Note well that this discussion is hypothetical, as no Covid-19 is ready, or even near-ready, for distribution to the general public. And the author of this article is not a physician, nurse, pharmacist, or healthcare professional.
Suppose that a Covid-19 vaccine is ready to be distributed to the United States or some other nation. I’ll use the U.S. as an example, since I live there, but the principles apply generally to most other developed nations. There will be many complex questions to be answered about the vaccine and its distribution. But let’s start with two simple questions: Who will distribute the vaccine? and Where will they distributed it? In other words, when the vaccine is ready, where do we go to receive the vaccine, and who gives it to us?
I’m sure many persons are assuming that you would go to your doctor, right? No. Bad idea. If and when we get to the point of vaccinating the vast majority of the population, if they are even willing to be vaccinated, you can’t send 300 million persons to line up a doctor’s offices. The doctors would not be able to see patients because there would be too many persons to be vaccinated. We can’t take doctors away from their work, during a deadly pandemic, to give shots.
And we can’t send a vast number of persons, some of whom are certainly sick with Covid-19 and don’t yet know it, to hand around for hours with a crowd of well persons. There would be a huge spike in cases, if we made that mistake. So the vaccine cannot be distributed by doctors, AND it can’t be distributed AT doctors’ offices, clinics, or hospitals. That would spread the disease before the vaccine kicks in, to the persons getting the vaccine!
This last point needs emphasis and explaining. When you receive a vaccine, it does not work until a point in time at least a couple of weeks after the shot. Some vaccines don’t really work too well until a second or third shot, with lengths of time between each shot. So it would be very stupid to have groups of persons crowd together while waiting for the vaccine, as they will be infected and the vaccine will not become effective in time to help them at all.
Then, to make matters worse, if you crowd people together at a clinic, doctor’s office, or hospital, some persons waiting for the vaccine are probably already sick and don’t yet know it. They will infect the medical staff and the patients waiting for medical care, and the persons waiting for a vaccine.
Why not have nurses distributed the vaccine? Most nurses are busy working with Covid-19 patients or other types of patients. People currently working fulltime as nurses are needed in their current jobs. We can’t put them at risk of getting Covid-19. This would endanger their fellow medical staff and patients, when they go back to their regular jobs after distributing a vaccine.
Having doctors or nurses distribute a vaccine would also endanger their lives. They will be exposed to a long line of persons from the general population, some of whom are already infected with Covid-19, are contagious, and don’t know it. And taking someone’s temperature is not a good enough defense against that possibility. Whoever is distributing the vaccine is at risk of contracting the disease from the persons receiving the vaccine. And if you vaccinate those persons first, it does no good, as it takes too long for the vaccine to begin to be effective.
What about pharmacists? They distribute the flu vaccine, right? There are not enough pharmacists to distribute a vaccine to 300 million persons (which is 90% of the U.S. population, assuming 10% opt out). And the pharmacists are needed at their current jobs. Then, too, we don’t want to risk the lives of any health care professionals, not doctors, nurses, EMTs, pharmacists, etc.
And pharmacy technicians cannot do the job either, as if they become infected, they will spread the disease to pharmacists and to the sick who are coming to pick up prescriptions. Then this same principle applies to all healthcare professionals; they can’t distributed the vaccine because they will become infected and will then spread the disease to other medical staff and patients.
Why not have volunteers from the general population, especially those who are not currently working, learn to give vaccinations? Then the healthcare workers would not be at risk? The problem here is that a large portion of the volunteers would tend to be elderly. Who runs the local polling places for national elections? It’s volunteers, and they are mostly elderly. Since the elderly are at greatest risk of Covid-19, they cannot be given the task of distributing a vaccine.
What about teachers? No, as if they become infected, they would spread the disease to the staff and children at schools. Then the children might spread it to their families.
Why not have the vaccine distributed by police officers? This type of medical task is not necessarily within the skill set of many officers. Some would do a good job at it. But their time and efforts are needed keeping order in society. It would take too many officers away from their work to have them distribute a vaccine. The police are already stretched thin enough. If the vaccine is distributed quickly to many millions of persons, there will not be enough police to even keep order at every vaccine site.
Who should distribute the vaccine? Young adults, in their 20s and 30s, who are not healthcare workers or teachers. It would be preferable, if they do not have children. Then they will not spread the disease to their kids, and the kids to other kids and other families.
The military is the best choice for distribution of the vaccine. Military personnel are mainly young adults, in good health. They generally do not have co-morbidities, so they are at low risk of dying if they become infected. They can easily be trained to give vaccines, as the military often gives training session to troops. They are accustomed to learning new skills, following directions, and keeping order.
If the vaccine is distributed by volunteers, there will be some persons — whether out of fear or arrogance — who will be disruptive. Some persons might try to cut line. Some might try to steal the vaccine, to sell it. Some might refuse to follow the rules required to receive a vaccine. There will be disorder, chaos, some vaccine doses will be lost. Some violence will breakout — if it is distributed by volunteers.
The military will be able to keep order, in a way that doctors and nurses or any type of volunteers from society in general would not be able to do. If there is any attempt at violence, the troops will keep order. And most miscreants, seeing armed soldiers at every location where the vaccine is distributed, will not even dare to come forward. People will respect their men and women in the military, and those who don’t respect them, will at least fear them. It has to be the military.
We are talking about 300 million persons over the course of a single month, which is 10 million persons per day getting a vaccine, across 50,000 locations for 200 persons vaccinated per location, on average. The range might be from 50 to 2000 per location, depending on the population density in the area. So more than a few persons at each location need to be trained to give vaccines.
But the military cannot distribute the vaccine at military bases. It would compromise the security of those bases to have 90% of the population circulating through the bases all in one month. So a location is needed which is found throughout the nation, rural, suburban, and urban, and which has ample parking and a large enough indoor space. And the location must be unused during the entire month or more than the vaccine is distributed.
There’s really only one location that meets these conditions: schools. There are just under 100,000 K – 12 schools in the U.S. They generally have large enough facilities. Schools are often used as polling places during elections. They usually have plenty of parking space. And people usually know where the schools are in their area.
We would need to send the children home for a month, while the vaccine is being distributed. But we have already done that during the lockdown. We know it can be done. (In fact, as I write these words, the schools are not yet reopened.)
So the military would be trained to give vaccines and to keep order, and they will do so at K-12 schools. We don’t need all 100,000 schools, so only about half of the schools will be used. In a few cases, some locations other than schools may be used. There may be a recently closed very large store with a large parking area, that can be used for this purpose, or any similar location.
After the vaccine has been distributed, the facility needs to be cleaned, again by the military. It should be a different set of troops who clean, than who distributed or kept order for the vaccination program. That way, if any troops contracted the disease while doing that work, they will not spread the disease while cleaning.
After cleaning, the school or other facility needs to be shut down for 8 days. The virus does not survive on most surfaces for more than 7 days. Then the school can be reopened and used. Do not clean the facility a second time after the 8 day shutdown, because the cleaning crew might introduce the virus into the facility. It is more certain that the virus will die from time, than from cleaning.
While the vaccine is being distributed it is crucial to maintain social distancing and every other type of personal protection from spreading the disease. We are talking about a plan to circulate 90% of the population through a relatively small set of locations. And many of them will be infected and not yet symptomatic. That means they won’t have a fever or cough or any other sign. But they could spread the disease. The last thing you want for a vaccination program is to turn it into a super-spreader event.
Note Well: the vaccine is not immediately effective. So if you contract the disease at the distribution location, you will not be protected by the vaccine at all.
So the military must have very strict instructions from the CDC on rules for vaccination. How far apart people are to remain, where they are to wait, the maximum length of time they can remain in a location waiting, etc. These rules must be decided at the federal level, and not be haphazardly determined at the local level.
It may take a new law from Congress or an Executive Order to allow the military to not only distribute the vaccine, but also keep order. But it is necessary. Over 130,000 lives have already been lost in the U.S. and half a million worldwide. The vaccine cannot be distributed by volunteers. And the medical system cannot withstand the weight of this task. We can’t have 90% of the population circulating through clinics and hospitals, or doctor’s offices and pharmacies in a single month. And we can’t take longer than 30 days to distribute the vaccine. It has to be the military, and not only the National Guard, but every branch of the military.
Note that the figures above may need to be revised, if we cannot convince 90% of the population (300 million persons) to accept the vaccine. Also, it is debatable whether 50,000 locations can be staffed for a month, and it is uncertain how many staff are needed per 1000 persons vaccinated. However, it would be foolish and unnecessary to take longer than a month to distribute the vaccine. The distribution program must be very well coordinated and run, but it can be done in one month…now we just need a working vaccine and enough doses.
Ronald L. Conte Jr.
Note: the author of this article is not a doctor, nurse, or healthcare provider.