The first 2.9 million batches of Pfizer’s two-dose novel coronavirus vaccine shipped from the company’s factory in Kalamazoo, Michigan, on Sunday, kicking off a massive national project health officials hope will bring the pandemic to an end sometime in late 2021.
But some states are better set up to snuff out the coronavirus than others.
The U.S. Centers for Disease Control and Prevention is divvying up the doses on a weekly basis as they roll out of Pfizer’s factory and sending them out via UPS and FedEx. Then, it’s up to authorities in each U.S. state and territory to decide exactly where those doses go—and who’s first in line to get them.
It’s a messy process. States are, in essence, deciding who gets protection first—and who must continue running the risk of catching COVID-19, and potentially dying of it.
“This is emergency triage,” Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast. “There are so many people at risk now and so many sectors that legitimately need attention with the early availability of vaccine.”
“There are going to be people and populations that are going to be left out,” Redlener said.
Perhaps no state illustrates that dilemma better than Florida. The state is uniquely vulnerable to the coronavirus owing to its combination of a huge elderly population—nearly 400,000 of whom live in nursing homes and other assisted-living facilities—and a GOP governor and legislature that have downplayed the seriousness of the pandemic while actively resisting local authorities’ efforts to control transmission via social-distancing measures and mask mandates.
Florida badly needs the vaccine in order to hold back a rising wave of infections—around 9,000 new cases a day in recent weeks—and prevent a nightmarish spike in deaths. The state has already lost nearly 20,000 people. How many more die depends in part on who state authorities allow to get vaccinated first as the supply of the vaccine slowly grows.
But Florida is already getting it wrong, according to experts surveyed by The Daily Beast, and the results could be disastrous.
As states loosely align their own vaccine-distribution policies with broad guidance from the CDC, four highly vulnerable groups are competing for the first batches of vaccine: frontline health workers, elderly nursing home residents, workers in essential industries, and people of color.
The problem: Florida health officials under the leadership of Gov. Ron DeSantis are putting them in the wrong order, experts said.
Neither the Florida Department of Health nor DeSantis’ office responded to requests for comment for this report.
Florida’s strategy, a draft of which is available here, is to rush 55 percent of its initial supply of 180,000 doses of Pfizer’s genetically engineered “messenger RNA” vaccine—enough to vaccinate 90,000 people, assuming no spoilage—to big hospitals for vaccinating their own staffs.
The state is setting aside the remaining 45 percent of doses for people in nursing homes. It appears likely that proportion will also apply to the rest of the approximately one million doses Florida expects to receive from Pfizer before the end of the month.
But, as is the case in most states, none of Florida’s early doses are going to essential workers such as grocery-store staff, transit workers, pharmacy employees, and teachers. What makes Florida’s plan so controversial is that, unlike many other large states, Florida authorities have declined to restrict businesses and schools or to mandate mask-wearing. Those policies have left Floridian essential workers no choice but to work among an especially infective public and risk exposure.
Likewise, DeSantis has not detailed a plan to rush vaccines to communities of color that, owing to structural disadvantages going back generations, are uniquely vulnerable to the virus. In Florida as in many other states, there’s significant overlap between essential workers and communities of color, further underscoring the importance of vaccinating these groups as fast as possible.
“The need for strong equity strategies in Florida is extraordinary,” Lawrence Gostin, a public-health expert at Georgetown University, told The Daily Beast.
As it stands, Florida’s hundreds of thousands of essential workers must wait, probably for months, until Pfizer can produce and ship a lot more of the vaccine.
DeSantis and his health officials should switch up the order and move essential workers closer to the front of the line, experts told The Daily Beast. “The moral claim essential workers have to be in the front of the line for vaccines is overwhelming,” Gostin said.
“We cannot once again leave poor and low-wealth essential workers to be last,” Rev. William Barber II, co-chairman of the Poor People’s Campaign, told The New York Times.
It might make sense for Florida to have essential workers wait for their shots if the state were making other efforts to protect these workers. But it’s not. In September, DeSantis issued an executive order blocking Florida cities from penalizing people for not following local mask mandates.
The same order made it harder for cities and counties to close restaurants. “I’m opposed to mandates, period,” said DeSantis, a close ally of President Donald Trump. “I don’t think they work.”
DeSantis has repeatedly demonstrated a poor understanding of the basic science of a viral pandemic and vaccines. He even appeared to endorse a fringe proposal that people skip the second dose of Pfizer’s two-dose vaccine. Data from Pfizer’s large-scale Phase 3 trials made it very clear that without that second dose, the vaccine does not work.
With a science-denier in charge, Florida is more or less forcing essential workers to interact with an unmasked public—and then refusing to help those same workers get vaccinated early.
Of course, experts acknowledged that moving essential workers up in line for the vaccine means bumping other vulnerable people back. It’s not that hospital staff and residents of nursing homes don’t deserve protection. They do. And it’s not that vaccinating these populations early won’t save lives. It will.
But these groups have ways of protecting themselves that many essential workers don’t.
“Health-care workers in most facilities are going to be totally decked out in the most advanced PPE available,” Redlener explained, using the acronym for personal protective equipment such as gloves, goggles, masks, and face-shields. “That’s not true of a clerk in a grocery store or pharmacy or a bus driver.”
Likewise, because nursing homes are highly controlled environments, staff can wear additional PPE, and limit visitations in order to protect residents and reduce the urgency of vaccinating them. “Nursing homes are doing a great deal of testing of residents and staff,” Jeffrey Klausner, a professor of medicine and public health at UCLA who previously worked at the CDC, told The Daily Beast.
And considering that the staff of nursing homes are a major vector for outbreaks at the facilities, vaccinating staff offers protection to residents—potentially freeing up doses that would go to residents to go to essential workers.
“If staff can be vaccinated and ensured protective masks, PPE, etc., then one should be able to control infection and deaths in these settings and use the early supply of vaccines to vaccinate the other front-line and minorities groups,” Edwin Michael, an epidemiologist with the Center for Global Health Infectious Disease Research at the University of South Florida, told The Daily Beast.
Florida’s nearly 22 million people could get more, and more equitable, overall protection from the state’s initial batches of the vaccine if authorities diverted a portion of the early doses to essential workers. But even that strategy won’t prevent the hardship that all the experts said is coming—or reverse the harm DeSantis has already inflicted on his state.
“The coming vaccines are far too late and too low in terms of supply to prevent the coming third waves in most U.S. counties even if the planned phased roll out begins in earnest from January 2021,” Michael said. “Our simulations show that the only way to contain the coming waves is to increase social distancing measures, with even a moderate increase in the people complying with these measures able to suppress and even flatten these waves in many areas.”