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With the first doses of the FDA-authorized Pfizer vaccine going into the arms of doctors and ICU nurses this week and millions more doses on their way to hospitals and nursing homes nationwide, FDA is moving forward with timetables for authorizing additional vaccine candidates for public use. As images of these frontline heroes getting their shots reach American households, the public's interest in the vaccines' safety and availability is intensifying and the prospect of getting vaccinated becomes more "real" for many people.

This is a historic moment

The development and distribution of the COVID-19 vaccine, an unprecedented effort to vaccinate the entire population of the United States in record time, represents a truly historic moment. We overcame innumerable scientific and regulatory hurdles with remarkable speed. Even so, we are still in the earliest days of what may prove to be a "long winter." The vaccine distribution effort is taking place against the backdrop of vaccine hesitancy and deep political, social, and economic divisions that have challenged the public's trust in the government and in the public health community's response to COVID-19. A wary public will have questions — lots of questions.

States have developed COVID-19 vaccine distribution plans and stand ready to get vaccines to healthcare workers, other essential workers, and people at an elevated risk of serious illness. What comes next?

To date, Maximus Public Health experts have reviewed and offered comment on COVID-19 vaccine distribution plans developed by nearly all 50 states and the Indian Health Service. A careful review of state vaccine distribution plans reveals a reassuring and professional regard for the important task of making sure that vaccines get deployed to the right places at the right times to ensure maximum impact from an initially limited number of doses. The steel thread that runs through all the plans we've reviewed is a strong commitment to the best available science and an unambiguous emphasis on prioritizing those Americans who are:

  • Individuals at the greatest risk for serious health complications if they become infected
  • Healthcare and other essential workers who have the greatest exposure risk and whose service is vital to keep society running

Most plans don't fully anticipate or accommodate what is sure to be a huge communications challenge. As public health practitioners and federal authorities gain practical experience with the different vaccine candidates and get feedback from the states and from the public, clear lines of communication — outbound and inbound — will become a critical element of how successfully the rollout proceeds into next year. Winning the public's trust and support will take serious work and planning. And worryingly — even before the Pfizer vaccine received emergency use authorization, shady websites went live promising access to the vaccine for worried households and spreading misinformation.

Key concerns for state and local vaccine distribution and communications planning

Don't underestimate the level of interest and questions the public will have regarding vaccines, vaccination risks, and eligibility criteria for being vaccinated. We forecast state and local health programs, providers, and pharmacies will experience unprecedented surges in calls, email, and web traffic over the coming weeks and months. This is informed by our work this year assisting programs at all levels of government respond to COVID-19, including:

  • Expanding CDC's 1-800-CDC-INFO to 24/7 coverage and adding agents to keep pace with the volume of calls and emails from healthcare providers and the public. When volumes peaked in April, 500 agents responded to more than 16,000 calls and 2,000 emails per day.
  • Launching an outbound call center in just four days for the Office of the Assistant Secretary for Health (OASH). At its peak, we received test results from 47 federally facilitated COVID-19 testing sites across 12 states.
  • Assisting communities in six states with COVID-19 screening, scheduling, and contact tracing-related services.
  • Supporting unemployment programs in 17 states to assist millions of individuals to submit claims as well as perform a wide range of tasks, including adjudication, fact finding, and fraud investigations.

As states move past phase 1a in their distribution efforts, they must anticipate and prepare to answer the public's expectation for clear and timely information. Without adequate planning, health departments will be overwhelmed with questions and providers and pharmacies will be paralyzed by demand for vaccinations. Moreover, states must be prepared to manage the public's expectations by providing transparent information about any setbacks or changing circumstances. Those states that invest time and resources to this effort will be best positioned to build trust and cooperation necessary for success.


The success of the entire venture may rest on states establishing trust by ensuring transparency and clarity in all vaccine-related communication efforts. Any disconnect in information or appearance of impropriety will only drive members of the public to unreliable, and potentially harmful, sources of misinformation. Scams around the COVID-19 vaccine have seen a tremendous upsurge in recent weeks and risk spreading misinformation and further deepening concern and mistrust.


States will have to anticipate and manage public expectations and prepare to communicate effectively with diverse audiences with differing levels of information and familiarity with the relevant medical information. Disadvantaged populations — both urban and rural — will be approaching the decision on when and how to get vaccinated with different varieties of skepticism. African American communities are especially familiar with the tragic abuses of the Tuskegee Syphilis Study and other horrendous abuses of people by government public health researchers. As a result, people of color may view any effort to prioritize their vaccination on grounds of their elevated risk of hospitalization or death with suspicion. A significant number of all demographic groups surveyed have self-reported hesitation to be among the first to get vaccinated out of an abundance of caution, misunderstanding the relative risks, or concern over long-term effects.


"We expect the surge in call volumes and direct contact with state and local public health agencies to be very similar to what we saw when the Affordable Care Act rolled out in 2009 — or more recently when people filed for unemployment due to COVID-19-related job losses. States that underestimate the inbound side of the equation when developing their coronavirus vaccine distribution and communications plans are likely to see hours-long hold times and households with few trusted sources to turn to for information."

A centralized resource for understanding and navigating COVID-19 vaccination

A centralized state resource for understanding and navigating the complex vaccine roll-out could offer tremendous benefits to the public — and helps states build credibility and trust in the vaccine effort.

Without a dedicated place to find information and ask questions, people will inundate providers, pharmacies, government agencies, and other resources — both legitimate and misleading — for information. Offering a resource for coordinating consistent and reliable information will help control the rampant spread of misinformation that has characterized much of the response to COVID-19.

By investing sufficient planning, scripting, and resources, states can create centralized information and coordination service centers to provide the most straightforward customer journey and experience throughout the protracted vaccination process. This "Vaccination Hub" would provide transparency and direction to the public and providers, align expectations, and build trust in the vaccination program — all key to building patience and perseverance as we work through the long duration of the COVID-19 pandemic together.