In Berlin, the process of transforming large, now unused public spaces into mass vaccination hubs started weeks before a vaccine was approved.
Albrecht Broemme, the project manager in charge of setting up six of them, began laying out Lego models of six mass vaccination sites in November. Working with the staff of the Federal Agency for Technical Relief - he used to be the president of the agency and retired from it in 2019 - he turned his colorful plastic mock-ups into real-life facilities capable of churning out thousands of jabs a day. The goal was setting up sites that Berliners could file through like IKEA shoppers.
Among the first mass vaccination centers is the Arena Berlin, a bus-depot-turned-event space built in the 1920s. The building now has 80 vaccination booths numbered and separated by white metallic panels, capable of delivering 4,000 doses a day. Together, the six Berlin sites are expected to cost between $70 million and $95 million according to the Washington Post.
Across the world the goal is the same: Inoculate a maximum amount of people as fast as possible. More than 50 countries are racing to vaccinate their populations to fend off the rising death toll of a third wave of infections. To supplement the existing network of hospitals, medical clinics, pharmacies and other healthcare facilities, many are establishing mass vaccination sites capable of processing crowds - often sports arenas, convention centers and stadiums, but also parking lots and deserted shopping malls.
"To move beyond vaccinating people in hospitals and long-term care facilities, vaccination sites must be established where large groups of people can be vaccinated quickly," Eric Toner, senior scholar at the John Hopkins Center for Health Security, told Bloomberg CityLab in an email. "This requires very large facilities. These are expensive to set up and operate, but can be very efficient."
So far, Germany, the U.K. and the U.S., and also Israel, have been at the forefront of this mass vaccination building boom. In Berlin, authorities have designated an ice-skating rink, a velodrome, two airport terminals, and a trade-fair hall to deliver shots. In the U.K., the Epsom Downs Racecourse south of London is one of seven hubs that opened in January, operated by various trusts of the National Health Service (NHS); the U.K. government recently added 10 more sites to its list, including Blackburn Cathedral in Lancashire. In Bristol, the crowds of Bristol Bears supporters at Ashton Gate Stadium have been replaced by NHS personnel: The military helped turn the 27,00-seat venue into a vaccination center in December.
In the U.S., mass vaccinations facilities are being assembled in New York City's Citi Field, Boston's Fenway Park, and outside California's Disneyland. President Joe Biden, who pledged to deliver 100 million shots in his first 100 days in office, released a 200-page national strategy document on Thursday that outlined a range of efforts to speed production and distribution, including a pledge to "create as many venues for vaccination as needed in communities and settings that people trust." Some experts say an even more torrid vaccination pace will be needed, since the current vaccines' two-shot regime would fully inoculate only 50 million people by April. According the Centers for Disease Control, state and local vaccine centers are administering as few as 46% of the doses that are being shipped to them. To break the pandemic's grip, the vaccine effort will have to go big, fast.
When it comes to conducting this kind of public health mobilization, the U.S. is sorely out of practice, and so are other nations that haven't had to vaccinate large swaths of the population in recent memory. The vaccination campaign that conquered polio from the U.S., for example, launched in 1955 - the disease caused 57,000 cases in 1952, at the U.S. outbreak's peak. That effort also faced setbacks due to serious production and distribution problems, and took several years to complete.
The last mass vaccination effort Western countries conducted was during the 2009 H1N1 "swine flu" outbreak. "The 2009 H1N1 pandemic is, I think, the closest example that jurisdictions have had to real-world mass vaccination in their communities," said Divya Hosangadi, senior analyst at the John Hopkins Center for Health Security. "But it was a different scenario, and the level of urgency for the Covid-19 pandemic is a lot higher, and there are a lot more operational challenges as well to a greater scale."
The H1N1 vaccination campaign was laborious: Between October 2009, when the vaccine started being distributed, and May 2010, only 27% of Americans over 6 months old got vaccinated. Shortages and ill-defined priority groups led to confusion; confidence and interest in the vaccine eroded as it came too late, after a second wave had passed, Healthline reported. The effort led to a wave of research evaluating U.S. preparedness for emergency mass vaccination. In a 2020 paper she co-authored with five colleagues, Hosangadi concluded that the U.S. was poorly prepared for emergency mass vaccination - and the rocky start of the Covid-19 vaccine distribution shows that some of those problems remain.
In particular, overstressed state, county, and city health departments have, in the absence of federal help, shouldered most of the burden of the vaccination campaign. "In the U.S., some of the challenges have been compounded by a longstanding lack of funding to state and local health departments," Hosangadi said. "Funding packages and different measures that are being implemented today help to alleviate that, but it takes time to set up that infrastructure, and for years and years now, in the U.S., the public health structure has been underfunded."
Covid-19 comes with its own set of challenges that make building mass vaccination sites more complex: The airborne, highly contagious disease necessitates a host of space and ventilation countermeasures to protect staff and clients, and the vaccines themselves require demanding "cold chains": The vaccines that have been approved so far have short shelf lives, and the Pfizer/BioNTech one must be stored in ultra-cold freezers that can reach -94 degrees Fahrenheit.
Mass vaccination centers enable important economies of scale, as there is much more to the process than just getting an injection. Those getting inoculated must be provided with vaccine information and sign consent forms, and they require time and space to recover. (In the U.S., this recovery period must last 15 minutes.) Staffing needs go beyond finding trained vaccinators. Volunteers are needed to help guide people through the structures, including translators.
In Germany, when Broemme was sketching out his plans for vaccine centers, security was also a concern. "With the centers it's indeed possible that people opposed to vaccination or others willing to use violence might say, 'Let's set this on fire because we think vaccinations are stupid,'" he told AP. Vaccine supplies are being carefully watched and kept in locked freezers to avoid theft and resale on the black market. Cybersecurity threats have also become salient, as all super-coolers are equipped with a trove of technological apparatus, including GPS trackers and Bluetooth sensors.
"Subtle changes in design are often overlooked. People think that if you build it, people are going to come. And it's not really the case."
"A major challenge with getting the population vaccinated is dealing with logistics," said Mitesh Patel, director of Penn Medicine's Nudge Unit, a behavioral design team applying behavioral economics to influence patients' decision-making process. "There are many more doses of vaccines that have been distributed than have been given. And a large part of that is just that you have to schedule people, they've got to come in, and there are only so many people you can vaccinate in a day."
That's why sports facilities make such appealing host sites for mass vaccinations: Built to collect and process vast crowds, they are large enough to allow for social-distancing, are often transit accessible, and typically boast ample parking capacity. Sports venues can have psychological advantages as well, Patel says. "If you can associate memories to sports stadiums where you used to support your favorite team, or somewhere where you saw some kind of show or performance, there maybe be some more familiarity and comfort with going to that place to get the vaccination," he said. "Sentiment is very important, and subtle changes in design are often overlooked. People think that if you build it, people are going to come. And it's not really the case."
Overcoming vaccine resistance with design is a hallmark of Italy's vaccination effort: In December, the government announced a plan to create a network of 1,500 vaccination pavilions sited in town squares. The temporary wood-and-fabric structures, designed by architect Stefano Boeri and decorated with images of primrose blooms, are meant to "convey a symbol of serenity and regeneration." Other Italian inoculation centers leverage the nation's vast cultural resources. In the city of Turin, plans are afoot to convert a portion of the 10th-century Castello di Rivoli, now a museum of contemporary art, into a vaccination clinic. A similar effort is underway at the London Science Museum. "Art has always helped, healed, and cured - indeed, some of the first museums in the world were hospitals," Castello di Rivoli director Carolyn Christov-Bakargiev said in a statement, according to Artforum. "Now we are repaying the favor."
But most inoculation infrastructure is far more mundane - think parking lots. Drive-through Covid testing clinics have been common throughout the U.S., but adapting them for vaccination involves a different layout: They need multiple stations for clients to check in, sign consent forms and get inoculated, plus a parking lot for recovery.
Ali Asgary, an associate professor at York University in Ontario, Canada, is the associate director of its Advanced Disaster, Emergency and Rapid Response Simulation. His work right now consists in optimizing the layout of vaccination drive-through clinics and mass vaccination sites, given a number of constraints provided to him by hospitals and local jurisdictions, who ask him for help in organizing the campaign.
Instead of Legos, Asgary uses simulation software called AnyLogic to model drive-through Covid clinics. The interface allows him to adjusts several variables: How many lanes? How many people in the cars? What's the staffing? With every additional of piece of data he gets, he is able to refine his simulations, and the software provides a rendering of what the site and its throughput would look like. He's developed an application to facilitate it, too.
Not all public health experts are convinced that building mass vaccination sites is the best way to accelerate the inoculation campaign. In the U.K., some doctors have complained that the government centers are "white elephants" that channel too much funding and attention, not leaving enough for general practitioners and local pharmacies and clinics that already have vaccination capabilities. Centralizing doses in a small number of large sites can force people to travel far away from where they live. If poorly set up or run, big vaccine centers can be confusing and lead to hours of waiting and potential disappointment, hampering rather than helping the distribution process.
"There are stories of people who will wait for hours to find out that this day supplies of vaccines have run out," Patel said. "And that's very unfortunate. That person who waited for hours and then didn't get it might be very frustrated and not go back for another chance to get the vaccine. The same way they create logistical efficiency, they also create some logistical problems."
"People are basically asked to put the tires on the car while the car is moving," Patel added. "You have to figure things out, and that is a challenge."
(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)