The U.S. federal government is allowed to treat territories like Puerto Rico differently from states. They’ve used this legal loophole to give Puerto Rico less funding for healthcare for decades, so you might be wondering — will Puerto Rico get the COVID-19 vaccine the same way the states will?
The good news is that vaccination kits will be sent out to all the states and territories, with the number of kits for each jurisdiction depending on the population. Puerto Rico’s population is larger than that of 20 states, so this means that Puerto Rico will receive appropriate amounts of the vaccine.
Once a state or territory receives the vaccine kits, the federal government is no longer involved. Each state, territory, and tribal government will need a plan to deliver the vaccine.
This will be harder in some places than in others. In Alaska, for example, the population is spread so far that it will be hard to gather enough people to fill a mass vaccine facility. Pfizer’s minimum order is 975 kits, and an official told the Washington Post that “you’re not going to have 900 people within 1,000 square miles.”
The smallest minimum order currently is 100 kits. A rural health center might have just 20 staff members, with no access to the super-low temperatures required for storage of the vaccine. Gathering 100 front-line healthcare workers together for a vaccination event in the short time possible could live rural areas with inadequate health care.
Puerto Rico has very concentrated population in urban areas, but logistics to get vaccinations into rural areas could be very difficult.
The different vaccines also have different instructions, and the people who administer the vaccines must be trained. Puerto Rico already suffers from a shortage of healthcare professionals, so this could also be challenging.
Puerto Rico’s plan
Puerto Rico’s plan was turned in to the CDC in draft form in October. Quite a few elements were still works in progress at that time, and there have probably been updates.
However, Puerto Rico was intending at that time to begin with vaccinations for healthcare providers at their medical facilities (hospitals and clinics). 66 medical facilities were identified for the first phase of vaccinations. About half these facilities already have systems in place that can be used to remind people who receive vaccinations to come back for their second dose.
Puerto Rico is also planning to deploy mobile vaccination centers.
Most states are beginning their vaccinations with front line healthcare workers and elderly people living in long-term care homes. Puerto Rico does not have a system of care homes as most states do, so this will be a difference between states and Puerto Rico.
Puerto Rico’s plan includes identifying critical populations — people whose need for the vaccine might be more urgent — as a first step. The initial estimates for possible critical populations was more than 1.5 million people.
The Centers for Disease Control identify these groups as critical populations:
- frontline health care workers
- other essential workers
- people living in long-term care facilities
- people with underlying health conditions that make them more vulnerable to COVID_19
- people age 65 or older
- people from ethnic groups with higher transmission rates oof COVID-19
- students and teachers, including those who live and work at colleges and universities
- people in prison
- homeless people and those living in shelters
- rural people
- people with disabilities
- those who are under-insured or uninsured
Puerto Rico has requested one million vaccine kits, but does not expect to receive that many in the first shipment. However, a larger critical population could actually help with distribution of vaccine doses. Getting vaccines to small numbers of eligible people outside of major cities is one of the challenges facing every state and territory.
Companies hope to ship vaccines as soon as they’re approved, so they are asking all states and territories to be ready with their vaccine distribution plans as quickly as possible.