Record-keeping requirements will also be an overwhelming task, officials said. The C.D.C. wants to track, in real time, the age, sex, race and ethnicity of everyone who is vaccinated — states usually provide such data quarterly, at best — so it can analyze how well the vaccination campaign is going among different demographic groups day by day and make adjustments if certain populations or regions have low vaccination rates. The C.D.C., which holds frequent planning calls with state and local health officials, is also still working on persuading states to hand over the personal data of their citizens. In its data use agreement with the states, the agency has requested each vaccine recipient’s name, date of birth, address, race, ethnicity and certain medical history.
“States have never had to report that to the federal government,” said J.T. Lane, the chief population health and innovation officer of the Association of State and Territorial Health Officials, adding that his organization was seeking clarity on exactly how the information would be used. In particular, the organization’s members worry that the information could be used by Immigrations and Customs Enforcement to track undocumented immigrants.
As soon as the F.D.A. approves a vaccine, the C.D.C.’s Advisory Committee on Immunization Practices will meet to issue recommendations, already in the works, on how it should be distributed. It will almost certainly say that health care workers should be the group with the highest priority for vaccination, followed by essential service workers, people with high-risk medical conditions and those older than 65.
But states will be allowed flexibility within those guidelines; Maryland, for example, plans to include its prison and jail populations in its “Phase 1” priority group. State officials also have to figure out whom to focus on within priority populations if they get less vaccine than they need.
During the C.D.C. advisory committee’s meeting last month, some members said they wanted to ensure that information about any safety problems would be made public quickly. The Department of Health and Human Services has said its goal is to start shipping a vaccine within a day of F.D.A. authorization. Until now, the F.D.A. and the C.D.C. have maintained one data system for patients or providers to report bad reactions to vaccines. They plan to supplement that system with a smartphone-based tool that checks in with individuals who have been vaccinated to see whether they have had any health problems.
The C.D.C. advisory group has also stressed the importance of a campaign to persuade the public to take the vaccine, noting that messages were likely to be more effective if they came from community leaders than from the federal government. North Carolina says its campaign will use “photos, video, and personal testimony of celebrities, leaders of historically marginalized populations, and other trusted messengers receiving vaccine as early adopters.”