James Blumenstock of ASTHO discusses effective vaccine distribution for states

 Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.

In today’s COVID-19 update, AMA Chief Experience Officer Todd Unger speaks with James Blumenstock, senior vice president for Pandemic Response and Recovery at the Association of State and Territorial Health Officials (ASTHO), about what it will take for states to effectively distribute a COVID-19 vaccine once approved.

Learn more at the AMA COVID-19 resource center.

Speakers

• James Blumenstock, senior vice president, Pandemic Response and Recovery, Association of State and Territorial Health Officials (ASTHO)

Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we're talking with Mr. James Blumenstock, the senior vice president for Pandemic Response and Recovery at the Association of State and Territorial Health Officials or ASTHO, about what it will take for states to effectively distribute a COVID-19 vaccine once approved. Mr. Blumenstock is calling in from Brielle, New Jersey.

I'm Todd Unger, AMA's Chief Experience Officer in Chicago. Mr. Blumenstock, a lot of attention has been placed on developing a COVID vaccine. But there's the huge challenge of distributing it. What will be the state's role in distribution?

Blumenstock: Great. Hey Todd, thanks so much for having us, and really having an opportunity to add to this conversation going forward because it's so critically important for the nation's health and the nation's security.

So, first is you talk about distribution of the vaccine. There's a second part to that, and that's also administration. It is really the goal and the objective of state and territorial public health departments to ensure that the vaccine is safely, efficiently, and equitably distributed and administered across the country. So the goal today is, as you would often here, is the reference to that last mile, which is so tactical, of once the vaccine gets into the states and territories of having a very structured and effective process where they could be allocated to health care facilities and providers that have been determined to be prepared and trained to administer the vaccine to the populations who need it the most.

Unger: Let's dig into that process. What have the states been asked to do and how will this kind of roll out from there?

Blumenstock: Sure. So, the states' obligation really is to provide this network throughout the communities of providers that are standing ready to receive and administer the vaccine. What goes into that process? Well, states are working out their plans in anticipation of how much their allocation will be from the federal government. Then they're also assessing their populations that fit into the highest categories that's most at-risk that should get the vaccine first. So the planning effort, and this is really a heroic and historic planning effort, is to match sort of the anticipated vaccine that's coming from the federal government over the course of time to those communities and those providers that could really have the capability and capacity to administer the vaccine to the at-risk individuals at first.

It's the key of enrolling literally hundreds of thousands of providers across the country that are suitably located and equipped to provide the vaccine, and then managing the inventory to be as effective and efficient as possible because it's not all going to come at one time. We'll get small amounts early. And early could be before the end of the calendar year. Then certainly as we roll into 2021, more supply will be coming available, assuming that it's been deemed safe and effective by the FDA, which will sort of broaden or open up the pipeline if you will into the communities where more and more individuals would be eligible to receive the vaccine.

Unger: So, we talked about at the state level. How does that kind of work its way down to the local health departments? What role do they play in the distribution planning as well?

Blumenstock: Yeah. So local health departments play a critical role because as most people say, public health is all local. It starts and finishes at the local community level. So while the state health departments or the state government is responsible for the overall jurisdictional planning of that state and territory, they rely on key partners. And I could just sort of name dozens of them, but certainly the medical community as well as local health departments are key partners, players, and are essential to the success of this campaign.

So they're in large part responsible for executing a lot of the plans, for overseeing a lot of the services that are being provided, and in some cases, actually delivering the services. Public health will stand up mass vaccination clinics throughout the communities around the country as time goes on, just like we did 11 years ago during H1N1, like we could do tomorrow if there's a measles outbreak or a hepatitis A outbreak where members of the public need to be vaccinated quickly. So that's a key role of local health departments. They have the resources. They have the relationships and the connections with a lot of the local leaders that are key to making this a successful effort.

Unger: What do you see as kind of the key areas of concern right now about the distribution at the state level?

Blumenstock: Well, we're dealing still with a lot of uncertainty. So, while planning will continue to advance every hour of every day, you can do so much speculation and forecasting. But until some of those critical details are in place, final plans, if they will ever be final, won't be realized. So, the state and local health departments are in the process of recruiting the providers to provide the immunizations. They are working on developing communication materials so that the public could be properly informed and educated and counseled because it's critically important to reach that appropriate level of trust and confidence in the eyes of the public. Having trust in the public health system but also confidence in the product, the vaccine.

But a lot of that can't be accomplished until number one, we know which vaccines will be approved and deemed efficient or effective. We don't know really how many of those candidate vaccines will pass that finish line, what will be the volumes of their production on a week to week, month to month basis, and we certainly also don't know what the recommendations are for their use. One vaccine maybe approved for certain age groups and others vaccine could be approved or not approved for other age groups. So that's sort of a mix and match, but the key responsibility here is to ensure that the individual gets matched most appropriately with the vaccine that's best suited for their circumstances or conditions.

Unger: Well, what would you like to tell physicians and physician practices about what they need to know about the vaccine distribution and what they should be doing right now to prepare for it?

Blumenstock: So, two points. First, work very closely with your state health department. If you have an interest and capability to serve as a COVID-19 vaccination provider, you as a professional and the facility or the business that you're affiliated with is in a community that they could use your services, reach out. If you're not contacted by then, reach out to your state health department and share your interest in becoming a provider of this vaccine.

And then regardless if you choose to do so or not, you encounter patients, members of your community every hour of every day. They're going to turn to you for advice, assistance, some of that really intimate conversation, and they will probably ask you, "What should I do? Should I take it? Should I get it? What are you doing? What are you telling your families?" So the ability to number one have as much scientific, scientifically accurate, objective information so that you could inform your own professional judgment and opinion and have that message scripted in your mind. Anticipate that that question could be asked of you, not dozens of times, probably hundreds of times. Every time you encounter a patient. And have that area of information or that type of information available so you can honestly, confidentially, and objectively give them the best professional opinion that you can because they're going to turn to you and ask you that question. That is for sure.

Unger: Well, this is obviously a big job and complicated one, and you have been really vocal about the fact that there are just not enough funds to implement these distribution plans. Can you talk about that?

Blumenstock: Sure. So, this campaign has been referred to as monumental, historic. I mean, a lot of descriptors. And that is not an over exaggeration. In anticipation in preparing a process where we are hoping to vaccinate hundreds of millions of individuals in a very short period of time is a very comprehensive, complex, labor intensive effort that will take resources. You cannot do it effectively or successfully with what you currently have or just moving around pieces of the puzzle form one program to another for the duration of this campaign. We need to scale up and have this infrastructure that's capable of providing the service that will match the demand and the need to provide this public health service.

So administering the vaccine, the logistics of storing it, transporting it, the ancillary supplies that have to be procured so that the vaccine can be safely administered, the medical waste properly disposed of, all the information technology for record keeping and tracking not only of the vaccine but also of those individuals receiving the vaccination. Again, it takes time, effort, and resources, money, whether it be in the form of salaries, contracts, procurement, rental. We've had that experience 11 years ago during H1N1. In comparison, that was a really simple national campaign against the influenza pandemic. This is a totally different ball game here that is so complex and expansive. So more resources are needed.

Unger: How much money are we talking about?

Blumenstock: So, our association and others estimate from start to finish $8.4 billion was our professional judgment. To put that in some type of context, 11 years ago when we did the H1N1 influenza pandemic response, the public health system was funded a little over $1 billion. Again, 11 years ago in a much simpler campaign than we're preparing for today.

Last month, the CDC themselves issued a professional judgment or estimate that would take around $5.5 to $6 billion for this campaign. So you could see where we are, where the CDC estimates, and where we were 11 years ago compared to right now none of that money is in place for the full term implementation of the campaign. The U.S. government did fund the state health departments $200 million a couple of months ago for the purposes of pre-event planning and readiness. Funding that was much appreciated, greatly appreciated, much needed, and it really is serving a good purpose for this pre-launch planning and readiness. But it is insufficient to sustain the type of response that we're going to have to put in place for the next 10, 12 months or so.

Unger: $8.2 billion, so to speak left.

Blumenstock: Exactly. Yeah. The other two points to make here is that we cannot move assets around from one public health program to another. These agencies are members. While they're preparing for this vaccination campaign, they're also dealing with the acute effects of the pandemic as far as outbreak response, managing cases, ensuring that everyone receives proper health care. At the same time, they're managing natural disasters like wildfires, hurricanes, day-to-day disease outbreaks like hepatitis or the measles. So those programs need to be sustained. We just can't sort of move from one program to another on a temporary basis because that would really erode and undermine the basic public health foundation that we're trying to build up so that we have a healthier community that could be more resilient in a times of when we're experiencing a pandemic.

Unger: Well, I want to ask you a little bit more about the funding because that's such a gap. Where are these funds supposed to go once...Who's going to distribute them and make sure that this all works?

Blumenstock: So, what we would hope and expect is that Congress would appropriate the funds that we are requested that would go to state, territorial, and local public health departments. We, because of what we do, have the greatest affinity with the CDC, the Centers for Disease Control and Prevention. So we have existing business relationships with CDC. We have outstanding day-to-day technical and operational relationships. So we feel that probably the most effective and efficient means would be for Congress to appropriate these funds, provide it to CDC who in turn would share those funds with state health departments, local health departments, tribes and territories to build the services and sustain the services that we've talked about over the last few minutes.

That's the way it has been done many, many times before. It's a fairly turnkey operation. The system is standing by and ready to operationalize, but we're missing that one last piece. Support from the administration and a congressional action to put funds in place.

Unger: Well, assuming that the funding is secured to address these challenges, how much time are we looking at between when a vaccine is approved and when we're able to get it to a large portion of the population?

Blumenstock: So the public health system will be ready to administer the first tranche of vaccine in a matter of weeks because if we do receive both a green light from the FDA and a recommendation, green light from the ACIP, which is the Advisory Committee on Immunization Practices that helps determine the best and most appropriate use, the public health system will be able to mobilize within hours to begin to distribute and administer vaccine to the highest risk populations across our country. But again, that's just a small sliver of the larger pie of 330 million individuals that are theoretically could be eligible and interested in this over time.

So we will start the campaign, no time will be lost, but as time goes on where more vaccine comes available and we cast a wider net and go full bore throughout all the communities, that's when these assets become critically important because the last thing we want is for our capacity to be a rate limiting factor in the amount of vaccine that we could offer and provide to members of our nation who want it and need it.

Unger: Well, thank you so much. As you know, everybody's hoping this comes soon and it rolls out smoothly. We really appreciate you providing all this information about the challenges with distribution. Appreciate you being here today, Mr. Blumenstock.

That's it for today's COVID-19 Update. For resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us. Please take care.

Blumenstock: Thank you, Todd.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.