Covid-19 Live Updates: Vaccine Shipments Start to Roll in the U.S.

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50 states, the most ambitious vaccination campaign

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The first of nearly three million doses of the first Covid-19 vaccine were packed in dry ice and put on trucks at a Pfizer plant in Kalamazoo, Mich., on Sunday morning, destined for hundreds of distribution centers in all 50 states, the most ambitious vaccination campaign in American history.

Workers applauded as the first truck left the plant carrying a load of the vaccine.

The inoculation effort, set in motion after the Food and Drug Administration’s emergency authorization on Friday night of the vaccine developed by Pfizer and BioNTech, comes as the U.S. coronavirus death toll approaches 300,000. And it is happening amid fears that Americans will continue to crowd together indoors over the holiday season and accelerate surges in cases, hospitalizations and deaths.

Officials reported more than 207,000 new cases and more than 2,200 deaths on Saturday. That brought the total number of U.S. cases to more than 16 million, by far the most in the world, less than a week after the country surpassed 15 million. More than 3,000 deaths were reported for the first time on Wednesday.

The first injections are expected to be given by Monday to high-risk health care workers, the initial step toward the goal of inoculating enough people by spring to finally halt the spread of a virus that has sickened millions and upended the country’s economy, education system and daily life.

UPS and FedEx said plans to ship the vaccine were already underway on Saturday. That morning, vials of vaccines were being packed and prepared for shipping at Pfizer facilities, with employees from the Centers for Disease Control and Prevention on site to make sure there were no mishaps, according to a senior C.D.C. official.

After leaving the plant in Kalamazoo, Mich., the vaccines are then slated to go to UPS and FedEx distribution hubs.

From there, they were expected to be dispersed to 636 locations across the country, Gen. Gustave F. Perna, the chief operating officer of Operation Warp Speed, the federal effort to bring a vaccine to market, said during a Saturday news conference.

Mr. Perna specified that 145 sites would receive the vaccine on Monday, 425 on Tuesday and 66 on Wednesday. He likened the operation to D-Day.

“D-Day was the beginning of the end, and that’s where we are today,” he said, but he cautioned that it would still take months “to eventually achieve victory.”

About 2.9 million doses of the vaccine are to travel by plane and guarded truck from Pfizer facilities in Michigan and Wisconsin to designated locations, mostly hospitals. States are largely planning to follow C.D.C. recommendations about who gets vaccinated first: health care workers at high risk of exposure and residents of nursing homes and other long-term care facilities, a population that has died from the virus at disproportionately high rates.

FedEx and UPS will transport the vaccine throughout most of the country, and each delivery will be followed by shipments of extra dry ice a day later. Pfizer designed special containers, with trackers and enough dry ice to keep the doses sufficiently cold for up to 10 days. Every truck carrying the containers will have a device that tracks its location, temperature, light exposure and motion.

UPS and FedEx have said that doses will arrive at their destinations a day after leaving the Pfizer facilities, and both have said that the shipments will be given priority over other packages.

Locations across the country this weekend were already beginning to prepare for the vaccine’s arrival.

The rapid development of the vaccine, and its authorization based on data showing it to be 95 percent effective, has been a triumph of medical science, but much in this complicated next stage could go wrong.

The Pfizer vaccine needs to be kept at minus 94 degrees Fahrenheit, and the special boxes it is being shipped in can be opened no more than twice a day, to maintain the deep freeze. Side effects, like achiness or headache, could cause some of the nurses, doctors and others who are first in line for the vaccine to miss a day or two of work, challenging overburdened hospitals.

Rollout of the Pfizer vaccine is also less centralized in the United States than in other countries that are racing to distribute it. (In Britain, the process is very centralized, and in Canada, it is somewhere in between.)

States say they have only a fraction of the funding they need from the federal government for staffing to administer the shot, for tracking who has received both doses of the vaccine — a booster is needed three weeks after the initial injection — and for other crucial pieces of the effort.

Additional vaccines are in the pipeline. Moderna recently applied for emergency authorization for its vaccine and said it was “on track” to produce 20 million doses by the end of this month and between 500 million and a billion through 2021.

Reporting was contributed by Roni Caryn Rabin, Julie Bosman, Reed Abelson and Richard Pérez-Peña.

Both CVS and Walgreens will send teams of pharmacists and support staff into thousands of long-term care facilities in the coming weeks to vaccinate all willing residents and staff members.Credit…Shannon Stapleton/Reuters

The Food and Drug Administration’s emergency authorization on Friday night of the vaccine developed by Pfizer and BioNTech cleared the way for a complex effort led by the giant pharmacy chains CVS and Walgreens to give the vaccine to nursing home residents and workers, who have died from the virus at disproportionate rates.

Both companies have contracts with the federal government to send teams of pharmacists and support staff into thousands of long-term care facilities in the coming weeks to vaccinate all willing residents and staff members. CVS and Walgreens are both planning to administer their first vaccinations on Dec. 21.

More than 40,000 facilities have chosen to work with CVS. Nearly 35,000 picked Walgreens. Each U.S. state has already picked, or will soon pick, either the Pfizer or the Moderna vaccine for all of its long-term care facilities that will be working with CVS and Walgreens.

CVS has designated about 1,000 of its store pharmacies to serve as hubs for receiving the Pfizer vaccine. The shipments will come via FedEx and UPS.

“Those folks know that they are to bring that product right back to our pharmacy,” said Chris Cox, a CVS executive leading the company’s planning of the effort. “So no dropping it off at the back door, no dropping it off with our front store colleagues — it is to go straight to the pharmacy counter, so that the pharmacists themselves can receive it.”

On the morning the Pfizer doses are ready to go out to a nursing home, pharmacists will load them into small, hand-held coolers intended to keep the doses refrigerated for up to 24 hours. The pharmacists will drive with the doses in their own cars — traveling separately from several support staff members in an effort to maintain social distancing restrictions. The farthest long-term care facility will be about 75 miles by car, though most drives will be much shorter.

Once the CVS teams arrive at a nursing home, they’ll go room by room to administer shots to residents, while facility workers will generally be vaccinated in a common area. The visit will last two to four hours on average, Mr. Cox said. The CVS teams will generally make three visits to each home. For the Pfizer vaccine, each visit will be separated by about three weeks, the amount of time between the first shot and the booster.

“There’s a healthy level of anxiety here because the stakes are so high and the purpose is so great,” Mr. Cox said. “But I’d also say that we’ve been planning this for months — and we’ve been planning for the hardest and most potentially complex scenarios that could face us — so I feel confident that we’re ready to go.”

States are largely planning to follow recommendations from the Centers for Disease Control and Prevention about who gets vaccinated first: health care workers at high risk of exposure to the coronavirus and residents of nursing homes and other long-term care facilities. But there is some variation among their plans.

Gov. Ron DeSantis of Florida said that “tip-of-the-spear, high-contact workers” in hospitals would receive the very first shots and that he hoped to reach “as many elderly people as we can” by the end of December. Ohio has prioritized getting initial doses of the vaccine to people in nursing homes and assisted living centers. And in Mississippi, Dr. Thomas Dobbs, the state health officer, said frontline hospital workers would get the shots ahead of nursing home residents, in part to ease any anxiety those residents might have about the vaccine.

“They’re still a little bit hesitant,” he told reporters on Tuesday. “If we don’t put ourselves out there first, take the first doses of vaccine and show that we believe in it and trust it, I don’t think the long-term care folks are going to have the uptake they need.”

In most states, the concerted effort to vaccinate nursing home residents will begin a week later.

CVS, Walgreens and other pharmacies are also set to play a key role in vaccinating the general public once vaccines are more widely available, but that process will involve people going into their local pharmacies and could be weeks or months away.

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