Pedestrians wearing protective masks walk past Pfizer Inc. headquarters in New York City, New York, on July 22nd. Jeenah Moon / Getty Images

When Molly Howell, a state health agency in North Dakota, saw a webinar on the distribution of what is expected to be the first US Covid-19 vaccine, her head began to turn.

“How do we do that?” She texted a colleague who also attended the webinar.

Her colleague responded with an exploding head emoji.

On Monday, Pfizer announced that initial phase 3 clinical trial results show the vaccine is more than 90% effective. If the vaccine is approved by Pfizer, it will also be the most fragile vaccine used in the US, and state health officials tasked with distributing it fear the process will not go smoothly.

Pfizer’s vaccine must be stored at about minus 75 degrees Celsius, which is about 50 degrees colder than any vaccine currently used in the US. Doctor’s offices, pharmacies, and government laboratories don’t have freezers that are almost as low.

The solution consists of a set of handling and storage requirements that a doctor at the US Centers for Disease Control and Prevention calls “very complex”.

The CDC asked states to be ready to receive the vaccine from Pfizer by November 15, but state officials say they first heard the specific requirements on October 15, giving them weeks to prepare.

According to Dr. Kelly Moore, associate director of the Immunization Action Coalition, which supports the frontline workers who will deliver the coronavirus vaccine, state health officials were “shocked” when they heard storage requirements for the new vaccine. These requirements include sourcing and handling large quantities of dry ice, which is in short supply in many parts of the country.

“We all assume that there will be major mishaps,” she said.

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