Doctors, nurses and other healthcare workers will be first in line.
Those at high-risk, such as the elderly and people with chronic conditions, will come next, along with frontline workers, like law enforcement and other first responders.
Finally, healthcare providers will make the coronavirus vaccine available to the general public --through a public health mobilization of a scope not seen since the mass vaccination campaigns against polio decades ago.
Kansas and Missouri are providing their first look into how they plan to vaccinate millions of residents in the coming months. It's a process that could mark a turning point in the struggle to conquer a pandemic that has ravaged both states and continues to infect and kill residents every day.
Both states filed draft vaccine plans with the Centers for Disease Control and Prevention in the past week. The hefty documents -- Missouri's plan is 111 pages and Kansas's is 45 -- publicly outline strategies for the first time.
The documents describe who will get the vaccine first and how health officials will distribute doses across the states. They also grapple with how to handle potential logistical roadblocks, such as a vaccine that requires ultra-cold storage. Only 10 percent of Kansas hospitals currently have the ability to store vaccines at ultra-cold temperatures, for example.
The plans also call for closely monitoring for any signs of safety problems with a vaccine. Whichever vaccine candidate is ultimately approved, it be will be fastest vaccine development process in modern history.
Among the plans' highlights:
-- The vaccine is free, but recipients may be asked to pay (or their insurance may be asked to pay) a small administrative fee, likely less than $20. But no one can be denied a vaccine based on the ability to pay
-- Both states may deploy mobile vaccination clinics
-- Officials are planning for the likelihood the vaccine will require two doses
The way government and health officials approach vaccination will prove critical to whether inoculation efforts are successful. But some health professionals fear that, like every other aspect of the pandemic, it will become a partisan political issue -- or the basis for new conspiracy theories that take root in the internet.
"My concern is we're going to have the same issues we've had with masks. The vaccine is going to become a political issue when really we should be following the science," said Heidi Lucas, director of the Missouri Nurses Association.
Even some nurses are hesitant about getting a vaccine, given the speed at which possible vaccine candidates are advancing, she said.
"It's going to have to come, again, from both sides of the aisle saying the vaccine is safe as well as our governor perhaps getting on television, getting in front of the media and getting their vaccine first to reassure the public," Lucas said.
Fewer Americans seem interested in getting the vaccine as soon as it's available, according to a new survey from The Harris Poll and the health news website STAT. The poll of 2,050 Americans on Oct. 7-10 found interest in immediate vaccination dropped from 69 percent in August to 58 percent in the poll.
The Kansas and Missouri plans both call for extensive outreach efforts.
"The way you address the confidence ... is through transparency and process," said Dan Manley, an assistant chief for the Lee's Summit Fire Department who is part of a local work group focused on the vaccine effort.
'A time of little sleep'
Phil Griffin, the Kansas Department of Health and Environment bureau director for disease control and prevention, said the agency's biggest focus will be on providing as much information as possible. He emphasized that while the vaccine development process for the coronavirus has been much faster than usual, "there's still crossing all the same barriers," including large-scale clinical trials.
The Food and Drug Administration has not yet approved a vaccine, though several candidates are in advanced clinical trials. One of the companies developing a vaccine, Pfizer, said it won't be ready to seek emergency authorization of its vaccine from the FDA until mid-November. It's unclear how quickly it would take the agency to approve the request, but it will face enormous pressure to act fast.
But planning for a vaccine is already well underway across the country. On Monday, Health and Human Services Secretary Alex Azar confirmed that all 64 jurisdictions that the agency had requested submit vaccine distribution plans -- including all 50 states, U.S. territories and some large metro areas -- had done so.
"As of this morning, all 64 jurisdictions have submitted their initial #COVID19 vaccine distro plans to @CDCGov, a huge milestone in the ongoing collaboration between the federal govt and jurisdictions," Azar tweeted. "We'll continue to work with them to be prepared for a safe, effective vaccine."
The Kansas and Missouri plans are in basic agreement on what demographics will get the vaccine first and in what order, beginning with healthcare workers.
Griffin provided a broad definition of who will qualify as a healthcare worker: anyone in a hospital-like setting who may come into contact with infected patients.
Nursing home residents and workers are next. The facilities, with large concentrations of elderly, frail and sick individuals, are especially susceptible to lethal outbreaks of the virus. Nursing home employees -- often much younger than those they care for-- may give residents the virus without knowing it.
"The asymptomatic nature of this virus makes it difficult to keep it from entering long-term care facilities through these essential staff," Nikki Strong, director of the Missouri Health Care Association, said in a statement.
Emergency workers and other essential personnel will receive the vaccine soon after. Who exactly counts as essential -- and in what order they should receive the vaccine -- may be up for debate, at least in Kansas.
Griffin said KDHE will use advisory committees to help determine who should receive the vaccine and when. The plan indicates KDHE is taking input from groups representing individuals with disabilities, people of color, children and other demographics.
"I anticipate that being a time of little sleep," he said.
Missouri plans to concentrate vaccination efforts in federally qualified health centers, rural health clinics, private physicians and pharmacies. Local and state health officials will target the most vulnerable, including the homeless and incarcerated, and help colleges and universities get students vaccinated.
The state plans to have a mobile medical unit at the ready, staffed with health department employees, to take the vaccine to at-risk populations.
"I think what you're seeing is the ability to allocate a scarce resource as we try and identify how the resource can do the most good for the greater good," Manley said. "So if we look at the population that has the greatest risk, that's where it's important for us to provide the resource."
A second dose
While public health officials are in agreement that an eventual vaccine should be offered first to frontline workers and those most at-risk, including elderly individuals, the Trump administration has not outlined in what order states will receive vaccine shipments.
The geography of the federal distribution effort will likely be determined by which areas of the country are experiencing outbreaks once the vaccine is authorized for shipment, one official said.
Griffin said there have been "some questions" about whether states will receive vaccines based on the severity of the virus in their area, but no definitive answers.
Both Kansas and Missouri are being hard hit at the moment, though conditions could be significantly different months from now. Reported new cases and deaths are trending upward in both states.
As of Monday, 872 people had died in Kansas. In Missouri, 2,615 had died as of Tuesday.
As doses become more readily available, both states will enlist as many places as possible as vaccination sites. Expect to see hospitals, health departments and eventually pharmacies and doctor's offices become vaccination sites.
Some vaccines in development require a second dose, likely taken three weeks to a month after the first. Kansas plans to give every vaccine recipient a card with instructions when they receive their initial dose, its plan says.
Both Kansas and Missouri maintain vaccine registry systems that can be used to generate postcards and other reminders about a second shot. The systems can also share information, meaning that in the Kansas City metro area someone who lives in one state could get the shot in another.
The logistics of storing and distributing the vaccine could prove challenging, especially if the vaccine requires ultra-cold storage at temperatures of -70 degrees Fahrenheit. Griffin said a survey of about 100 Kansas hospitals showed that just 10 percent currently have the capacity for ultra-cold storage.
But Griffin said the Centers for Disease Control and Prevention and HHS have advised Kansas "to not be focused on purchasing or expanding" ultra-cold storage capacity. He said vaccines requiring those conditions would be shipped directly from manufacturers in special units called "pizza boxes" that can hold up to 5,000 doses.
The boxes can maintain the required temperature for up to 10 days if strict guidelines about how often they're opened are followed, Griffin said.
"It is going to be a big lift," Griffin said of the vaccination effort. "There's no hesitation in saying that."
McClatchyDC's Michael Wilner contributed reporting
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