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F.D.A. clears Pfizer vaccine

The Food and Drug Administration’s emergency authorization on Friday night of the vaccine developed by Pfizer and BioNTech has set in motion the most ambitious vaccination campaign in the nation’s history. This weekend, 2.9 million doses of the vaccine are to begin traveling by plane and guarded truck from Pfizer facilities in Michigan and Wisconsin to  chosen locations, mostly hospitals, in all 50 states.

The first injections are expected to be given by Monday to high-risk health care workers, the initial step toward the goal of inoculating enough Americans by spring to finally stop the spread of a virus that has killed nearly 300,000, sickened millions and faltered the country’s economy, education system and daily life.

The fast development of the vaccine, and its authorization based on data showing it to be 95 percent effective, has been a victory of medical science, but much in this complex next stage could go wrong.

The Pfizer vaccine needs to be kept at minus 94 degrees Fahrenheit, and the special boxes it is being shipped in can be opened no more than twice a day, in order to maintain the deep freeze. Side effects, like achiness or headache, could cause some of the nurses, doctors and others who are first in line for the vaccine to miss a day or two of work, challenging overburdened hospitals.

States say they have only a fraction of the funding they need from the federal government for staffing to administer the shot, for tracking who has received both doses of the vaccine a booster is needed three weeks after the initial injection and for other crucial pieces of the effort.

“Our teams are on standby, ready to pivot,” said Dr. Anne Zink, Alaska’s chief medical officer. Most of the state’s allocation will be delivered to a central location and then flown in small amounts, often in tiny planes, to far-flung hospitals and clinics that will need to quickly administer it.

Preparations for this moment have been months in the making. Military planners have looked at a range of potential obstacles, from large-scale protests that could disrupt traffic to poor weather conditions. In an emergency, officials are prepared to use military airplanes and helicopters to deliver vaccines to remote locations.

FedEx and UPS will transport the vaccine throughout most of the country, and each delivery will be followed by shipments of extra dry ice a day later. Pfizer designed special containers, with trackers and enough dry ice to keep the doses sufficiently cold for up to 10 days. Every truck carrying the containers will have a device that tracks its location, temperature, light exposure and motion.

For all the planning, and contingencies, there is still a good deal of confusion. States are receiving initial allocations according to a federal formula based strictly on their adult population. But many hospitals say they still don’t know exactly how much they will get or when the shipments will arrive.

“It’s really been a lot of the unknowns about the logistics,” said Dr. Jeffrey A. Smith, the chief operating officer for Cedars-Sinai, noting that the medical center was also treating the highest number of Covid-19 patients it had seen since the pandemic began in March.

Other hospital systems are reeling from the news that their initial allocations will be much smaller than they had hoped. The Cleveland Clinic, one of the 10 hospital groups in Ohio that are receiving the first batch of vaccines, is expecting only 975 doses in an initial shipment, even though it has more than 40,000 employees around the state.

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