The role of the military in the vaccine must be strictly behind the scenes

WASHINGTON – When President Trump talks about efforts to deliver the coronavirus vaccine to millions of Americans eager to return to their normal lives, he often says he is relying on the military to make it happen.

Mr Trump has created the impression that troops would pack vials, move them from factories to pharmacies, and maybe even administer shots. And at times military officers working on the extensive Interagency program to get those drug company vaccine doses into doctor's offices have indicated the same thing.

In reality, the role of the military has been less public and more penetrating than this characterization suggests.

When companies don't have the physical space to conduct their drug trials, the Department of Defense has purchased trailers and permits to set up pop-up locations in parking lots. When a required piece of plastic or glass was scarce, the military used a law passed during the Korean War to force manufacturers to move them to the top of the line. If a hurricane hits somewhere and blocks trucks, the military has the transport ready.

Distribution of the vaccines, however, is largely left to their manufacturers and commercial carriers. Black Hawk helicopters don't land next to the neighborhood drugstore to deliver the dose. No troops will fire.

"It is extremely unlikely anyone in the government would touch a vaccine, whether it be loading a truck, unloading a truck, moving dry ice or actually injecting the vaccine, before Americans get it," said Paul Mango, who Deputy Chief of Staff for Policy for the Department of Health and Human Services; and as the lead spokesperson for Operation Warp Speed, the federal multiagency consortium for the rapid tracking of a vaccine.

However, he added, "Every logistical detail you can think of, needles, syringes, swabs, bandages, dry ice" could be procured through the government contract process and often faster than the private sector.

Numerous Department of Defense personnel are being dispatched through the government agencies involved in the effort, making up a large portion of the federal personnel dedicated to the effort. Those numbers have led some current and former officials at the Centers for Disease Control and Prevention to grumble privately that the military's role in Operation Warp Speed ​​was too big for what is essentially a campaign Public health is.

"Frankly, it was breathtaking to see," said Paul Ostrowski, director of delivery, production and sales for Operation Warp Speed. He is a retired Army Lieutenant General chosen by General Gustave F. Perna, Chief Operating Officer of Operation Warp Speed, to manage the logistics for the program.

During a pandemic, it became even more difficult to argue for volunteers for four accelerated vaccination attempts – a task under any circumstances – when it was often impossible to ask hundreds of thousands of subjects to sit in waiting rooms at hospitals and other health centers. The Pentagon has helped three companies – AstraZeneca, Moderna, and Janssen – set up popup sites to conduct trials in 63 locations across the country.

Required for each location: double-width trailers with wheelchair ramps and sewage treatment plants. Some also need to be hurricane-proof.

These are the types of things the military can get quickly through their contract system, as well as any permits required to set up. "We have the opportunity to set up large-scale residential capacities all over the world at any time," said General Ostrowski.

Military officials can call companies, he said, "and say," I need X trailers and I need them right now. "The staff on his team" works closely with all city officials to ensure that we all have certificates and that all codes are addressed, "he said.

The two drug companies Pfizer and Moderna, which are currently running the vaccination race, have estimated they will have 45 million doses, or enough to vaccinate 22.5 million Americans, by early next year. Since they began making vaccines pending federal approval, they should be ready to ship them out within days of being secured.

However, some businesses have been hampered by a lack of excess manufacturing capacity in the United States and a shortage of many of the goods needed to manufacture and package vaccines. When it comes to raw materials, the military has been able to use its contracting muscles as well as the Defense Production Act, a Korean War law that allows the federal government to enforce some control over the private sector.

"Everyone wants this substance or this product," said General Ostrowski. "That's what we do. We understand supply chains."

Operation Warp Speed ​​has placed six orders under the Defense Production Act for companies to be at the forefront of certain shipments, such as the large vats needed to make a vaccine. In October, the government awarded $ 31 million to manufacturer Cytiva to expand production of the vats.

"There is only a certain number of producers in the world," said General Ostrowski. "We were able to make sure they knew where the priority was."

Military officials also came up with a clever idea – if it works – to coordinate the delivery of vaccines to drug stores, medical centers, and other vaccination centers by mailing kits of needles, syringes, and alcohol wipes. Vaccine manufacturers are notified when the kits arrive at a vaccination site so they know they need to ship cans. Once the first dose has been given, the manufacturer will be notified so that they can send the second dose a few weeks later with a patient's name.

However, when it comes to the Herculean task of vaccine distribution, the task largely rests with the manufacturers in getting the vaccines from the loading dock to pharmacies and doctors' offices.

While governors can use their National Guard units in their vaccination programs, the military plays the least part in shifting vaccine doses – and troops are certainly not expected to help administer shots, despite Mr Trump's suggestion.

"I was surprised when Trump talked about the Defense Department's distribution of vaccines," said Dr. Marcus Plescia, Chief Medical Officer of the Association of State and Territorial Health Authorities, who was deeply involved in the vaccine planning process. “The military doesn't matter there. And if it were, we'd be in the arms about it because we're lawyers for the states. "

Concerns about conspiracy theories related to the vaccines are even more reason to keep the military out of sight, said Dr. Plescia. "There have been many concerns about vaccine hesitation and it would not be very helpful to have a few troops around," he said. "Even the participation of the National Guard could have a downside."

As one of the largest liquid injectable drug suppliers in the country, Pfizer already has a large network of commercial mail order companies that help move its drugs from its Michigan manufacturing facility to suppliers across the country. This is all the more important as the company's coronavirus vaccine needs to be stored in freezing temperatures.

The military has spent hours doing table exercises to ponder how the program could go wrong and how it might need to step in to help.

"The government has offered all its support and stands ready to help remove obstacles," said Amy Rose, a Pfizer spokeswoman. Of the six companies that developed a vaccine, the pharmaceutical company was the only one to reject federal funding.

Pentagon planners have examined a number of risks to vaccine distribution, from large-scale protests that could disrupt traffic to poor weather conditions. The military says it can use its planes and helicopters to deliver vaccines to remote locations, but only when no other means of transport are possible.

The military will also oversee the distribution of vaccines through an operations center. "You will know where each vaccine dose is," Mango told reporters when he called. "If there is any danger of a vaccine dose running out, they will direct the movement to another location."

General Ostrowski said this particular assignment was worth postponing his retirement. "This is very important to our nation and our world," he said. "I couldn't think of a better challenge and something more noble than to be able to do this."

Abby Goodnough reported from Washington.