An Air Force nurse provides a COVID-19 vaccine at Fort Pickett, Virginia, on Sept. 18. (Photo: Department of Defense/Eric Ramirez)v

This is an excerpt from Medically Necessary, a health care supply chain newsletterSubscribe here.

The challenge: The U.S. has enough COVID-19 vaccines to run a booster campaign, but predicting demand, staffing clinics and managing the proper inventory could still be a challenge. 

The U.S. has about 40 million doses of COVID-19 vaccines on hand, according to a report from the Associated Press.

At a press briefing on Friday, White House COVID-19 coordinator Jeff Zients argued that the vaccine supply chain, which now includes 80,000 administration sites, is ready to deliver those doses to patients.

“We stand ready to help … get the job done at the local level,” he said. “We’ve put a special focus on making sure those most vulnerable, particularly residents and staff in long-term care facilities, can get booster shots quickly and efficiently.”

Azra Behlim, who is responsible for vaccines and pharmaceutical services for the group purchasing organization Vizient, said the U.S. is in a much better position than it was at the beginning of the vaccine rollout last year. But that doesn’t mean a booster campaign will be easy.

“When we first launched these shots last year, it was really the supply that caused these long lines. … Thankfully, we aren’t in that situation today,” she told FreightWaves. “The biggest challenge is making sure that you have the right inventory in the right spot where people are actually willing to go.” 

Background: In August, the White House unexpectedly preempted public health agencies and announced plans to provide booster shots for Americans by September

That decision prompted backlash. Earlier this month, a group of scientists, including several from the Food and Drug Administration, published a paper arguing that boosters weren’t necessary. 

Eventually, regulators caught up with the politicians, but they decided to offer boosters to a much smaller group.

Last week, the FDA approved a third dose of the Pfizer-BioNTech vaccine, administered six months after the second dose, for some groups. A few days later, the Centers for Disease Control and Prevention recommended booster shots for everyone 65 and older and people over 50 with underlying medical conditions. People 18 and older who work in high-risk jobs or have underlying medical conditions can also get a third shot if they choose.

The mixed messages have confused some health care providers, according to a report from The Washington Post. Neither the CDC nor FDA has provided definitive guidance about which jobs fall into the category of high risk.

At the press briefing last week, Wolensky said patients will decide whether they fit into those categories. They will simply have to tell health care providers they are eligible to receive a shot.   

“As with the first rollout of vaccines in the primary series, what we are doing now is self-attestation,” Wolensky said.

Zients said the CDC’s recommendations mean 20 million Americans are immediately eligible for booster shots and eventually 60 million people will be. 

The demand: The U.S. currently administers about 600,000 COVID-19 shots per day. Offering boosters to millions could have a big impact on demand. But it’s hard to predict exactly how that will play out. 

On Tuesday, Zients said 400,000 Americans have already received boosters at pharmacies alone and 1 million people have scheduled boosters at pharmacies. 

Behlim said vaccine administration sites will be responsible for predicting demand at their locations and ordering appropriate supplies. Vizient is helping some sites analyze historical and demographic data to predict how demand will change now.

“In this case, we’re looking at Pfizer, indicated automatically for patients 65 and older. … We can easily help you identify how many patients that is,” she said. “If they were treated with your health care system on the first round, chances are people are going to come back to that same location for their boosters.”

Kody Kinsley, who leads COVID-19 operations for North Carolina’s Department of Health and Human Services, said the state is using a similar analysis to gauge demand. 

A statewide survey found that 80% of vaccinated North Carolinians plan to get a booster when it’s available. Public health officials then determined how many people who received their first shots at a given location would now be eligible for a booster. 

“We’ve been able to build out an algorithm that tells us what the estimated demand would be,” Kinsley told FreightWaves. “Then we squared that against what our known supply is in each county to make sure that we are plotting for appropriate delivery.”   

The workforce: In anticipation of increased demand, CVS announced plans to hire nearly 25,000 pharmacists, pharmacy technicians and nurses to help administer COVID-19 booster shots and flu vaccines. Grocery chain Hy-Vee also plans to hire thousands of pharmacists to help with boosters.

“With the continued presence of COVID-19 in our communities, we’re estimating a much greater need for pharmacists, trained pharmacy technicians, nurses and retail store associates,” CVS Pharmacy President Neela Montgomery said, according to a press release.

Behlim said the simultaneous rollout of the flu and COVID vaccines this fall and winter could stress some locations, but she’s not overly concerned about staffing. 

“We have enough manpower in the field for that,” she said. “However … the same pharmacists, the same nurses will be administering the flu shot. [Patients] can also get the COVID booster, but it will take more time.”

Kinsley agreed that staffing was a bigger concern than supply, but he felt confident that administration sites in North Carolina were ready.

“If everybody came … on day one, they would have trouble,” he said. “If they smooth out over the next month or six weeks, then it should be fine.”

The inventory: The fact that boosters are only authorized for Pfizer-BioNTech’s vaccine could also cause some inventory challenges. 

For example, each CVS location only distributes one type of vaccine. That simplifies inventory management, but also means many locations can’t offer booster shots because they don’t have the Pfizer-BioNTech vaccine.  A CVS spokesperson said 5,600 of the company’s 9,600 stores can currently distribute Pfizer boosters. 

In some cases, small vaccine clinics have been using Moderna’s vaccine because it is available in smaller shipments. The Moderna vaccine comes in shipments of about 140 doses while Pfizer-BioNTech comes in shipments of more than 1,000 doses.

In order to request vaccines in North Carolina, administration sites have to show that they can use up all the doses in a shipment over the course of three months.

Kinsley said the state already has a system to address that issue. Over the summer, some vaccination sites struggled to get through the large Pfizer-BioNTech shipments. In response, North Carolina sent those shipments to hub locations, which then broke shipments down into more manageable packages for smaller vaccination sites.  

“If one vaccine provider had excess doses that they weren’t on track to use, then we could ship those doses from that provider to another,” he said. “We’re leveraging that now heavily for boosters.”

Behlim said the best strategy to maintain the right supplies is to look at historical data. Locations that administered lots of Pfizer-BioNTech shots previously are likely to administer more boosters.

“Up until this new booster recommendation, it really didn’t matter if you had Pfizer or Moderna on the shelf,” she said. “Going forward, folks who are looking to stock a little bit more Pfizer would only be doing so based upon how many times they administered Pfizer shots the first time around.”

What’s next? A recent survey of about 1,500 people from the Kaiser Family Foundation found that most vaccinated adults are eager to get a booster shot. That means the booster campaign could have a big impact on demand. The survey found that more than 80% of vaccinated adults will “definitely” or “probably” get a booster shot.

Currently, Pfzier is the only vaccine authorized for a booster shot, but Moderna and Johnson & Johnson have both provided the FDA with data about their booster shots.

The current recommendations for boosters already include a wide swath of Americans, but the eligible population will continue to grow as more patients hit the six-month mark since their second shot. Some top public health experts still expect boosters to eventually be available to everyone, according to a report in Politico.

Between the booster campaign, plans to offer vaccines to children and efforts to convince more unvaccinated people to get the shot, vaccine demand is poised to increase quickly.

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