How to Get More Americans Vaccinated, Faster
I’ve studied geography and reported on the pandemic. Here’s what I see.
Vaccines don’t save lives, vaccinations do. The Trump administration’s plan to get vaccines into the arms of Americans has largely failed, with now only 39.4% of the distributed doses administered as of January 15. Having researched and reported on the pandemic for the past year, I wanted to conduct analysis and propose a vaccination plan, leveraging key locations for vaccination. I first drew attention to the lack of a federal strategy in a tweet, saying that “relying on CVS and Walgreens as cornerstones of a vaccine rollout plan is like using a spigot at a camping site to put out a forest fire.”
Let’s first identify the problem. The Trump administration’s Operation Warp Speed has excelled at producing a vaccine and accelerating its development, but it’s the “last mile” problem that has failed. Underfunded health departments and lack of a federal plan have inhibited rapid vaccinations.
Additionally, America lags behind other nations significantly when it comes to vaccinations per capita. While speed will increase into this month, we still have more work to do. We have also seen a discussion on whether to consider a single-dose regimen in order to speed up vaccinations. There are some valuable viewpoints captured here, but I will not weigh in as I believe that doses administered will never catch up to supply.
As the Biden-Harris administration begins to take control of the nation’s pandemic response, I am incredibly optimistic about its vaccination plan, which aims to create federally supported vaccination centers and utilize other models to reach vulnerable communities. I am confident that the administration will rise to the challenge and harness the power of the federal government to keep the American public safe. The suggestions I have outlined here represent a small portion of a complete governmental response to an immense health crisis.
My plan
My vaccination plan is based around three components — breadth, depth, and equity — all aiming to increase the number of opportunities (locations and times) that Americans can be vaccinated.
Breadth
The Trump administration has forged partnerships with ~37 pharmacy companies to help distribute vaccines. As we can see from this NBC News analysis, 80% of Americans live within five miles of a participating pharmacy chain.
We need more mass vaccination sites (which some states have organized, but we need a federal effort). As a geographer, I look at why places are located where they are and how they can best serve communities. Here are my criteria for a possible vaccination site:
- The site cannot disrupt normal function of society (schools are less than ideal).
- The site must be able to have a high throughput of individuals.
- The site needs to have the ability to hold and monitor for allergic reactions.
- The site cannot cause a superspreader event during vaccination (no tight indoor spaces).
The key here is while pharmacies will be a huge help, we need to increase our reach into “pharmacy deserts.” President-elect Joe Biden has advocated for vaccination mobiles to reach rural America, but to enhance reach we turn to one place: the fairground.
Using geospatial analysis to estimate individuals’ proximity to a fairground, convention center, or exhibition center, we can see that 45% of Americans live within five miles of these locations. These are now often unused and suitable for mass drive-through or walk-in vaccination.
These places are often also well known to members of rural communities and function as central meeting places. Possible layouts could include areas where individuals can drive through, be placed in a holding lot to monitor for reactions, and then cleared when ready.
Depth
However, in urban areas, convention centers may not be enough. It is for this reason that we discuss depth in vaccination; the goal is to create high-capacity mass vaccination sites. For this, we turn to major sporting venues (those used by the MLB, NBA, NCAA, NFL, etc.). This is where depth comes in.
Experts such as Dr. Jonathan Reiner and Dr. Peter Hotez have called for these sites to be opened as mass vaccination centers. The federal government should forge partnerships with these organizations (a good PR opportunity here) and start setting them up. In addition to using stadiums, others have proposed using the National Guard, and I agree.
A look at the numbers reveals that 43,376,740 people (13.22% of the population) live within five miles of a stadium. In order to promote easy access, I propose vaccination shuttles in urban areas to enable people to travel to these sites. As NYC Councilmember Mark Levine points out, they should be open 24/7.
Equity
We must also consider vaccination equity, ensuring that minority (including undocumented) communities have easy access to a vaccination site. For this, we turn to the MLB. Its 29 stadiums in the U.S. are often located in urban areas. MLB stadiums are critical locations to help address racial and ethnic inequities. In counties with stadiums, the average percentage of Black residents is 22%, compared to 9% in counties without stadiums. For Hispanic residents, those statistics are 19% and 11%.
We must also highlight inequities in the pharmacy network. Here is a map of participating pharmacy chains (red dots) overlaid with the percentage of Black residents in counties (blue shading).
Some counties (especially those in the South) have high proportions of Black residents but low numbers of pharmacies per capita. This is why one type of location (pharmacies) will not work on its own; enhancing our overall portfolio of vaccination sites is necessary.
Combined, we can see that these three types of sites (pharmacies, fairgrounds/convention centers, and major sports venues) fill a needed vacuum. I propose that the federal government set a goal of ensuring a certain percentage of the population lives within five miles of a chosen vaccination site.
Distribution
In order to fulfill cold chain requirements and for shipping efficiency, I propose a hub-and-spoke model for shipment, especially in rural areas. Vermont uses this for opioid use disorder treatment and it has shown impressive results. Hubs could include local or county health departments, who would then dispatch vaccines to vaccination sites (fairgrounds, etc.).
In addition to the locations of sites, infrastructure needs to be built up, including reservation systems and the ability to complete paperwork electronically. Eventbrite is simply not going to cut it.
We also need to invest in human capital, as former Baltimore City Health Commissioner Dr. Leana Wen points out: “We should be enlisting community health workers, retired health professionals, and medical, nursing and dental students.” Funding health departments would go a long way. I would also call for a Peace Corps-style group of young individuals to help others register for vaccines, enabling us to break down technological barriers.
I would also call on the federal government to be even more transparent with its vaccination data, posting a list of sites nationwide where individuals can go to get vaccinated (I believe such a system is currently in the works).
Finally, we need public education campaigns, as top experts have repeatedly pointed out. Public health officials should be providing vaccination services in multiple languages, with multilingual informational materials easily accessible.
I acknowledge there are limitations to the analysis I have presented, including reaching Native American communities, cold storage issues, and others. This is not a one-size-fits-all approach. With careful planning, effort, and analysis, we will be able to vaccinate the vast majority of the population by the end of this year.
To see a full interactive map of the locations I have proposed, click here.
This story was adapted from a January 5 Twitter thread.
