Another bit of good news came when a Pfizer rep told her that the company’s thermal shippers should be able to sustain the vaccines for 20 days, as long as the dry ice in the package is replenished. Add to that an additional five days of thawed refrigeration, and the vaccine could be kept for a total of 25 days. That extra five-day stretch is key for the administering the second dose, Lewandowski notes. “If you are designing an immunization campaign, you can stock up enough vaccines so that everybody can get their two doses.” But Wisconsin’s rough winter weather will throw some kinks into the plans — mainly, some of the state’s older residents may not be able to drive to clinics. “We will need to find traveling nurses to provide to the elderly population,” Lewandowski says. 

In Vinita, a rural town of 5,000 people in Oklahoma, Melissa Gastorf, who works at a tribal healthcare system, says that the Cherokee nation plans to buy three or four freezers to keep at different clinics. Moderna’s vaccine, whose announcement came several days after Pfizer’s and is said to be nearly 95% effective, can be stored at standard refrigerator temperatures, a more appealing option for many healthcare providers. “The fact that it can be stored in a refrigerator makes it easier, especially for those clinics that give out vaccines on a regular basis,” Gastorf says — so they can use the existing fridges. Through their elders, the tribes typically get to have a say in their medication supplies and negotiate directly with pharmaceutical companies. “Usually we have a pharmacy committee that does the negotiations with different companies,” she says. Through a government-funded program, the tribes offer their own health services, so the members’ vaccinations will be covered, but getting to the clinics will be an issue. “Not everyone has a reliable means of transportation, and some don’t have any,” Gastorf says. The tribes’ health system has public nurses who could travel to people, but they would need to store the vaccines at proper temperatures while transporting them.

For others, even if they had the authority and ability to purchase the right equipment, issues with unreliable infrastructure become limiting factors. Maryal Concepcion, a family physician hired by the Physicians Network Medical Group Inc., who works at an Adventist Health clinic in Arnold, California, notes that buying freezers won’t guarantee the vaccines’ viability. Her clinic is located in the middle of Stanislaus National Forest, where dry air and wind periodically create fire hazards, forcing the local power company to shut down electricity. “The longest we’ve been without power was five days,” Concepcion says, which resulted in vaccine losses at her practice. The clinic had installed a power generator, but during a recent outage, it failed. “We had a generator, and we still lost vaccines,” says Concepcion, for whom a shelf-stable vaccine that doesn’t need to be refrigerated would make the most sense.

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She would still have to worry about community trust, low in her area, in the vaccine. “I’m expecting a lower than 50% desire to even have the vaccine because in our county we have a significant amount of anti-vaxxers,” she says.

While the vaccine logistics can be overwhelming, the vials won’t start arriving at doctors’ offices overnight. Neither Pfizer’s nor Moderna’s vaccines have yet been granted emergency-use authorizations, although Pfizer has just announced it has the safety data to apply for it. Also, the first rounds of vaccines will be sent to hospitals to immunize their frontline workers, so the general population will start receiving them afterwards. That gives physicians some time to prepare and work with their local public health departments.

“How, when and where the vaccine is administered will depend on the vaccine that is authorized, who is recommended to receive it and when, and the individual jurisdiction plans for distribution,” Ada Stewart, a family physician in Columbia, South Carolina, and president of American Academy of Family Physicians, wrote in an email. The Centers for Disease Control (CDC) offers a “playbook” of operational guidance for jurisdictions by state, she adds. “Physicians should work with their local public health officials and the CDC to learn about their local jurisdiction’s plan and how their patients and practice will be affected.”

This article originally appeared on Medical Bag