With cases of COVID-19 surging across the country, there has been incredible urgency for a safe and effective vaccine. But there are sobering messages from public health officials and vaccine company executives in recent days that the vaccine likely won’t be available to a majority of the U.S. population until well into 2021.
The approval of a vaccine, however, will only be the first step toward restoring the health and security of our nation. There is an important distinction between the creation of a vaccine designed to prevent the spread of COVID-19 and a successful process of manufacturing, distribution, and administration.
The development of a vaccine—particularly at the scale of supporting the needs of the entire population—takes time. In addition, manufacturing and distributing this vaccine is a monumental logistical and security challenge. A safe and efficient vaccination effort presents one of the most complex logistical challenges the nation has ever faced.
The COVID-19 vaccine deployment plan envisions administering at least 300 million doses in the U.S. alone—and more than 600 million if two doses are required. In the proposed Phase 1 alone, the target population for vaccines could involve approximately 5 million U.S. hospital workers and more than 8 million long-term care services users. This is six times the normal amount for the flu vaccine.
Thousands of vaccination locations will need to be identified and created, with many sites having to be accessible to lower-income individuals with transportation challenges. Many Americans living in rural areas do not have the facilities with appropriate refrigeration required to handle the temperature-sensitive vaccines. There will be a need for strict physical security, tracking and delivery controls, cybersecurity protections, sensitive handling, and temperature controls.
That is why, along with the Department of Health and Human Services, the President has turned to the Department of Defense—the nation’s experts in logistics—to lead Operation Warp Speed.
A key tenet in the military’s operational planning for any contingency is to never allow for a single point of failure. Our military regularly scrutinizes each part of an operation to ensure every contingency has been considered and no resources are left on the sideline. The scale and importance of a COVID-19 vaccination program demands the U.S. government focus on resilience. This necessitates bringing to the table every key player—from manufacturers, distributors, and delivery services to providers, payers, and public health experts—to build the strongest distribution approach possible.
The U.S. private medical distribution network consists primarily of three large distributors, which together service about 95% of pharmaceutical distribution, each covering about one-third of the market. This current system has built-in redundancy in case any of the companies experiences delays in their distribution.
Yet the U.S. government has thus far provided a contract to distribute the COVID-19 vaccine to a single U.S. company: McKesson. It will be an extraordinary challenge for one company to oversee vaccinations of more than 300 million people through one distribution network.
Putting all of our eggs in a single basket exposes our vaccination process to the potential for what we in the military call a single point of failure risk.
Just as our military contracts out to dozens of U.S. companies to support logistics efforts around the world, so should the U.S. government consider multiple distributors for the COVID-19 vaccine. There are a range of companies, both medical distribution companies and companies specializing in logistics, that have capabilities and strengths in different regions of the country and are ready to help.
The military is already conducting multiple tabletop exercises to plan for contingencies and potential distribution failures. The Defense Department would be prudent to use these exercises to test how multiple distributors could effectively deliver vaccines while reducing the single point of failure risk.
Multiple vaccine and therapeutic candidates are conducting the later phases of clinical trials needed to demonstrate their safety and efficacy. But there is less clarity around the national vaccination effort. The parameters around who will receive the vaccine, when, and how are still murky. The sooner the process is made more transparent, the more trust and confidence the public will feel.
The trust of the American people will be the most important factor in a successful vaccination effort. Any interruption in any part of the vaccination effort, particularly distribution, could destroy this trust.
The U.S. has the most professional military in the world. I have no doubt that with the Defense Department supporting the development, production, and distribution of COVID vaccines, America can carry out an effective vaccination program.
James Stavridis, a retired U.S. Navy admiral, was 16th supreme allied commander of NATO and 12th dean of the Fletcher School of Law and Diplomacy at Tufts. In both positions, he focused on global health concerns and issues, including the logistics associated with solving medical challenges in the Middle East, Africa, and Europe.
