Current State of Mass Vaccination Preparedness and Operational Challenges in the United States, 2018-2019

Abstract

Mass vaccination is a crucial public health intervention during outbreaks or pandemics for which vaccines are available.The US government has sponsored the development of medical countermeasures, including vaccines, for public health emergencies; however, federally supported programs, including the Public Health and Emergency Preparedness program and Cities Readiness Initiative, have historically emphasized antibiotic pill dispensing over mass vaccination. While mass vaccination and pill dispensing programs share similarities, they also have fundamental differences that require dedicated preparedness efforts to address. To date, only a limited number of public assessments of local mass vaccination operational capabilities have been conducted. To fill this gap, we interviewed 37 public health and preparedness officials representing 33 jurisdictions across the United States. We aimed to characterize their existing mass vaccination operational capacities and identify challenges and lessons learned in order to support the efforts of other jurisdictions to improve mass vaccination preparedness. We found that most jurisdictions were not capable of or had not planned for rapidly vaccinating their populations within a short period of time (eg, 1 to 2 weeks). Many also noted that their focus on pill dispensing was driven largely by federal funding requirements and that preparedness efforts for mass vaccination were often self-motivated. Barriers to implementing rapid mass vaccination operations included insufficient personnel qualified to administer vaccinations, increased patient load compared to pill-dispensing modalities, logistical challenges to maintaining cold chain, and operational challenges addressing high-risk populations, including children, pregnant women, and non-English-speaking populations. Considering the expected availability of a severe acute respiratory syndrome coronavirus 2 vaccine for distribution and dispensing to the public, our findings highlight critical considerations for planning possible future mass vaccination events, including during the novel coronavirus disease 2019 pandemic.

Critical Concepts for COVID-19 Mass Vaccination Site Operations

“…Novel vaccines naturally lead to a certain degree of hesitancy, increased questions, and patient anxiety. 7 To decrease the time spent with the vaccinator, common questions should be anticipated, and answers provided in advance of arrival at the vaccination station. Scribes can be helpful, allowing efficient data entry while the clinician can dedicate additional attention to the patient.…”

Response to Hosangadi et al, Current State of Mass Vaccination Preparedness and Operational Challenges in the United States, 2018-2019

“…The authors' share that ''interviewees most commonly cited children and pregnant women as priority populations, as they are often at high risk for severe disease and complications.'' 1 The same is true for Black populations, and the lack of acknowledgement of this group by the interviewees is both concerning and reaffirms the often disregard of the experiences of the Black community. Additionally, the authors state that ''every interviewee acknowledged that gaps remain with respect to incorporating vulnerable populations into mass vaccination preparedness''-this is clear neglect for the protection of special groups and demonstrates how systemic racism manifests in the practice of health security in the United States.…”

“…T he authorship team of the Health Security article ''Current State of Mass Vaccination Preparedness and Operational Challenges in the United States, 2018-2019'' 1 comprehensively describes essential strategies for future mass vaccination preparedness efforts. I appreciate the authors' special attention to certain high-risk populations such as children and pregnant women.…”

“…3 As the authors acknowledged, ''mass vaccination plans must ensure equitable allocation and access to the vaccine.'' 1 While I concur that access and allocation are both of paramount importance, it cannot be overstated that building relationships with Black communities and ongoing reciprocal partnerships are also essential ways to address the systemic racism that was revealed during the pandemic. We must now look to intentional antiracist recovery efforts from COVID-19 and be proactive in our equity-focused approach in planning for future outbreaks and mass vaccination events.…”

Terrorist Attacks Against Vaccinators: A Review

“…6 Mass vaccination is operationally complex. 7 Vaccinators must be healthcare personnel trained to safely administer the vaccine and monitor for side effects. Recipients must be physically present to receive their dose, which introduces significant throughput and security challenges at large public events.…”