COVID-19 vaccine likely won't be widely available in rural areas early, CDC says

When a COVID-19 vaccine is approved by the FDA, it likely won't be available widely in rural communities at first due to challenges in shipping and storing it, a CDC official told ProPublica.

"Early, when we don’t have lots of doses, I frankly do not anticipate that vaccine will be widely available in every rural community," Amanda Cohn, MD, CMO for the CDC’s Vaccine Task Force, said Nov. 3, according to ProPublica. "The first couple months will be not ideal, but we really want to listen to our rural partners and understand what we can do to make it better."

Pfizer's vaccine appears to be closest to receiving authorization. The drugmaker said Nov. 9 that an interim analysis showed it prevents 90 percent of COVID-19 infections. But Pfizer's vaccine, as well as others in late-stage trials, have complicated shipping and storage requirements that would make it very difficult for rural providers who treat small numbers of patients to receive access to the vaccines. 

Pfizer's vaccine must be administered in two doses 28 days apart and stored at temperatures about minus-90 degrees Fahrenheit. It has to be delivered in packages with dry ice that store 1,000 to 5,000 doses, ProPublica reported. The storage boxes can keep doses viable for up to 10 days and the ice can be renewed up to three times. The vaccine can survive in a refrigerator for five days, but it can't be refrozen if unused.

State health officials who are drafting  plans for vaccine storage and distribution haven't figured out how to get the vaccine to people living far from cities, according to ProPublica, which obtained  draft plans from 47 states. Operation Warp Speed, the government's initiative to expedite development of CVD-19 drugs and vaccines, is only responsible for delivering the vaccines to the states, which then have to make plans to distribute them to their residents. 

If the boxes contain at least 1,000 doses of the vaccine, health systems in large cities may go through that amount quickly, but rural providers who don't treat many patients likely wouldn't. It would be challenging for them to use enough vaccines quick enough so they're not wasted. 

According to draft plans obtained by ProPublica, Washington state's health department doesn't have a warehouse to store the vaccine at low enough temperatures. Arizona's plan says it doesn't expect the vaccine can be handled by the state's rural and tribal communities, and Kansas' plan assumes that shipments will be far smaller than 1,000 doses, ProPublica reported. Georgia's plan relies on counties working out their own plans. 

State health officials told ProPublica that their plans are evolving as they get more information. Operation Warp Speed has said it wants to start shipping the vaccine the day it gets FDA authorization, so states have to be prepared.

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