President Donald Trump has often touted the role of the military in distributing a COVID-19 vaccine, but health officials close to the process who are concerned about public distrust are taking pains to say the federal government won’t actually be handling vaccines.
The president said at the final presidential debate that the distribution of a vaccine would be swift because he’s “counting on the military.”
“We have our generals lined up, one in particular that’s the head of logistics. … He’s ready to go,” Trump said Oct. 22.
But Paul Mango, a spokesman for Operation Warp Speed, the federal effort to develop vaccines, clarified the next day: “It is extremely unlikely that anyone from the government will touch a vaccine, whether that’s loading a truck, unloading a truck, moving dry ice or actually injecting the vaccine prior to Americans getting it.”
Mango said the Defense Department would oversee logistics from a distance. Operation Warp Speed is led by the departments of Defense and Health and Human Services.
“I know what the president means because [Operation Warp Speed leader Gen. Gustave Perna] has briefed him several times on this, and that is we have the best logisticians in the United States at the Department of Defense,” he said. “Every logistical detail you could think of: needles, syringes, swabs, bandages, dry ice, trucks, U.S. marshals guiding those trucks, planes, flying in equipment, getting vaccines out.”
Perna clarified at an Oct. 27 event that the military is helping with things like planning, logistics, augmentation and program support.
“There will not be this vision that some people have that there’ll be Army trucks driving through the streets delivering vaccine,” he said, adding that is not “feasible or the right way to do it.”
Even if federal troops do not end up handling vaccines, National Guard units operating under control of a governor may do so in many states, which could lead to public confusion.
A review by CQ Roll Call of 16 states’ COVID-19 vaccination plans indicates that at least nine expect to incorporate state National Guard units under governors’ control. The draft proposals indicate plans for those units to provide backup transportation and security. At least one state, Maryland, signaled intentions to use its National Guard Medical Service Corps to administer shots.
Sandra Quinn, a University of Maryland health equity professor who studies racial differences in flu vaccination rates, said the public is unlikely to make a clear distinction between state-deployed National Guard and Trump’s invocation of “the military.”
Two Democrats on the Senate Armed Services Committee have called for a hearing on the military’s role in Operation Warp Speed. Elizabeth Warren of Massachusetts and Mazie K. Hirono of Hawaii wrote that the organizational structure of Operation Warp Speed, dominated by members of the military, is a “stark departure” from prior public health crises.
A Defense Department spokesperson told CQ Roll Call there is sufficient U.S. commercial transportation capacity so “there should be no need for a large commitment of DOD units or personnel” in distribution. Any DOD support in distribution beyond planning would be an exception, such as if military air assets were needed to deliver vaccines to a remote location, according to the agency.
Federal officials’ careful comments in recent days on the military’s role reflect growing concerns that even with a safe and effective vaccine, conflicting messages and deep distrust could jeopardize its success.
Quinn said the president’s comments further linking the COVID-19 vaccine and the government won’t help.
“White people would be more likely to question the government’s competence, while African Americans would be more likely to question the government’s motives. Does the government really have our best interest at heart?” she said of her research.
Touting the military’s logistical prowess is unlikely to be an effective way to assuage concerns rooted in centuries of harms by the government and medical community on Black, Latino and Indigenous Americans.
For example, in the infamous Tuskegee experiment that occurred from the 1930s to the 1970s, the government enticed Black men to participate in a study of untreated syphilis by promising medical care that was ultimately withheld. This year, human rights groups alleged that officials at a U.S. Immigration and Customs Enforcement facility performed hysterectomies on women without their consent.
Susan Winkler, chief executive of the Reagan-Udall Foundation, a nonprofit that advises the Food and Drug Administration, is conducting focus groups with people who experience health disparities and are also at an increased risk for COVID-19. She said their concerns were often left out of previous research on attitudes toward vaccines.
Some front-line workers in health care and retail, as well as Black, Latino and Indigenous people, have fears around the speed of the vaccines being developed and worry about being “guinea pigs,” according to the interim findings, which she recently presented to the FDA.
The National Guard’s role
Some states indicated that they plan to use their Guard units to help stretched public health departments plug holes.
While states and territories have received just $200 million from the Centers for Disease Control and Prevention specifically for vaccine distribution, that’s a tiny fraction of the $8.4 billion that advocates for public health departments say is needed for the unprecedented challenge. States could leverage other federal funding but face competing pandemic-related needs.
Without more funding, hiring the manpower necessary to vaccinate millions of people will be impossible, advocates for public health departments say.
Some of the plans, including Nevada’s, note that the CDC won’t reimburse states and territories for any of the freezer trucks or specialized containers necessary to transport vaccines requiring storage at ultra-low temperatures to remain stable. So the West Virginia National Guard is purchasing freezers with its own funds, according to a state health department spokesperson.
Some states don’t specify a role for the National Guard but do list the Guard as a participant on vaccination working groups. Greg Poland, a Mayo Clinic internist and expert in vaccination with the Infectious Diseases Society of America, said the Guard’s involvement is to be expected, given the sheer scale of the challenge of vaccinating every American.
“You’re not standardly administering the flu vaccine. There’s been no event like this in history. You want to get it out to as many people who want it as quickly as possible,” Poland said.
But memories of the National Guard policing Black Lives Matter protests in many cities, sometimes deployed by the president, remain fresh. The Pennsylvania National Guard was recently sent into Philadelphia to quell people protesting the death of Walter Wallace Jr., a Black man who was fatally shot by police.
Some social science research shows that people who have experienced police brutality are more likely to distrust medical institutions.
Transparency is important, experts say. Some states have not yet published their draft vaccination plans.
“Clarifying [the National Guard’s] role is really important, and some of that will have to happen at state and local health departments. As they finalize their plans, they should be talking to their communities,” Quinn said.
Surgeon General Jerome Adams warned last week that if a vaccine doesn’t have equitable uptake, it could further widen the gap separating how the pandemic has affected white and Black, Latino and Indigenous Americans.
“This is going to be, in my opinion, the most scrutinized vaccine ever produced. And honestly, we’ll likely have a stronger safety signal and efficacy signal at the time at which it’s going into people’s arms of any vaccine that’s been put out there. But people need to have that confidence,” he said. “Otherwise, we’re going to see health disparities actually increase and not decrease.”