With wind chill already dragging temperatures down to the low 30s in Anchorage, Alaska, nurse manager Deyana Thayer has her insulated snow gear ready to go as soon as a COVID-19 vaccine is finally available for younger children -- since her team will brave the elements to administer the shot in drive-thru clinics that make it easier for kids to get it in the warm comfort of their family’s’ car.
Though regulatory bodies are still weeks away from greenlighting a vaccine for children as young as five, meticulous planning and coordination between state and federal health officials has already been underway for weeks to stand up the complex nationwide launch.
“Quite a few parents are waiting on pins and needles,” Thayer said.
The White House on Wednesday announced its plan to distribute vaccine to cover the some 28 million children ages 5-11 if authorized, including a national public education campaign to "reach parents and guardians with accurate and culturally-responsive information about the vaccine and the risks that COVID-19 poses to children."
The administration is "eagerly awaiting" federal regulators' review, Surgeon General Vivek Murthy told reporters, and have "a lot of reasons to be hopeful" about the vaccine's safety and effectiveness.
"We need everyone on board for the work ahead of us, because every parent should have the information and tools that they need to help keep their kids safe and to help protect the kids under five who can't get vaccinated yet," Murthy said.
In a new operational planning guide sent to state health officials and obtained by ABC News, the Centers for Disease Control and Prevention advises jurisdictions should be "ready to vaccinate" the newly eligible group, following Food and Drug Administration and CDC signoff.
CDC advises states to request their pediatric doses in advance -- even before the FDA advisory panel meets to debate whether to move ahead -- in hopes of smoothing the way for an eventual "manageable and equitable launch."
Those "pre-orders" are allowed to begin Wednesday.
"This is as much of a logistical puzzle as it is a communication or a scientific one," Dr. Nirav Shah, President of the Association of State and Territorial Health Officials and director of the Maine CDC said. "Make no mistake, this is an all hands on deck situation."
To prioritize the "increased logistics needed" during initial rollout, the government is preparing to temporarily halt shipments of adult Pfizer doses during the first week of the pediatric launch, according to planning documents. While paused, adult doses' availability still should not be impacted.
An imminent vaccine for kids follows a summer where pediatric COVID infections soared -- upping the ante on protecting tender ages from the pandemic’s worst, and additionally stopping children from passing the virus to other vulnerable people.
“There will be a lot of pent up demand,” Shah said.
The FDA and CDC must sign off before shots to kids are given; key meetings with independent advisers are set for late October and the first week of November.
Once greenlighted, the pediatric doses will be sent to thousands of sites across the country, including more than 25,000 pediatricians’ offices, more than 100 children’s hospitals, tens of thousands of pharmacies, and hundreds of school and community- based clinics, the White House announced Wednesday.
Though the White House has purchased 65 million Pfizer pediatric vaccine doses -- more than enough to fully vaccine all children ages 5-11 in America -- the first launch will dole doses out in waves based on states’ eligible population of kids. Shipments can recalibrate based on shifting demand.
Within days, more than 15 millions of doses are set to begin distribution across the country: roughly 10 million allocated to states, five million to pharmacies, and approximately 265,000 for other federal health agencies, three sources familiar with the rollout said, with a focus on sites already with the infrastructure in place.
“Parents want to get the vaccine in a place where they trust, and their child is comfortable,” said Claire Hannan, executive director of the Association of Immunization Managers.
But pediatricians cannot shoulder the rollout alone, Shah and Hannan said.
Combatting not only the pandemic, they're also giving seasonal flu shots and other vaccinations for the same age group -- like Measles Mumps and Rubella, Chickenpox and HPV, all are also typically given to kids within the five to 11 range, but which have different storage requirements from the COVID vaccine.
Vaccinators must now also juggle two different COVID vaccine formulas: a full dose for older adolescents and adults -- and one third of that dose one for younger children.
To troubleshoot any ensuing confusion, federal health officials are outlining a new color-coded cap system for each formulation of the vaccine, though still "preliminary." Purple-capped vials will contain doses for adult and older adolescents, a chart offered to states said; orange-capped vials will contain doses for kids aged 5-11.
In New York, the state’s largest healthcare provider Northwell Health is considering colored bracelets to help coordinate which dose goes to which child, division chief of general pediatrics at Cohen’s Medical Center Dr. Sophia Jan said.
Even with "sufficient" supply, as the administration has assured, distribution could pose a challenge in some rural areas, where the population of eligible kids may be more spread out across many miles, Hannan said.
"The logistical challenge will be matching everyone up, matching the vaccine with a vaccinator and then getting the word to parents to make all those pieces come together," Shah said.
The CDC-backed website VaccineFinder, which helps connect eligible people with vaccine appointments, plans to update their provider portal to allow for booking kids' shots, once available. The site was founded by Dr. John Brownstein, chief innovation officer at Boston Children's Hospital and an ABC News contributor, who runs the site in partnership with Boston Children's, Castlight Health and the CDC.
Schools offer an attractive locus to meet kids where they’re at, and some jurisdictions plan to use them as a "mainstay" of the pediatric rollout, Shah said, including in Maine.
Columbus Ohio health officials are looking at holding after-school and weekend clinics in partnership with Nationwide Children’s Hospital and area schools, public health spokesperson Kelli Newman said.
New York’s Northwell plans to deploy staff specifically trained to work with young children and children with special needs, partnering with schools and places of worship for further community engagement, Jan said.
That outreach will be a crucial piece of the puzzle.
"Making sure that folks have the information, that it's accurate, that it's timely -- that's going to be challenge number one, two three," Shah said.
The CDC has already released promotional materials in English and Spanish offering guidance on how to talk with parents about the shot.
On Wednesday, the administration stressed the importance of meeting families "where they are" in their education campaign, not only working with schools, pharmacies and pediatricians but also with children’s hospitals for clinics on nights and weekends; and deploying mobile clinics to ensure as much accessibility as possible.
Pediatric doses will be packaged and shipped with "all the supplies need to vaccinate kids, including smaller needles," White House COVID-19 Response Coordinator Jeff Zients said.
In Maine, health officials are hoping to run ads timed with authorization, focused on parents’ education about the shot’s safety and protection against the virus.
"We want to almost preserve the bandwidth of pediatricians to contend with and work with and educate parents who are extremely hesitant," Shah said.
State health officials expect "more questions" than ever before with the pediatric rollout, Shah said -- and they’re bent on being ready to answer them with good information.
"It's understandable because of what's at stake," he said.
ABC News' Anne Flaherty, Eric M. Strauss and Sony Salzman contributed to this report.