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The large shipment sizes of Pfizer’s Covid-19 vaccine will complicate an already complex distribution process for small and rural communities, experts say.

Pfizer has planned for the ultra-cold storage requirements of its vaccine, with thermal shippers that can hold at least 975 and up to 5,000 doses.

“That’s not workable from a small town, rural perspective,” Alan Morgan, chief executive officer of the National Rural Health Association, told CNN Monday. “It just isn’t.”

Smaller communities will have to spread those doses among multiple providers, Claire Hannan, executive director of the Association of Immunization Managers, told CNN Monday.

“States that have smaller providers or rural communities, they’re looking for ways to break up those 975 doses, spread them across more providers, without endangering the cold chain,” she said. 

Hannan said immunization managers are looking into various solutions, like using a hub-and-spoke model, where the vaccine is stored in a central location for providers to pick up, or having doses sent to a warehouse site, where they will be repackaged before distribution.

If rural communities don’t come up with workable plans for distribution, the danger is that rural hubs will be sidelined, Morgan said.

“That type of approach just sets up these rural communities across the US for really unacceptable mortality rates and the potential for the collapse of the health care system,” he said.

Pfizer did not have an immediate response questions about the concerns over shipment sizes.