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From the Lab to Your Upper Arm: Challenges Ahead for the COVID Vaccine

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The last chapter of 2020 reads like a Hollywood blockbuster. The multinational race for a COVID vaccine has culminated in three viable candidates: Pfizer, Moderna, and Astra-Zeneca. They’ve spent months tripping over one another to get across the finish line, and now as the curtain draws on 2020 — vials are being packed up in GPS-tracked, ultra-cold shipping containers and sent to hospitals and pharmacies across the country. 

Representatives of the billionaire class like Goldman Sachs economists are banking on widespread COVID immunity by the spring. They’re predicting 50% of the U.K. population will be immunized by March, allowing big business to jumpstart their profit making machines. But, resolving the COVID story arch won’t be so easy, and there is no quick fix for the economic and health crisis facing working people. One tremendous challenge we now face is getting the vaccine from the lab’s loading dock to your upper arm. This is no easy feat, especially on the basis of capitalism where logical planning is thrown out the window in the pursuit of maximizing profits. 

Where Are We Now?

Hospitals across the country are buckling under the demands of the record breaking spike in COVID cases. Small to medium sized facilities in hard-hit areas are being forced to stash ICU patients in ambulance bays until beds open up. Nurses and doctors are being asked to come out of retirement to alleviate staffing shortages. A University of Arizona COVID tracking unit warned that the state risks “a catastrophe on a scale of the worst natural disaster the state has ever experienced.” 

Unless serious measures are taken to bring the virus under control, including shutting down non-essential businesses, which requires providing a new round of robust stimulus to workers and small businesses, things will get much, much worse. Experts have warned that holiday travel could trigger an outbreak far worse than we saw last spring, and yet hospitals could very well hit their capacity before Christmas! 

The emergence of three viable vaccine candidates is extremely welcome news to all of us who have lost jobs, lost wages, lost loved ones, or lost our minds during this pandemic. Any alleviation of the tremendous sickness and anxiety workers have been subjected to over the past nine months is good news. Yet getting from where we are now, with a dramatic surge in COVID cases and the expiration of almost all emergency stimulus programs, to where we need to be, with widespread immunity, means overcoming some daunting hurdles.

Clearing the First Hurdle: Development

The COVID vaccines were indeed developed at “warp speed.” Thanks for this goes not to Trump or his bombastic COVID response team, but is due instead to the foresight of scientists around the world who had been studying coronaviruses for 20 years.

Many of the building blocks of a COVID vaccine had been in place for years. In just the past decade, scientists have been tasked with developing vaccines for Ebola, Zika, and H1N1 and have been studying new vaccine technologies — particularly mRNA based platforms. 

But unfortunately, the scientific community does not float outside the confines of capitalism. Research and development for a number of vaccines has been prematurely cut off when there wasn’t money to be made, directly hamstringing our ability to resolve public health crises quickly. Had proper resources been given to pandemic preparedness, and were scientists not forced to beg big donors for grant money, we could have gotten COVID under control much sooner. As professor Jason Schwartz told the Atlantic: “Had we not set the SARS vaccine research program aside, we would have had a lot more of this foundational work that we could apply to this new, closely related virus.” 

For this reason and others, the brand new technology used in COVID vaccines is largely untested, leaving open the possibility that they are not widely effective or have certain long term consequences. 

The Next Hurdle: Scaling Up

The next phase in the life cycle of COVID vaccines is getting it into our bodies. It would seem to most that we’ve already overcome the biggest challenges in vaccine development: making a hyper sensitive mRNA vaccine that, after being injected into muscle cells, tricks the body into making a protein piece similar to that found on the outside of the COVID virus, therefore triggering the body’s immune response to something that looks like COVID but isn’t and immunizing us to a future COVID infection. Phew!

Sadly, because there is no coherent and centrally driven plan to carry out mass immunization, the biggest challenges may still be to come.

Billions of dollars were invested into developing the vaccines, but so far only millions have been invested in scaling up and distributing them (though in renewed stimulus talks, major investment in distribution has been discussed). While there are federal guidelines for production and distribution, all the actual decision making has been left up to the states. States that have vastly different demographics, needs, resources, and have each approached the pandemic with a wide range of seriousness. States that have received $0 in federal dollars to carry out vaccine distribution are seeing hospitals already stretched to maximum capacity, and are buckling under huge budget deficits. 

States are expected to receive the first shipments of the vaccine within weeks. While this urgency is welcome, it means there’s very little time for them to answer burning questions including: Which agencies and authorities are taking up which component of this operation? Which vaccine are we receiving? How will it be stored once it’s here? Who is getting the vaccine first? How will we track who received which vaccine and when they need their second dose? Where will we get enough syringes? Vials? Gloves? 

In receiving the vaccines, local authorities will need to navigate a web of shipping and logistics companies like UPS, FedEx, and likely certain airlines. These logistics networks are already under strain because of the dramatic surge in online shopping — especially as the holidays approach. Will UPS drivers and their seasonal helpers be expected to transport someone’s grandson’s Christmas present alongside highly sensitive, temperature controlled, ultra-cold “shippers” with 975 vaccine doses?

Once the vaccine arrives, where will it be stored? Some hospitals have gone out of their way to secure ultra-cold freezers which can maintain the Pfizer vaccine at -94 degrees. Many hospitals that are receiving the Pfizer vaccine however, especially under-resourced rural hospitals, will likely store the vaccine in its “shipper.” Keeping the vaccine viable in the shipper means replacing at least 50 dry ice pellets (per shipper) every five days and using the contents within 15 days or the contents degrade. States will need to pre-order vast amounts of dry ice in the middle of a national dry ice shortage. Shippers also cannot be opened more than twice a day and for only a minute at a time otherwise the contents are compromised. It’s worth nothing that these same hurdles don’t apply to the Moderna vaccine which can be stored at regular freezer temperature.

Once the question of storage is resolved, there is a short window wherein the vaccines need to be administered before they’re no longer viable. This means that before the vaccines arrive, you need to have sufficient administration tools: syringes, vials, and gloves at bare minimum. You also need healthcare workers trained in administering the vaccines which each have very specific instructions. The Pfizer vaccine is diluted before it’s administered and the bottle has to be gently inverted ten times to mix the contents. The Moderna vaccine on the other hand does not require any onsite mixing. These additional burdens being placed on healthcare workers is happening in the context of a staffing shortage at hospitals across the country which have triggered strikes and workplace actions for safe staffing in New York, Massachusetts, and elsewhere.

Beyond administering the vaccine, there is the challenge of tracking who has received it, which vaccine they received, and when they are due for their second dose. The dose intervals are different for each vaccine and ensuring that people go in for their second dose will be a logistical challenge in and of itself. And all of this is happening in the context of a huge amount of vaccine skepticism which will require a massive campaign to overcome.

What Needs to Happen?

The dysfunction described above is not necessary or somehow predetermined. All of these challenges and complications have logical solutions. Solutions that, on the basis of capitalism, are cast aside because they interfere with the narrow profit interests of competing corporations. 

Instead of leaving this process up to “the invisible hand of the market,” there needs to be a national, publicly controlled plan to achieve mass immunity to COVID-19. 

The first step needs to be the immediate, sweeping use of the Defense Production Act which grants the President authority to direct production during a time of crisis. Through this, currently stalled manufacturing plants could be ordered to immediately begin mass producing vials, syringes, and gloves. Shipments could then be sent to every county in the country. 

Once the vaccine is ready for shipment, the currently competing logistics networks at Walmart, Amazon, FedEx, and UPS should be brought into temporary public ownership as a step toward full and permanent public ownership. These networks are vast, efficient, and allow us to order something with the click of a button and receive it on our doorstep the next day. There’s no reason these resources shouldn’t be deployed to resolve this ongoing public health crisis. In addition to its sprawling storage and distribution capacity, Amazon has one of the most comprehensive tech platforms in the world. Its employees should be freed up to develop an open-source, free platform to track immunization in every state and locality using Amazon’s digital tools. 

In order to enable health care professionals to administer millions of vaccine doses, we need an emergency public investment in our hospitals to increase capacity. There were 1.4 million healthcare workers laid off or furloughed during the pandemic because of revenue lost due to the temporary suspension of elective procedures. These workers should be immediately rehired and there should be emergency, publicly funded “upskilling” programs to train current healthcare workers in new skills necessary to bring the pandemic under control. Any new stimulus package needs to include funding for hospitals to build up their immunization infrastructure. 

This pandemic has exposed the rotting corpse that is American healthcare. Competing hospital networks, pharmaceutical companies, and health insurance providers make up our amorphous healthcare “system.” There is no universal system to track people’s medical needs, and every time you lose your job, your healthcare goes with it. We need an urgent transition to a Medicare for All, single-payer based system.

Taking all of these urgent steps is made extremely difficult when decisions are made based on the narrow profit-driven interests of billionaires. Imagine if we had democratically-elected workers councils at the national, state, and local levels coordinating production, distribution, and administration of the vaccine. These councils would need to include representatives from each notch in the logistics chain including scientists from the labs where the vaccine is made, workers from the factories where it is bottled, truck drivers who transport the vials, healthcare workers who administer the vaccine, and tech workers who keep track of who has been immunized. We would be far better positioned to bring this virus under control if the race for profits was removed from the equation and our COVID response was instead determined by democratically accountable workers’ councils tasked with making decisions in the interests of public health.

Ironically, even the International Air Transport Association (IATA) — the corporate cartel which represents almost every single major airline — has issued a statement urging coordination rather than competition in distributing the vaccine: “Governments, supply chain partners, humanitarian organizations and pharmaceutical manufacturers must collaboratively prepare themselves for a widespread global coordinated response to distribute vaccines to where they are needed in a timely, safe and secure manner.”

Lives Could Have Been Saved

This pandemic has exposed the deadly consequences of capitalism’s blind profit-driven motivation. Hundreds of thousands of American lives have been lost because of the disjointed, chaotic, and unprepared response to this public health crisis.

Had there been a centrally organized, democratically run, and publicly controlled plan in place to address this crisis, hundreds of thousands would not have died, millions could have avoided illness, millions wouldn’t have been sent into dire poverty, and millions wouldn’t have spent the entirety of 2020 facing existential dread. 

The chaotic roll out of vaccinations, combined with the entire 2020 experience, demonstrates how badly we need to usher in a socialist society where the top 500 corporations are brought into public ownership and democratically controlled by workers themselves rather than parasitic private interests. It’s only on this basis that we will avoid crises even worse than this in the future.

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