Faced with a slow, chaotic vaccine rollout and ever-rising Covid-19 cases, President-elect Joe Biden has an ambitious plan: to administer 100 million doses of the coronavirus vaccine in his first 100 days in office. Since the vaccines became publicly available in mid-December, 12.3 million shots have made their way into the arms of Americans, an average of 384,000 doses per day. Mr. Biden’s goal of tripling this rate can be achieved if the United States implements a vaccination campaign that treats Covid-19 more like an act of bioterrorism and less like the seasonal flu.
While the United States does not currently have enough vaccine to inoculate all 331 million Americans, supply is far from the only obstacle to ending the pandemic. Only 39 percent of the 31.2 million doses distributed to states so far have been administered. The challenge has been managing the complex logistics of mass vaccination in tandem with addressing the concerns of people who are reluctant to be vaccinated.
Fortunately, we don’t have to develop a strategy from scratch. The federal government has already thought through what it would take to vaccinate large numbers of Americans in a short period.
In the months after the Sept. 11 attacks, the federal government amassed a cache of medicines and vaccines that could be used to protect civilians from a bioterrorist attack involving anthrax or smallpox. Researchers working for the government estimated how many clinics and workers would be required to rapidly dispense and administer stockpiled vaccines and medicines. The Biden administration can learn from these efforts to inoculate Americans against Covid-19.
Building on the strategies developed for smallpox vaccination, we estimate that vaccinating an average of one million people daily for 100 days would require at least 400 vaccination sites across the country, staffed by somewhere between 100,000 and 184,000 people. About 17,000 of those workers would need to be qualified to administer vaccines. Our model assumes that each clinic would operate 12 hours per day and have 10 vaccination stations (like checkout lines in a grocery store) that together could vaccinate 200 people per hour. This plan would require 120 to 220 workers at each clinic per shift and could immunize 2,400 people per clinic per day.
Of course, the coronavirus is not completely analogous to smallpox. Our numbers are based on guidelines from the Centers for Disease Control and Prevention and vaccination exercises that were conducted in San Francisco and New Jersey more than a decade ago. Some of our assumptions may not be appropriate for all states or settings, particularly rural areas that lack infrastructure and trained workers. But this approximation gives us a window into the scale of effort required to achieve the Biden administration’s immunization goals.
Distributing a million vaccine doses a day for 100 days will require substantial federal investment; state and local public health departments simply do not have enough people qualified to conduct vaccinations at this scale. You must be a doctor or nurse to administer vaccines in many states, although some allow trained pharmacists, medical assistants and physicians assistants to do so. To ensure adequate staffing, states will need to train and authorize other health workers, such as dentists, emergency medical technicians and paramedics, to give vaccines.
There is also the problem of demand. Mass vaccination plans for bioterrorism generally assume the population is willing to be vaccinated. Reports of health care workers refusing coronavirus vaccinations are deeply worrisome. State and local governments need to bolster their engagement with community groups to address concerns about the vaccines.
Increasing the volume of vaccinations need not come at the expense of getting doses to the people most at risk from Covid-19. Because it’s important to ensure that people getting vaccinated meet current eligibility criteria, mass vaccination clinics can focus on people over 65, whose age can be easily verified. Mobile clinics can vaccinate essential workers and people who get their medical care at federally qualified health centers, a population that disproportionately includes lower-income individuals and members of minority groups.
Health departments need more resources to dispense vaccines to every American who wants one. Mr. Biden’s $1.9 trillion spending proposal includes $20 billion to establish community vaccination programs and requests funding to hire 100,000 health workers. Those programs should include people qualified to administer vaccines and enough workers to manage large vaccination clinics. It is money well spent in a pandemic, and Congress should authorize it.
Distributing 100 million doses in 100 days would be the most ambitious vaccination campaign in U.S. history. It needs support that will be equal to the task.
Thomas J. Bollyky (@TomBollyky) is director of the global health program at the Council on Foreign Relations and the author of “Plagues and the Paradox of Progress: Why the World Is Getting Healthier in Worrisome Ways.” Jennifer B. Nuzzo (@JenniferNuzzo) is a senior fellow for global health at the Council on Foreign Relations and an associate professor at the Johns Hopkins Bloomberg School of Public Health. Prasith Baccam is a computational epidemiologist at IEM, an emergency management and homeland security consultancy.