Written by Cecilia Rogers

The approval of a COVID-19 vaccine brought on a global sigh of relief and some much-needed hope for the return to normalcy. However, this cause for celebration also raises a new challenge: how to distribute the vaccine. Different countries have adopted various methods to administer the vaccine to their citizens, and recent updates on vaccine distribution reveal some of the successes and pitfalls of their strategies.

The obvious barrier to distribution is supply. Low supply has led to a bidding war for doses of the vaccine in which lower income countries invariably lose. Resource hoarding has endangered countries such as South Africa who are fighting novel strains of COVID-19. Moreover, on an individual level, people in positions of power and wealth have been quick to attempt to use money to access the vaccine. Prominent doctors for the stars of Hollywood have reported getting hundreds of calls a day from patients asking how their monetary influence can get them the vaccine. However, this concern for global equity is not the only issue that has arisen; once countries acquire doses of the vaccine they are struggling to distribute it. Countries such as the United States and Canada have adopted decentralized methods of distributing the vaccine. In Canada, rules for distribution vary by province or territory as they do by state in the United States. The lack of coordination within these countries has slowed down progress. The United States has reported that less than half of the doses given to states have been administered, but newly elected President Joe Biden’s new administration has offered some hope by promising a more centralized approach in the near future. Without a centralized plan, many aspects of vaccine distribution have been left to local health officials and hospitals who are struggling to figure out where to allocate their resources; these institutions are overstretched as they continue to work on other responses to the pandemic (i.e. contact tracing, testing, and treatment of coronavirus). Decentralized efforts have also led to delayed communication resulting in very late notice of new shipments of the vaccine. Consequently, health officials are pressed for time to notify those eligible to make an appointment to receive the vaccine. 

Ann Jinks, a CRNA at UVA Health, describes some of the logistical problems with making vaccination appointments. She mentions how UVA has partnered with the Virginia Department of Health to determine which members of the community qualify to get the vaccine. While there has been tremendous effort to administer the vaccine to the surrounding community, she remarks that “so many people I know who want to get the vaccine, who have signed up with the health department wait daily to see if they are able to get an appointment.”

Another factor influencing vaccine rollout is the excessive forms of bureaucracy which have limited the rates of vaccine administration in regions such as the UK. At the start of vaccine distribution, doctors volunteering to administer the vaccine in the UK were asked to complete unnecessary training including preventing radicalization training. Training is important, but requiring the completion of 18 modules of superfluous information works to hinder rather than promote efficient vaccine distribution.

Despite all the challenges of global vaccine distribution, there are stories of success. The leaders in vaccine distribution by portion of population are Israel, United Arab Emirates (UAE), and Bahrain. These are all small countries which makes logistical factors such as transportation of the vaccine between distribution sites much simpler. Another factor which has led to their success is the structure of their universal health care systems. These systems are centralized and digitized allowing for easy identification of target populations for vaccine administration. Israel also invested very early in the vaccines paying top dollar for doses. These countries have also found success in allocating resources towards reassuring the public that the vaccine is safe; other countries such as France and the US have been dealing with high rates of skepticism surrounding the vaccine’s safety and efficacy due to misinformation commonly spread on social media platforms such as Facebook and Instagram. In Israel, the prime minister Benjamin Netanyahu was the first Israeli to be given the vaccine. These countries have also worked with religious leaders to increase trust of health officials and the vaccine within their communities.

 Moving forward there are many steps that should be taken to better global vaccine distribution. The main focus is increasing supply; there simply are not enough vaccines to administer. While increasing supply, efforts should be made to address the equity of vaccine distribution. Populations such as citizens of lower income nations, refugees, prisoners, and undocumented immigrants cannot be ignored in the pursuit of global protection from the virus. Given the success of universal health care systems, more centralized and organized strategies should be adopted. The removal of bureaucratic red tape from the process of administering the vaccine is also necessary to speed up operations.

A study in Australia has revealed that increasing the capacity of medical centers, streamlining transportation between medical centers, and limiting the size of vaccine packs could increase vaccine administration rates. Increasing capacity refers to increasing the number of doses medical centers are capable of administering. Possibilities for increasing capacity are hiring more staff, developing mobile vaccination units, and setting up more vaccination sites other than hospitals such as local pharmacies, workplaces, schools, etc. Ann Jinks describes one of the major issues as “getting the manpower needed for the distribution.” She recounts, “recently, two satellite clinics opened up in Charlottesville. I know it is a huge undertaking to find enough vaccinators to man the clinics at such short notice.” Therefore, while continuing to increase vaccination sites, the need to hire more vaccinators becomes even greater. Having a sufficient number of vaccination sites also helps solve some of the issues with transportation. Quick transportation of vaccines between nearby sites increases the likelihood that each site will be able to have access to ample supplies throughout the day. Furthermore, smaller pack sizes of the vaccine reduce the need for transhipment between medical centers, whereas larger packs need to be broken down at one location and shipped to multiple centers. 

On a global scale, there have been successes along with numerous setbacks. With continued efforts to improve vaccine distribution and global communication about what methods and systems work and what does not, vaccine rollout can be greatly improved so society can finally experience the return to normalcy for which it longs.

Edited By: Madelynn Park