Illustration: Annelise Capossela/Axios

Now that there are glimmers of hope for a coronavirus vaccine, governments, NGOs and others are hashing out plans for how vaccines could be distributed once they are available — and deciding who will get them first.

Why it matters: Potential game-changer vaccines will be sought after by everyone from global powers to local providers. After securing supplies, part of America's plan is to tap into its military know-how to distribute those COVID-19 vaccines.

How it works: In his May 15 announcement of Operation Warp Speed (OWS) — the official effort to accelerate the fight against the pandemic President Trump said that "when a vaccine is ready, the U.S. government will deploy every plane, truck, and soldier required to help distribute it to the American people as quickly as possible."

  • "The military are, in essence ... a hyper-planning institution and they're logistics. And they have a reach and a capacity unlike other institutions," says Stephen Morrison, senior vice president at the Center for Strategic and International Studies.
  • While specific details are unknown, according to Morrison and Andy Pekosz, professor of microbiology and immunology at Johns Hopkins University, the effort may build upon the current seasonal flu vaccine system that distributes large numbers of vaccines to hospitals, clinics and providers over a short period of time. "That's the same framework we're going to want for COVID-19," Pekosz notes.
  • Some issues need to be thought out beforehand, says Pekosz. For one thing, people may need multiple doses, spaced weeks apart, and the whole process will likely take "many, many months."

Who gets the first vaccines will need to be prioritized under a rolling immunization protocol, which may initially target front-line health workers and high-risk groups, both Morrison and Pekosz said. Ensuring equitable access is also key.

  • Jonathan Moreno, a bioethicist at the University of Pennsylvania, tells Axios the CDC may release guidelines on how to prioritize the first group of vaccines.
  • He adds that the millions of military personnel may be near the top of that list, and "that's a lot of arms to poke."
  • Concerns over people jumping the line should not be high, Moreno says. "It wouldn't be a problem, if it's done properly, because you would have to account for every dose. And, if you're a logistician — and this is why the military is so good — you know exactly how many bullets you used in combat, down to the individual bullet."

Other considerations include what may happen once more than one vaccine is available and how to handle misinformation.

  • "There could be vaccines that require three doses, there could be vaccines that require one dose. There could be vaccines that may be performed at 70% and others that perform at 85%," Pekosz says. Gossip networks might start promoting one over the other, causing complications, he adds.
  • Topol also points to problems stemming from the "significant anti-vax minority, which is very worrisome."

Details: In the U.S., Operation Warp Speed will oversee the push for COVID-19 vaccines (plus diagnostics and therapies).

  • The public-private partnership incorporates leaders from drug companies, the military and various regulatory agencies. Army Gen. Gustave Perna is head of the logistics aspect.
  • BARDA, a federal agency that funds R&D projects and is part of the operation, has received more than $6.5 billion from Congress for countermeasures and so far has partially funded five vaccine developers: Merck and IAVI, AstraZeneca, Moderna, Sanofi's Protein Sciences and Janssen.
  • HHS recently said it hopes to have first doses of AstraZeneca's investigational vaccine ready as early as October. The company says it now has the capacity to source 1 billion doses through 2021.

What they're saying: While public health experts agree speed is key during a pandemic, this is countered by the fact that there's only so much time that can be cut from vaccine production and distribution.

  • "The problem with some of the timelines I've seen with Operation Warp Speed is that they probably aren't realistic in terms of the full testing of the vaccine that has to occur before we starting thinking about scaling up and distribution," Pekosz says.
  • Eric Topol, executive vice president at Scripps Research, agrees there are many challenges. "Obviously we'd like to get this synthetic immunity built using a vaccine rather than getting everybody exposed to the virus, but, it's a daunting task, no question. We've got 330 million people distributed throughout the country."

Plus, several of the platforms being used to develop COVID-19 vaccines are new, including Moderna's mRNA vaccine that stirred optimism last week, and are not yet proven as safe in humans and scalable for billions of people.

  • There's never been a successful vaccine made for humans against a coronavirus.
  • And this virus continues to stymie scientists, including how immune systems respond, which is important to understand for vaccine development.

The big picture: All nations — including developing nations with few funds — will need access to vaccines to build herd immunity.

  • The World Health Organization and nonprofits like the Gates Foundation and Gavi are taking steps to ensure developing nations have access to vaccines when available.
  • Many Big Pharma companies are promising they will distribute as many vaccines as they can produce, to everyone.
  • But, some worry the world will face the same issues it did during the H1N1 epidemic a decade ago, when nationalism and big money held sway.

The bottom line: "We've never faced anything of this scale, and urgency and complexity before. ... The pressures to get the vaccine out are simply going to be extraordinary," Morrison says.

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