No matter what you think of Joe Biden’s presidential victory and his touted plans to embrace science rather than magical thinking in the fight against the coronavirus, we are stuck with a simple reality.
The incoming administration will inherit one of the most daunting challenges a president has ever faced: planning and executing a nationwide mass vaccination campaign in the midst of a global pandemic.
Prior to retiring from the military, I worked as a COVID crisis planner at NORTHCOM, where we were terrified of a potential “COVICANE”. Fortunately, a major hurricane did not cause a Katrina or Harvey-type blow to a major city facing a coronavirus outbreak this year, at least on the scale we feared.
But our second biggest concern was what the virus might do to rural America. And it’s playing heartbreakingly right now.
With cases reaching over 10 million, the virus is everywhere and is spreading deep into every corner of the country. This is where the Biden administration will face its biggest challenge, especially when it comes to rolling out a potential vaccine.
My home state of Texas is a prime example. A 2016 report from the Texas Department of State Health Services illustrates the terrible state of rural health care. According to the DSHS, 235 of Texas’ 254 counties were medically underserved. There were many isolated counties with little or no access to health care. Some even lacked a single doctor.
It is a crisis that has been brewing for a long time. As the Texas Watcher Recently noted, in 2019, Texas budgeted $ 17.7 million for infectious disease surveillance, prevention and epidemiology – and more than $ 400 million for border security. So even when a vaccine is delivered, it will go to a state that is understaffed and underfunded.
Lipscomb County, a population of 3,302 in 2010, in the northeast corner of Texas, does not have a doctor. It should be noted that Lipscomb County is 550 km from Austin. Portland, Maine, is closer to Washington, DC, than these 3,302 isolated souls.
Given this isolation and lack of resources, vaccines themselves present a logistical challenge that borders on the impossible for rural America. The Pfizer vaccine, now the main competitor, will require ultra-cold storage of at least -94 degrees Fahrenheit and two rounds of shots. Another major vaccine candidate from Moderna also requires ultra-cold storage. Typically, hospitals and large clinics have this capability. Small towns without dispensaries, even the most basic ones, do not.
To deploy the Pfizer vaccine or any other vaccine, health planners will need to find a way to deliver it to rural areas while maintaining the required temperature long enough for the population to receive both doses. This scene will be repeated throughout small town America. This presents a great risk: An uncoordinated federal deployment of vaccines requiring ultra-cold storage could leave state and local governments competing for resources, just as they competed for PPE at the start of the pandemic.
Trump has indicated that the military will be the savior here, but the military has its limits. At NORTHCOM, we knew we could send military medical and logistics resources to the hot spots, but we couldn’t cover the country. Additionally, Trump’s sacking of Defense Secretary Mark Esper and the ongoing Pentagon purge could delay and disrupt plans being made by the Defense Department.
And there is another potential limiting factor here. When a vaccine becomes widely available, the military may be forced to take care of its own and deploy the vaccine to troops and their families around the world. So, despite Dr.Anthony Fauci’s promises, the literal cavalry may not come, at least not as fast as we would like.
This is how it always has been. The military plays a supporting role during disasters in what is known as the Defense Support to Civilian Authorities (DSCA) mission. As with any request for assistance from federal authorities, requirements emanate from local and state governments. FEMA decides on requests for federal resources. Sometimes the military is the best solution, but most of the time it is not.
At NORTHCOM, we were the military lead for the DSCA mission, and we only had one pandemic expert on staff at the start of the crisis. Subsequently, we released a lot of resources to fix the problem, but it’s just not realistic to think the military can replicate the hard work of state and local health care planners.
Instead of a military miracle, it will take almost seamless coordination between local government, state, and federal government to execute the plan. Our long winter with COVID could turn into a chore in the spring and summer even with an effective vaccine. Pockets of the virus could linger with us for months as we try to reach Americans in all isolated places like Lipscomb County.
Getting it right will be difficult, and given our climate of misinformation and vaccine skepticism, we can never get to the point where we are completely free from COVID. But maybe it’s also an opportunity to show the world that Trump was an anomaly and that we’re willing to work to get back to our normal – or normal – role as world leader. Hopefully, too, a successful vaccination campaign can begin to restore America’s shattered confidence in its public institutions.
Either way, people in isolated and underserved communities – from rural Texas to sacred manufacturing towns to overwhelmed Dakota – deserve our best luck.
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