COVID-19 Vaccine Distribution and Allocation: What Physicians Need to Know
Authors: Christine Laine, Deborah Cotton, Darilyn V. Moyer
Journal: Annals of Internal Medicine (2021)

Special Articles25 January 2021COVID-19 Vaccine Distribution and Allocation: What Physicians Need to KnowFREEChristine Laine, MD, MPH, Deborah Cotton, MD, MPH, and Darilyn V. Moyer, MDChristine Laine, MD, MPHSearch for more papers by this author, Deborah Cotton, MD, MPHSearch for more papers by this author, and Darilyn V. Moyer, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-0331 Eligible for CME Point-of-CareCME/MOC SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As of mid-January 2021, U.S. state and local governments had received nearly 40 million doses of COVID-19 vaccine. Unfortunately, only about half of these doses have made their way into people, demonstrating that the development of safe, effective vaccines is only the first of many steps toward vaccinating enough people to end the COVID-19 pandemic. Many physicians find the slow pace of vaccination frustrating and are eager to contribute to efforts to assure widespread vaccination. Some physicians find themselves in a confusing maze of bureaucracy when seeking vaccine for themselves and their nonphysician staff. Physicians are also fielding a deluge of vaccine questions from their patients, relatives, friends, and neighbors and need information to provide good answers.To prepare physicians and others to engage in the vaccination effort, Annals of Internal Medicine and the American College of Physicians has hosted a series of virtual programs on COVID-19 vaccine (1, 2). The third of these programs, held on 22 January 2021, focused on the timely and very practical issues of vaccine distribution and allocation. The Centers for Disease Control and Prevention (CDC), retail pharmacies, state health departments, and health systems each have essential roles in vaccine distribution and allocation. Panelists included Dr. Amanda Cohn (Chief Medical Officer of the National Center for Immunization and Respiratory Diseases and Executive Secretary of the CDC Advisory Committee on Immunization Practices, Dr. David G. Fairchild (Chief Medical Officer of CVS MinuteClinic), Dr. Mark Levine (Commissioner of Health, State of Vermont), and Dr. Wayne J. Riley (President, SUNY Downstate Health Sciences University). Dr. Jason Goldman, the ACP Liaison to the CDC Advisory Committee on Immunization Practices and a general internist in Florida, moderated a lively discussion during which he posed questions to the panelists submitted by forum attendees.A successful U.S. vaccination program requires many entities to be pulling toward the same goal—vaccination of enough people to achieve community-level immunity as quickly as possible. Major challenges include matching supply and demand at the local level, confusing and inconsistent prioritization criteria, misinformation about vaccine safety and effectiveness, logistical challenges that limit the types of settings with the capacity to efficiently administer vaccinations, and vaccine registries that lack interoperability. In addition, improvements to the public health system and addressing health inequities are vital, not only to address the current pandemic but to address ongoing health issues and the next pandemics to come (3). The panelists emphasized that simplicity, transparency, collaboration, accessibility, and fairness are fundamental to the vaccination program's ultimate success. View the forum in the video that accompanies this article to hear the panelists' perspectives on how best to incorporate these principles as the COVID-19 vaccination effort moves forward.Distribution and allocation of COVID-19 vaccine is a complex enterprise launched during stressful times within pandemic-weary health care and public health systems. While much attention is given to the stumbles encountered during the initial weeks of vaccination, we must not lose sight of the tremendous achievement of going from the first identified U.S. case of infection with a deadly, novel coronavirus to the availability of tens of millions doses of 2 highly effective vaccines (4). Rather than seeing the stumbles during these first weeks of vaccination as reason for despair, we must use them as opportunities to learn how to do things better during both the current and future public health crises.References1. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: what physicians need to know. Ann Intern Med. 2020;173:830. doi:10.7326/M20-6841 LinkGoogle Scholar2. Laine C, Cotton D, Moyer DV. COVID-19 vaccine: promoting vaccine acceptance. Ann Intern Med. 2020. doi:10.7326/M20-8008 Google Scholar3. Butkus R, Rapp K, Cooney TG, et al; Health and Public Policy Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: reducing barriers to care and addressing social determinants of health. Ann Intern Med. 2020;172:S50-S59. doi:10.7326/M19-2410 LinkGoogle Scholar4. Connors M, Graham BS, Lane HC, et al. SARS-CoV-2 vaccines: much accomplished, much to learn. Ann Intern Med. 2021. doi:10.7326/M21-0111 LinkGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Chris HubbardAssociate Researcher at Georgetown University Medical Center29 January 2021 Follow the Science Please We hear people saying we should follow the science about a variety of subjects in today's society. I saw the original study for the safety and efficacy of the Pfizer Covid 19 vaccine and the age limit was 85 years old for the study group. Now I am seeing the CDC and others say that there are no upper age limits to be eleigible for the vaccine. So the CDC is reccomending people with an age not represented in the study group, get the vaccine. This is not following the science as part of a RCT is to control and study groups - for example age groups - at random and this reccomendation is not consistant with the study evidence. People older than 85 getting the vaccine is not supported by the RCT study. What is concerning in this vulnerable and frail age population is that in the hurry to get the vaccine out there to the public, is no long term study of the possible effects of the vaccine on their immune system over time after being exposed, to the real covid 19 virus - possible auto immunity for example, or an exagerated immune resonse.. Lets be consistant with the science, either make the study include older groups or limit the vaccine implementation to the groups who were studied and therefore follow the science. Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPH; Deborah Cotton, MD, MPH; Darilyn V. Moyer, MDDisclosures: Disclosure forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-0331.Corresponding Author: Christine Laine, MD, MPH, Editor in Chief, Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, claine@acponline.org.This article was published at Annals.org on 25 January 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCOVID-19 Vaccine: What Physicians Need to Know Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine: Promoting Vaccine Acceptance Christine Laine , Deborah Cotton , and Darilyn V. Moyer COVID-19 Vaccine: Practical Clinical Considerations Christine Laine , Deborah Cotton , Darilyn V. Moyer COVID-19: Evaluation and Care of Patients With Persistent Symptoms Following Acute SARS-CoV-2 Infection Christine Laine and Deborah Cotton COVID-19: Clinical and Public Health Implications of SARS-CoV-2 Immunology Christine Laine , Deborah Cotton , Darilyn V. Moyer COVID-19: Challenging Clinical Questions Christine Laine , Darilyn V. Moyer , Deborah Cotton Outpatient Evaluation and Management of COVID-19 Christine Laine , Deborah Cotton , Darilyn V. Moyer Care of Patients With New, Continuing, or Recurring Symptoms After Acute SARS-CoV-2 Infection Christine Laine and Deborah Cotton Current Clinical Challenges in the Prevention and Management of COVID-19 Christine Laine and Deborah Cotton COVID-19 Is No Longer a Public Health Emergency: Implications for Patients and Clinicians Christine Laine and Darilyn V. Moyer Metrics Cited byAnalysis of research hotspots in COVID-19 genomics based on citespace software: Bibliometric analysisOutpatient Evaluation and Management of COVID-19Christine Laine, MD, MPH, Deborah Cotton, MD, MPH, Darilyn V. Moyer, MDCOVID-19: Challenging Clinical QuestionsChristine Laine, MD, MPH, Darilyn V. Moyer, MD, Deborah Cotton, MD, MPHCOVID-19: Clinical and Public Health Implications of SARS-CoV-2 ImmunologyChristine Laine, MD, MPH, Deborah Cotton, MD, MPH, Darilyn V. Moyer, MDCOVID-19: Evaluation and Care of Patients With Persistent Symptoms Following Acute SARS-CoV-2 InfectionChristine Laine, MD, MPH and Deborah Cotton, MD, MPHCOVID-19 Vaccine: Practical Clinical ConsiderationsChristine Laine, MD, MPH, Deborah Cotton, MD, MPH, Darilyn V. Moyer, MD March 2021Volume 174, Issue 3 Page: 413-414 Keywords COVID-19 Disclosure Forecasting Health care Immunity Prevention, policy, and public health Pulmonary diseases Safety Vaccines ePublished: 25 January 2021 Issue Published: March 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...