Since the outset of the COVID-19 pandemic, the focus of much of the scientific world has been creating and testing a safe and effective vaccine.
With news last week that drugmaker Pfizer was on the cusp of having its vaccine approved after it showed 90% efficacy against the virus, attention shifted to securely and rapidly distributing doses to health care providers throughout the country.
Though officials have had nearly a year to plan, there are still major gaps in that process, Illinois public health experts and supply chain specialists said.
"We've been in pretty close contact with state and county health departments really trying to get a handle on how the vaccine will be administered to the general population," said Dr. Phil Williams, associate vice president of pharmacy services at Edward-Elmhurst Health. "But we have not received final word on who is being prioritized for the vaccine."
That decision is ultimately made by the U.S. Centers for Disease Control and Prevention, local public health officials said. It's a decision the federal agency has yet to make.
It's an important one because Pfizer will have only 50 million doses ready this year, and only about half that number will go to the United States. And since this vaccine requires two doses spread over three weeks, that cuts the potential vaccination population in half.
Only about 12.5 million people will receive the initial inoculation -- less than 4% of the U.S. population.
The working theory is that health care workers and residents of long-term care facilities would be first in line, as they are the most at risk. But health officials also worry about the public's hesitancy to be inoculated.
"The biggest obstacle is having people believe the vaccine is safe and effective," said Chris Hoff, the director of community health resources at the DuPage County Health Department.
However, another major problem exists with the handling and transportation of the vaccine.
While Pfizer's vaccine has so far proved to be effective, it's also proved to be fairly delicate.
The vaccine needs to be stored at about negative 94 degrees Fahrenheit.
"I would say it's pretty rare for most health departments to have a freezer like this, and that a vaccine would require this kind of storage," Hoff said.
He said the county health department just purchased an "ultracold freezer" capable of maintaining the vaccines at the appropriate temperature. Williams said he just bought two -- one each for Edward Hospital in Naperville and Elmhurst Hospital.
The state's "Mass Vaccination Planning Guide" released last month notes that the "CDC does not advise providers to purchase ultracold storage equipment at this time."
When asked Thursday about the state's ability to handle the temperature requirements for the vaccine, Gov. J.B. Pritzker was not ready to commit additional state resources for the necessary freezers.
"Well, there's only been a preliminary study that's come out about that vaccine. I'm very optimistic about it," he said. "But investing in 100-degree-below-zero freezer equipment for the entire state before you even know if that's a vaccine you will use probably doesn't make any sense."
The freezer cost estimate on the high side is about $12,000 each. To outfit all 97 of the state's county health departments with one freezer would cost about $1.16 million. By comparison, the state spent $27.7 million on 2,000 new ventilators at the outset of the pandemic. It's unclear if any were ever used.
There are other cooling options.
The federal government has contracted health care supply shipping company McKesson Corp. to handle the logistics of transporting vials of the vaccine to providers where they will be administered. Pfizer is creating a special container for the vaccines that will be packed with dry ice (negative 109 degrees Fahrenheit) to keep them at the proper temperature.
"Dry ice isn't going to last for three weeks, though," said Ben Royer, owner of Chicagoland Dry Ice in South Elgin. "I'm very aware of the huge need for dry ice. I had a worldwide airfreight company, I'm not going to say who, email me asking if I could commit to selling them 100% of my supply. I told them I couldn't do that."
Refilling the special Pfizer containers every few days with fresh blocks of dry ice could prove just as costly as buying a freezer in the long run.
"We made a decision internally to buy the freezers, but I think most people, especially in rural areas, are relying on replacing dry ice," Williams said.
The state also has a fleet of temperature-controlled vehicles maintained by the Illinois Department of Corrections. Those could be deployed, if necessary, as well.
And Pfizer is not the only drugmaker developing a vaccine. About nine other companies are in various stages of development. Moderna Therapeutics is also close to making an announcement about its potential vaccine's test results.
Public health officials said many of the other potential vaccines are reportedly less temperamental than the Pfizer product.