Category: Covid-19 Vaccine

"Healthy, normal people don't die from the flu, but with this bugger, [COVID-19], it gets everywhere, including the sensory areas," said Dr. Sandra Gibney. "So, the lungs, the brain, the small intestine, blood vessels, and neurons."

Gibney, a board-certified internist and emergency room doctor, said novel coronavirus COVID-19 is so scary because of how pervasive it is but, luckily, a vaccination is close to being available for distribution.

She knows there are some concerned citizens wondering how effective the vaccine will be, how safe it is to take, or wanting to know more about ho its made, and she joined WDEL's Rick Jensen Show Monday to try and quell some of those worries.

It didn't really matter to Gibney how effective a vaccination might be--though the ones closest to being ready for distribution have shown in the 90 to 95% range--any increase in protection was worth it.

"If you told me I had a one-in-two chance of not getting the flu, I'd still take the vaccine trying not to get the flu," she said. "And if you told me I was going to die [from COVID-19] potentially, I'd certainly would think about it."

The current leading vaccinations use a messenger RNA approach, which deliver instructions to your body's immune system to explain to your body how to combat the COVID-19 virus if it ever shows up. She liked it to a chef and a kitchen assistant using a cookbook. It doesn't change what is in your body, rewrite genetic code, or anything like that. It's only providing an ingredient.

"DNA is our cookbook, that's where the recipe is stored, in that cookbook in the library," she said. "Basically, the chef's assistant is the RNA--what we're talking about this vaccine being, that's the chef's assistant. Once that RNA, or the chef's assistant, brings the recipe, then that's injected in the body, and encodes to make a protein. So, let's say, if you will, we're making a cake. We have used a recipe to make that cake. Now the RNA is like an ingredient of the recipe. However, it doesn't change the cookbook recipe that's there."

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The temporary introduction of this code provides the body with a game plan for how to defend against it should the virus show up again at a later time. However, the construction of the vaccine is a bit unique. Messenger RNA as a delivery for the vaccine, in particular makes it more unstable than some other available medicines, and introduces the need for cold storage to maintain its stability.

"That is unique to some of the vaccines. Not all of the vaccines use messenger RNA. Moderna and Pfizer both use messenger RNA-type," Gibney said. "It is so unstable it has to be frozen and that's why delivery for those two is going to be a little bit of an issue because they have to be frozen or that very unstable messenger RNA will break down."

The delivery itself is actually a novel approach to combating a virus.

"I'm not going to say that RNA vaccines have even been FDA-approved; they haven't," Gibney said. "This is a new and novel technique, but it's probably going to be the most effective and easiest to make a lot of vaccines very quickly."

The messenger RNA model also allows medical professionals to adjust their recipes on the fly, adding or deleting ingredients as necessary depending on how the COVID-19 virus mutates or evolves on its own.

"This is why the messenger RNA will be very valuable," she said.

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Newark-area doctor breaks down how COVID-19 vaccine will work, urges people to get it when available - WDEL 1150AM

ByStephanie Desmon

The legal precedent for mandatory vaccinations dates back to a 1905 Supreme Court case after a smallpox outbreak in Massachusetts. But as the U.S. reaches important clinical milestones in its vaccine development efforts, questions arise relating to distribution, and who becomes vaccinated and when.

Legal and public health expert Joanne Rosen, a senior lecturer in Health Policy and Management and the Center for Law and the Public's Health, spoke with Public Health On Call podcast host Stephanie Desmon for a recent episode about the precedent of vaccine mandates. She also discusses the history of vaccine exemptions and strategies states could consider to achieve widespread vaccination for COVID-19.

The short answer is yes. States have the legal and constitutional authority to require that the people who live in that state be vaccinated, or to introduce a vaccine mandate.

The authority for the state being able to compel vaccinationthe affirmation of that authoritygoes all the way back to a U.S. Supreme Court case in 1905 called Jacobson v. Massachusetts. That case arose in the midst of an outbreak of smallpox in Cambridge, Massachusetts, in 1902. Cambridge introduced an ordinance requiring all adults be vaccinated or revaccinated against smallpox. If they didn't [get vaccinated], they would have to pay a fine of $5.

Jacobson was a resident of Cambridge who, for a number of reasons, objected to the vaccination mandate and brought a lawsuit against Massachusetts for the mandate. He raised a number of arguments, including one that his constitutionally protected liberty interests were being infringed by this mandate.

In that case, the Supreme Court said that states have under their police powers, which is under the Constitution, the authority to enact reasonable regulations as necessary to protect public health, public safety, and the common good. Vaccination mandates constitute exactly that kind of permissible state action to protect the public's health. Even though it's 115 years old, this continues to be the benchmark case on the state's power to mandate vaccination.

Coverage of how the COVID-19 pandemic is affecting operations at JHU and how Hopkins experts and scientists are responding to the outbreak

In response to the argument about this individual liberty interest, the court said that sometimes individual interests might have to yield to state laws that endeavor to protect the health of everybodythe "common good." The court said: "The rights of the individual may at times, under the pressure of great dangers, be subjected to such restraint to be enforced by reasonable regulations as the safety of the general public may demand."

So, yes: Once COVID vaccines are available, states could elect to require that people who live within that state be vaccinated.

By and large, our immunization schedule begins as children, and we have to show proof of vaccination to go to school. It is a more complicated administrative manner to have a vaccine mandate that applies to adults because there isn't a point of common intersection with the state or with some agency of the state the way we have with children. I don't have a clear idea of this, but that would be something that states would have to work into a mandate. A requirement that people be vaccinated is only as effective as the way of ensuring that they are.

That also raises issues that the vaccine has to be made available without charge or in a way that allows people to get coverage for it if it's not covered by their insurance. Againhow are we able to keep track?

The other advantage that school-based proof of vaccination offers is for people who have some medical reason to not be vaccinated. All vaccine mandates include a medical exemption for people whose health would be imperiled because of an allergy to something in the vaccine or because they are immunocompromised or any other reason. When you go to school and show your proof-of-vaccination certificate or show that you've been exempted and you're not vaccinated, it means that public health offices have a record of who is and who isn't vaccinated. In the event of an outbreak of one of these vaccine-preventable diseases, we can identify and isolate the people who haven't been vaccinated and who are obviously at higher risk for being infected.

Yes, absolutely. The measles outbreak in New York was about a year or two ago and, in California, it was traced to Disney World in 2014 or 2015.

The reasons for these outbreaks were religious exemptions in New York and personal belief exemptions in California. The legislators of California and New York revoked nonmedical exemptions as a result so that they could ensure higher rates of people immunized against measles. And, guess what? The rate of measles immunizations did go up when those exemptions were removed.

One of the reasons that nonmedical exemptions were introduced in the first place was to try to respond to and prevent vaccine-related backlash. There's a very strong culture in this country and others of personal autonomy and not wanting the government to force you to do something or tell you what to do. People wanted to be able to make their own decisions about the risks they're willing to take. The introduction of these exemptions, in part, was kind of like a safety valve to let some of the pressure out of the system so that people could feel that they had some choice.

Although it seems counterintuitive, providing some opt-out mechanism in fact can protect the overall integrity and legitimacy of the vaccine regime and public health. Yes, the goal of public health is to ensure that as many people as possible are vaccinated to prevent further transmission of disease. This leaves the question of "How best do we achieve that goal?" A vaccine mandate looks like it's the most straightforward way to do it. But, if we have a lot of backlash and resistance to it, how do we then bring those folks onside?

One approach might be to start with a strong recommendation and education campaign. Physicians and health care providers can be part of this effort to educate people about the safety of vaccines. A particular issue that we may face with a COVID-19 vaccine that does arise with other vaccines, but not to the same degree, are questions about [safety] because it's brand new. Measles, mumps, rubella, polio, and smallpox vaccines have been around for decades, if not even longer. They are regarded as safe and we have decades of data. But COVID-19 vaccines are brand new, so there will probably be more concernseven among people who are fully vaccinated against other diseases and who have vaccinated their children.

One approach, perhaps, to start is strong recommendation, and being transparentas drug companies are doing their best to doabout what they know about safety. Then, once the vaccines are available, states can make it as easy as possible to get vaccinated. Even in the absence of a mandate, when you are vaccinated, there are public records kept and they can see what percentage of residents have voluntarily been vaccinated. If the percentage is high enough to ensure that the whole community is protected, there wouldn't be a need for a mandate.

They can and they have. It's very common in particular sectors. An employer has to have a "reasonable basis." If you worked in retail, I'm not sure a corporate entity could require that. They may want you to and recommend it, but it wouldn't be reasonably related to the requirements of their job.

But in sectors in which the employees are themselves at greater risk of contracting vaccine-preventable illnesses or who work with populations that are especially vulnerable if they do get sick, like hospital workers, health care workers, and people who work in [long-term care] facilities, employers have required that their staff be vaccinated against the flu each year.

Another thing that states could do, short of a requirement across the board that everybody be vaccinated, is they could begin with a mandate that focuses on those sectorspeople who are themselves at greater risk or who work in proximity with vulnerable populations. We don't want the employees themselves getting sick and being a bridge, or "vector," to infecting others who are vulnerable. People may object, but some more targeted form of vaccine mandate may make sense and also be possible.

This article originally appeared online as part of the Bloomberg School of Public Health's COVID-19 Expert Insights webpage.

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Could COVID-19 vaccines become mandatory in the U.S.? - The Hub at Johns Hopkins

Who will be the first to get COVID-19 vaccines?

By The Associated Press

https://apnews.com/article/who-will-get-covid-19-vaccine-first-2f9f8a32b5d9991790f4956497a50124

Who will be the first to get COVID-19 vaccines?

No decision has been made, but the consensus among many experts in the U.S. and globally is that health care workers should be first, said Sema Sgaier of the Surgo Foundation, a nonprofit group working on vaccine allocation issues.

An expert panel advising the U.S. Centers for Disease Control and Prevention is also considering giving high priority to workers in essential industries, people with certain medical conditions and people age 65 and older.

Once a vaccine gets a green light from the Food and Drug Administration, the panel will look at clinical trial data on side effects and how people of various ages, ethnicities and health statuses responded. That will determine the panels recommendations to the CDC on how to prioritize shots.

State officials are expected to follow the CDCs guidance as they distribute the first vaccines.

Vaccine supplies will be limited at first. There wont be enough to protect everyone, yet getting the shots to the right people could change the course of the pandemic.

Many other questions about distribution remain unanswered, Sgaier noted, such as whether to distribute shots equally across the country, or to focus on areas that are hot spots.

___

The AP is answering your questions about the coronavirus in this series. Submit them at: FactCheck@AP.org.

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Who will be the first to get COVID-19 vaccines? - Associated Press

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COVID-19 vaccines are almost ready to be distributed. Who gets them after health care workers? Here's a list. - USA TODAY

Harvard T.H. Chan School of Public Health

Harvard T.H. Chan School of Public Health

The race to find vaccines to protect people from COVID-19 is beginning to pay off.

Clinical trials of vaccines from Moderna and a partnership of Pfizer and BioNTech have now found their experimental vaccines to be highly effective.

The companies are expected to seek emergency authorization from the Food and Drug Administration to allow their use during the pandemic.

If the agency gives the vaccines the OK, as seems likely, the next steps would include figuring out how to distribute the limited supply of the vaccines quickly and fairly.

Meanwhile, cases of COVID-19 and deaths from the illness continue to rise. How will the leading vaccines fit in to the public health response and what other vaccines are on the way?

Watch an expert panel discussion on the effort to develop and deploy safe and effective vaccines against COVID-19 on Friday, Nov. 20, to be live-streamed here at 12 p.m. ET, as part of The Forum at the Harvard T.H. Chan School of Public Health.

Scott Hensley, an editor on NPR's Science Desk will moderate the discussion with:

Sarah Fortune, John LaPorte Given professor of immunology and infectious diseases at the Harvard Chan School

Barry Bloom, the Joan and Jack Jacobson research professor of public health and former dean of the Harvard Chan School

Marc Lipsitch, professor of epidemiology and director of the Center for Communicable Disease Dynamics at the Harvard Chan School, and

Rochelle Walensky, professor of medicine at Harvard Medical School and a practicing infectious disease physician at Massachusetts General Hospital and Brigham and Women's Hospital

This event is part of the Dr. Lawrence H. and Roberta Cohn Forum series.

You can email your questions to theforum@hsph.harvard.edu.

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Harvard-NPR Panel: Race for the COVID-19 Vaccine : Shots - Health News - NPR

An illustration picture shows vials with COVID-19 vaccine stickers attached and syringes with the logo of U.S. biotechnology company Moderna on November 17. Justin Tallis/AFP via Getty Images hide caption

An illustration picture shows vials with COVID-19 vaccine stickers attached and syringes with the logo of U.S. biotechnology company Moderna on November 17.

Journalist John Yang volunteered to take part in a Phase 3 COVID-19 vaccine clinical trial not for "great altruistic reasons," but because he wanted to get a vaccine sooner rather than later.

"It started off with self-interest I wanted to get the vaccine sooner," Yang, special correspondent for the PBS NewsHour, tells NPR's All Things Considered. "Then when I found out that it was the Moderna trial, a new technology, one that has never been approved for a human vaccine before, I got sort of excited. It sort of piqued the science nerd in me."

There are currently two COVID-19 vaccines that appear to be highly effective and are awaiting Food and Drug Administration approval. The first was created by pharmaceutical company Pfizer and its partner BioNTech, has reported being 95% effective. The second vaccine was created by the biotech company Moderna Inc. and is 94.5% effective, according to an analysis of its clinical trial. That's the one Yang took part in at George Washington University in Washington, D.C. He recently wrote about his experience for STAT.

Yang writes that he was also drawn to vaccine trials to participate in because he is considered high risk for contracting a severe case of COVID-19: he's over 60, has asthma and high blood pressure. He's also Asian.

"I think my ethnicity was a big plus because they really do want widen these tests to have participants of color and also they wanted to find out if it was safe for people with asthma and people with high blood pressure," he tells NPR.

Yang reports that had two shots about a month apart, and he says the first "really wasn't that bad." He didn't feel any of the effects until the next day, when he started experiencing mild achy joints and muscles, and says "fatigue was the main issue."

"The second shot really laid me low and very quickly," he tells NPR's Mary Louise Kelly, explaining that he experienced muscle and joint aches and a low fever, which came on faster than the first shot, all consistent with side effects NPR has reported. Other participants also reported pain at the injection site. "But as that came on faster, it also resolved faster. I got the shot on Tuesday. By Thursday, I was fine."

With the trial, Yang says he had a 50% chance of getting the vaccine an outcome he deeply wanted and a 50% chance of getting a placebo. So, when he started feeling side effects, he was actually happy.

"The first day I was a little disappointed when I went to bed that I was still feeling OK and woke up the next morning, happy to be feeling bad, like a kid hoping to get out of school," he says. "I was happy to feel that onset of the side effects."

While he doesn't know for sure if he got the vaccine or the placebo, he wrote in STAT that he hopes it was the vaccine that was injected into his arm not just saline solution. He said he is excited about the prospect that Moderna might offer the vaccine to the placebo group, too, now that the results from the study were so promising.

He told NPR he is happy that he "was able to help this help science advance. And also, I hope, help get a grip on this pandemic."

This comes as COVID-19 cases continue to surge in the U.S. On Wednesday, the nation passed a devastating threshold: 250,000 people have now died of the virus.

Gustavo Conteras and Justine Kenin produced and edited the audio version of this story.

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What It Was Like To Participate In The Clinical Trial For Moderna's COVID-19 Vaccine - NPR

A COVID-19 vaccine is on the horizon, but the state of Pennsylvania reports early distribution will be severely limited.

Dr. Jeffrey Jahre, an infectious disease specialist at St. Luke's University Health Network, said when the vaccine does arrive in the Lehigh Valley, the first group of people it will be available to is healthcare workers and staff that have contact with the sickest COVID-19 patients, those who work in the ER, ICU, and on COVID patient floors.

Next, it would be available to healthcare workers who do procedures that put them at high risk. It would be available to health care workers and patients who are in high-risk areas like nursing homes.

"We cannot require workers to get a vaccine that still has some unproven components although we are very, very optimistic that it will meet the needs," Jahre said.

Vaccines would also be available for other essential emergency workers, like firefighters and police officers.

"We think that in several months we think there will be enough vaccine for what we call other risk populations. For instance, people who are out there who have diabetes, high blood pressure, are over the age of 65," said Jahre.

Jahre said eventually the vaccine will likely be available to the general public in places like doctor's offices and clinics. The state may initially prioritize sending doses of the vaccine to areas that have the highest number of cases.

Jahre said St. Luke's has applied to be among the facilities that will become vaccine distributors and has made arrangements to have the necessary equipment to do so. While initial vaccine distribution won't mean the end of mask wearing and social distancing, there's a light at the end of the tunnel.

"The hope is if we can get enough people to take the vaccine, we can put a halt to the kind of pandemic we're seeing right now. It remains to be seen if that will actually come about and how many people will actually take this vaccine and of course the long-term effectiveness," Jahre said.

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COVID-19 vaccine on the horizon, but distribution in Pa. will be limited at first - WFMZ Allentown

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Two DC Officials Joined COVID-19 Vaccine Trials. Here's What It Was Like - DCist

Two new vaccines against the coronavirus that are poised to reach the Food and Drug Administration (FDA) for emergency approval are based on a new method for building vaccines that represents a groundbreaking shift in the way future vaccines are developed, a silver lining to the deep dark cloud of a global pandemic.

The candidates, one developed by Moderna and the National Institutes of Health and the other created by Pfizer and the German pharmaceutical company BioNTech, are called messenger RNA vaccines, or mRNA for short. Early studies have showed both vaccines are around 95 percent effective in preventing coronavirus infections, a tremendous rate that has thrilled health experts.

To say that [the early results are] proof of principle for mRNA vaccines is just a gross understatement, said Ruth Karron, director of the Center for Immunization Research at the Johns Hopkins Bloomberg School of Public Health. This is confirmation of this technology, and I think certainly for this kind of platform, mRNA is ideally suited for a pandemic situation.

The mRNA vaccines use a small segment of the ribonucleic acid of SARS-CoV-2, wrapped in a lipid shell. Once injected, the shell attaches to a human cell, and the segment of RNA teaches the cell to produce a specific protein. The immune system uses that protein to recognize a different protein, dubbed the spike protein, that the virus uses to attach to a human cell.

They basically were able to very precisely print out the mRNA sequence that would create a protein to recognize the virus, said Prabhjot Singh, a health systems expert at the Icahn School of Medicine and the Mount Sinai Health System. Its almost like 3D printing. Theyre able to say, heres the sequence of what we want to go after, lets design mRNA custom specifically to chase down that thing.

Once the bodys immune system recognizes the spike protein of an invading organism, it learns to launch a response. If someone who has been vaccinated encounters SARS-CoV-2, theirimmune system will recognize the same spike protein and attack the interloper before it can begin replicating.

When you see the virus, you already have components of the immune response that are specific to it, ready to detect it and able to prevent the beginning of the infection, said William Klimstra, an immunologist at the University of Pittsburgh whose laboratory is working on its own mRNA vaccine candidate.

More traditional vaccines and dozens of candidates for potential coronavirus vaccines still under development use pieces of live or inactivated virus built into another family of pathogens, called adenoviruses, that are harmless to humans. The immune system recognizes the adenovirus base, and whatever elements of the coronavirus it incorporates, and learns to recognize the new elements of the coronavirus as a signal to mount a response.

Those vaccines that use other viruses can carry some small risk of infection in a tiny segment of a vaccinated population. And they are not always completely effective influenza vaccines can reduce the risk of catching the seasonal flu by between 40 and 60 percent, according to the Centers for Disease Control and Prevention.

But the mRNA vaccines do not carry the same risk as adenovirus-based vaccines. The mRNA vaccines only carry the RNA that instructs the cell to create the spike protein; they do not carry any of the RNA that leads to disease in humans.

These mRNA vaccines are inherently extremely safe, Klimstra said. Theres no replicating virus that can spread and cause disease like the live attenuated vaccines.

The mRNA vaccines can also be produced at a faster pace than more traditional vaccine candidates. Laboratories do not need access to live virus to begin production; they can use genetic sequencing posted to online databases to begin designing their own mRNA candidates.

The biggest advantage of mRNA has been the speed at which you can develop the vaccine. If you have the sequence, you can make a vaccine, you dont have to grow the virus, Karron said.

The mRNA vaccines do carry small downsides: Because the messenger RNA itself degrades once it has taught a cell to produce the spike protein, it requires two doses spaced several weeks apart to achieve full effectiveness, unlike an adenovirus vaccine that requires only one dose. The two vaccine candidates developed by Pfizer and Moderna must also be kept at sub-freezing temperatures, a challenge for some medical facilities.

And experts warned that the early trials have yet to develop a comprehensive set of safety profiles that would fully show the potential for negative consequences, though none have emerged so far.

But the efficacy rates are tremendously encouraging, on par with some of the most impressive achievements in the history of public health, vaccines that have eradicated smallpox or nearly ended polio.

This efficacy is greater than what we would have expected, Karron said.

Its crazy high, Singh said. Its like ridiculously high, if these numbers bear out.

The eventual success of mRNA vaccines has the potential to reshape global public health, both in the race to contain future pandemics and in treating other more endemic diseases like cancer. If successful, it is likely to set off a clash in the scientific community that Singh compared to the emergence of the electric car maker Tesla and the disruptive challenge it posed to traditional automobile manufactures.

The technology has been used to create other potential vaccines, though those have only been tested in small-scale trials. Others have failed. None have been submitted to the FDA for final approval.

But the urgency of the crisis wrought by the pandemic, and the billions invested by governments around the globe in the race to create a vaccine, have broken the logjam.

I think it was a marriage of technology and need. As we as a global community recognized that we had a pandemic on our hands, that this was not going to be a controlled infection, people were thinking about what is the quickest way we can make a vaccine, and this technology was known, Karron said. It will really profoundly influence our approach to pandemics in the future, and it may also influence our approach to other non-pandemic pathogens.

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Technology underlying COVID-19 vaccines a massive medical breakthrough | TheHill - The Hill

While recent announcements from Pfizer and Moderna have raised hopes about a possible COVID-19 vaccine, several state officials have said they still need federal government money to ensure they can distribute the vaccine when it is released.

States say they will need more money from the federal government to hire staff to administer vaccines, develop data systems to track doses and communicate the importance of getting vaccinated.

At least a dozen states told ABC News that they will likely need additional funding or are awaiting additional funding. Other states suggested they are still deciding whether they will need additional funding.

Trish Riley, executive director of the National Academy for State Health Policy, said she wants to avoid a repeat of the problems the country faced early in the pandemic, when states were competing for essential resources like personal protective equipment and ventilators.

"That's the wake-up-at-night worry," Riley told ABC News. "States can't do this alone."

According to a letter to Congressional leaders from groups that represent local health officials and immunization managers, states may need as much as $8.4 billion in extra funding.

States have received $340 million for COVID-19 and flu vaccine planning efforts and are expected to receive $140 million more in December to design vaccine distribution plans and start updating the necessary information systems, but multiple states said they will need more federal money and still don't know how much will be available.

White House spokesman Michael Bars said states will not be responsible for the majority of expenses because the federal government has paid for doses and administration costs will be covered by private insurers, Medicare, and Medicaid. Shipment and storage will be covered by CDC's contracts to distribute the vaccine and through partnerships with private pharmacies like CVS and Walgreens to distribute vaccine doses to participating nursing homes and administer vaccines when one is made available to the general public.

"The Administration continues working hand-in-hand with our state and local partners and remain intensely focused on helping Americans communities prepare for and respond to health threats while ensuring they have the tools and resources to better treat patients and protect the most vulnerable. We are sparing no effort or expense to save millions of lives," he said in a statement Wednesday.

In response to concerns raised by the National Governors Association, Operation Warp Speed has said they are in the process of planning to make additional funding and resources available to support vaccine operations, information systems, and communications campaigns.

In this undated still image from video, a researcher works in a lab run by Moderna, Inc.

But many state officials say they are still concerned it won't be enough.

New Jersey Gov. Phil Murphy expressed concerns about the lack of federal government support during a press briefing on Monday. "As good as the distribution plan may be, we need the feds," he said.

"It is essential that we get federal support, and that includes money," he added.

Mississippi's health officer, Dr. Thomas Dobbs, said during a press briefing on Tuesday that the state "will certainly need additional funding," emphasizing that the vaccine distribution effort is expected to be a massive operation that will not be possible without federal support.

Kentucky Health and Family Services spokesperson Susan Dunlap echoed Dobbs' concern and said, "Once CARES Act funding expires after Dec. 30, funding will be insufficient."

"It is crucial that Congress provide additional financial support to states to successfully distribute COVID-19 vaccines," Dunlap said.

A North Carolina Department of Health and Human Services spokesperson told ABC News that the state has been allocated $5.9 million from the federal government for vaccine response so far and anticipates another $3-4 million in additional funds; still, they believe they will need approximately $30 million for its vaccination management and distribution efforts.

Officials from several other states -- including Georgia, Colorado, Idaho, Oregon, Maryland and Minnesota -- have told ABC News that they're expecting to receive additional financial support from the federal government in the coming days and weeks, but are still in the dark about how much more they will be getting.

New Jersey Gov. Phil Murphy speaks during a coronavirus briefing in Trenton, N.J., June 9, 2020.

Minnesota Health Department spokesperson Doug Schultz said additional funding from the federal government is needed to ensure the successful distribution of the COVID-19 vaccine to rural parts of the state.

Claire Hannan, executive director of the Association of Immunization Managers, said states need funding immediately. She said her biggest fear is that states won't have the money to hire and train nurses and other staff to administer vaccinations when a vaccine becomes available.

"I do fear that the vaccine's going to get shipped, we're going to be able to plan out the logistics, but we're not going to be able to have enough manpower for vaccinating and we're not going to have robust community engagement," she told ABC News.

She said it's unclear exactly how much money states will need for administering vaccines because it will depend how many people are vaccinated by private health care providers or through federal partnerships with companies like CVS and Walgreens; regardless, she said states need money to prepare and track that information and they should have access to federal funding for as long as they need.

Hannan said one of the concerns is that states need to train health care providers on specific information regarding the COVID-19 vaccine, which will likely be distributed quickly after the Food and Drug Administration signs off. Health care workers need to know how to store the vaccine and administer it; they also need to know the conditions for who can receive it under emergency authorization and must be able to communicate to patients about its possible side effects.

"The vaccine is so complicated that we don't want to just send a flyer in the box," Hannan said.

States also need money to conduct follow-up monitoring, which includes reminding people to get their second dose of the vaccine.

Experts say it will also take more resources for states to reach the populations that have been disproportionately impacted by COVID-19, this includes rural areas and communities that, historically, have been more reluctant to trust vaccines.

Centers for Disease Control and Prevention Director Robert Redfield warned Congress about the need for more funding and a COVID-19 stimulus bill back in September. He said the agency needed between $5.5 and $6 billion to help states distribute a potential vaccine, and even implied that he would be the one blamed if vaccine distribution plans failed.

Potential COVID-19 vaccine vials from Pfizer, Oct. 31, 2020.

Despite Redfield's warning, stimulus bill talks aren't going anywhere at the moment. Congress is currently more focused on an omnibus spending bill to prevent a government shutdown when the current funding expires on Dec. 11.

Democrats have included $4 billion in their package that would go to vaccine distribution for both a COVID-19 vaccine and the flu, but there is no agreement about whether vaccine funding will be part of the final bill.

Riley said state economies and budgets are already struggling from the economic downturn caused by the pandemic, and next year they could face more problems after they've exhausted emergency reserves of money. But she said getting a vaccine out efficiently will require federal leadership and money.

U.S. Department of Health and Human Services Secretary Alex Azar assured governors they would not be responsible for the expenses of the vaccine program on a call Monday, because the federal government will pay for doses of the vaccine and will reimburse providers for the cost of administering and transporting the shipments.

"What we need for you are the plans to help allocate and deliver vaccines to the appropriate places in ways that makes sense for your state and community. We're working to make this planning as simple as possible," he said on the call.

But Riley said that while federal leadership and a national strategy will help, without more funding the public health system will struggle to get the vaccine out.

"You can't underfund a system and then be surprised when it doesn't have capacity," she said.

ABC News' Laura Romero, Halley Frager, Arielle Mitropoulos and Mariam Khan contributed to this report.

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High hopes for a COVID-19 vaccine by the end of the year, but states say they need more money for distribution - ABC News