Along with clean drinking water, sanitation, and nutrition, vaccinations are some of the greatest achievements of modern public health.  Diseases that may have impacted the lives of thousands annually—measles, whooping cough, polio—have been almost eliminated as threats due to effective vaccination policies and programs. 

On September 16, the U.S. Centers for Disease Control released the COVID Vaccination Program Interim Playbook for Jurisdiction Operations.  With the release of the “playbook,” the clock is now ticking and a next act in the COVID era tragedy is beginning; preparation for a mass vaccination campaign. There is great hope that COVID-19 vaccines will be another public health success story and a stepping-stone on the path back to normalcy.

The First Acts of Pandemic Response—The Logistical Challenges of PPE and Testing

As we prepare for vaccines to become publicly available, local governments should consider the substantial logistical challenges of storing, distributing, and encouraging the use of the vaccines once they come to market and how vaccination will roll out in their communities, including where, when, and by whom.  Fortunately, local governments have recent experience with novel vaccines like the 2009-2010 swine flu, as well as years of experience with seasonal flu vaccinations.  However, as the CDC and other public officials note, the COVID-19 vaccine effort will be far more resource intensive than previous experiences.  Similarly, there are concerns about the experiences with the first and second logistical acts of the pandemic—PPE and testing availability and implementation.

In March 2020, The Journal of the American Medical Association (JAMA) noted that “PPE, formerly ubiquitous and disposable in the hospital environment, is now a scarce and precious commodity in many locations.” In response, manufacturing ramped up or repurposed the assembly line and sewing clubs sprang into action. While supplies of medical grade PPE may still be stretched, shortages of PPE necessary to fulfill the requirements of state and local mask mandates, for the time being, are not a major hindrance for local officials.  However, vaccination programs will require massive amounts of PPE to safely implement campaigns across thousands of cities, counties, towns, and villages.

While few expected the rollout of testing protocols, kits, and results to be an easy logistical experience, concerns remain that despite hundreds of labs and millions of swabs, the United States experience has been inadequate. Are case studies from the last six months prophetic, suggesting chaos for vaccine rollout; or are federal, state, and local leaders and managers developing better plans and addressing supply change challenges for the third great logistical challenge of the pandemic?

The Next Logistical Act—Vaccination Planning, Policies, Programs, and Implementation  

The clock has started for state and local officials to expedite planning for COVID-19 vaccinations in their jurisdictions. With the release of the CDC’s “interim playbook,” state and territorial health agencies are required to submit their rollout plans for COVID-19 vaccines by October 16, 2020.  While much remains unknown about the timing and availability of vaccines, local managers should use this time to ensure that their staff and community are planning ahead for a vaccination roll out.

• Socialize the Benefits of Getting Flu Shots.  Federal, state, and local health experts are urging as many Americans as possible to get a flu shot early this fall to avoid a much larger health emergency of flu and COVID cases. Managers should consider local public awareness campaigns to urge their residents to get their flu shot.
• Review Past Plans.  Local governments have been supporting immunization and vaccination programs for many years.  Managers should be familiar with how past campaigns operated and what was suggested for improvement. 
• Stay up to speed.  The vaccination process may start slowly but accelerate quickly.  City and county managers need to be situationally aware to anticipate how to respond to council and the public and to work with local, state, and federal stakeholders.  For example, it is widely expected that initial doses of a COVID-19 vaccine will require injections 21 to 28 days apart. Information about vaccines will be rolling out as trials scale up and emergency use authorizations begin.  Similarly, state plans for the vaccine are due to CDC on October 16, and it will be important to know the ramifications for local government staff and responsibilities.
• Study the Playbook.  The CDC guidance is the playbook for state and local officials.  Local leaders, managers, and staff should be familiar with this guidance and any that comes out in the future.  ICMA is adding vaccination guidance to its Coronavirus resource page and working with public health association colleagues to leverage their expertise in interpreting CDC guidance.
• Inventory Your Community.  No two communities are alike. If your community has special challenges such as a large homelessness issue; a need to communicate in multiple languages; lack of facilities appropriate to safely administer vaccinations; or any other special characteristics, make sure that state and local public health officials are aware and taking that information into account in their plans and protocols.
• Inventory Your PPE.  Work with your local health officials now to ensure that your community will have the necessary PPE for workers who will be managing, administering, and providing COVID-19 vaccinations.
• Identify Your Essential Workers.  Since the first supply of a vaccine will be limited, CDC guidance will prioritize certain populations, including the “critical infrastructure” workforce.  Managers should work with their public health professionals to identify the public health, public safety, and other essential workers in their own organizations.
• Be Prepared for Confrontations.  Since the vaccine rollout is likely to be very prescriptive, localities should be prepared for argumentativeness and confrontations.  Adequate security at all public vaccination locations should be considered.
• Assess and Inventory Your Technology Compatibility with Necessary Software and Systems. There will be a vast amount of reporting and data needed with a COVID vaccination effort.  With the possibility of different vaccines becoming available at the same time, keeping track of who has had what inoculation and when will require effective and compatible technology and software.  There has been a rush on computer equipment with so many children remote learning, so local governments should start procuring any additional technology they need as soon as possible to avoid receiving the “this item is back ordered” automated response from vendors.
• Coordinate with Surrounding Jurisdictions.  A CDC-led series of public listening sessions with state and local officials noted that a common concern expressed by all was lack of coordination and policy inconsistences between bordering jurisdictions.  Managers should consider instituting new or joining ongoing interjurisdictional conversations on synchronizing efforts to the maximum extent possible.
• Promote Vaccination Safety. Widespread public skepticism about the virus and vaccination was another major concern raised by stakeholders in the CDC’s listening sessions.  Local leaders are urged to promote vaccine safety and efficacy as those details are revealed by vaccine makers and the CDC.

Military leaders from Sun Tzu to Napoleon Bonaparte, Dwight Eisenhower to Colin Powell have all relied upon a simple truism for success: “amateurs talk about tactics, but professionals study logistics.” The curtain is opening on the next act of the coronavirus pandemic while sizeable parts of the script are still being written.  Mass vaccination will be a complex and difficult logistical operation featuring intergovernmental cooperation and public-private partnerships unlike most others. The pandemic has been a c-suite issue and whole of government problem since the beginning.  Ensuring that vaccination programming runs smoothly in your jurisdiction will likely require similar if not more leadership to oversee and understand planning efforts, program startup, implementation, and any course corrections that may be needed along the way.

Additional Resources and Guidance

COVID Vaccination Program Interim Playbook for Jurisdiction Operations (CDC)

Factory to Frontline: The Operation Warp Speed Strategy for Distributing a COVID-19 Vaccine (CDC)

Early COVID-19 Vaccination Program Action Items for Jurisdictions (National Association of City and County Health Officials)

COVID-19 Vaccination Planning Library (Association of Immunization Managers)