on one shot in the arm? But that’s where we find ourselves today. This situation requires us to work together across many boundaries, with particular thanks to our private sector partners such as those we’ve heard from today.

Speaker Biography

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Nancy Messonnier, MD

Director
National Center for Immunization and Respiratory Diseases (NCIRD) at the
Centers for Disease Control and Prevention (CDC)

Nancy Messonnier, MD, is the Director of the National Center for Immunization and Respiratory Diseases (NCIRD) and is currently leading CDC’s efforts on COVID-19 vaccine. In late 2019, Dr. Messonnier directed NCIRD to activate a center-based response to an unknown respiratory disease in China that later transitioned to a full agency response to the COVID-19 pandemic. In the COVID-19 response, Dr. Messonnier is leading the effort to support the COVID-19 vaccine program in the areas of distribution, administration, implementation, safety, and access for hard-to-reach populations with the goal of ensuring that a safe and effective COVID-19 vaccine is available to every American who wants one.

Dr. Messonnier’s full bio