The US set a new daily record for Covid-19 deaths on Jan. 6, reporting the loss of 3,963 lives. So where are the vaccines?
Thus far, the rollout of doses from Pfizer and Moderna has been underwhelming. The US set a goal of vaccinating 20 million people in December 2020, but by Jan. 7 the US Centers for Disease Control and Prevention (CDC) reported that only 5.3 million first doses had been injected, and only about 17 million doses have been sent to states. The slow pace means it will take longer to bring the pandemic under control, increasing both the human and economic toll of this crisis.
The problem appears to be government dysfunction—specifically, an unfulfilled need for support from the federal government to the state agencies and local healthcare providers tasked with distributing the vaccine. To reach safe levels of immunity in the US by May would require providing 1.8 million doses every single day after Jan. 15, according to a letter (pdf) the American Hospital Association (AHA) sent to Health and Human Services secretary Alex Azar today.
How does the US get there?
US lawmakers voted on $8.7 billion in funding to support vaccine distribution in late December, which was further delayed by president Donald Trump’s aborted veto threat. That money is now being distributed, but it was needed months ago to prep for distribution. The main organizations responsible for delivering the vaccines—hospitals, clinics, and pharmacies, but more importantly the healthcare workers therein—are already stretched thin by the pandemic itself. Some states are calling up retired medical professionals to perform vaccinations, which might move quicker if the federal government suspends medical license requirements and covers liability insurance.
Beyond personnel, the available vaccines need to be kept cold, which requires working freezers and dry ice. More people coming to health centers also means more protective equipment is required. The incoming Biden administration has suggested it will use wartime authorities that the Trump administration largely bypassed to increase production of components like vials and syringes but also the drugs themselves. Since the CARES Act was passed in April 2020, the US government has spent more than $3.5 billion on vaccine research, testing, and production, and nearly $500 million on vials and pre-filled syringes.
Once the vaccine rollout expands beyond specialized facilities like hospitals and nursing homes, Utah Senator Mitt Romney has called on the federal government to mobilize an army of vaccinators at sites like public schools. Such sites are likely to require significant logistical support, perhaps with state governors calling out the National Guard, to deal with everything from IT issues to physical infrastructure to transportation.
There are 64 jurisdictions in the US responsible for vaccine distribution, and each one has their own plan. Initial doses were allocated based on estimates of how many high-priority vaccine recipients are in each jurisdiction, but some hospitals have received fewer doses than expected, while others have received many more, and per the AHA, they don’t know who in the federal government to call with questions. The AHA wants frequent calls for local officials to connect with the federal government to share best practices and standardize vaccine distribution approaches. It also wants the government to set out vaccination goals and be transparent about where they are being reached in order to funnel assistance to the places that need it most. Right now, HHS is sharing data about how many doses have been distributed, but not comparing them to any kind of benchmark.
The complex guidelines developed by the CDC and passed along to the various jurisdictions for their own tweaks may be slowing the distribution of vaccines. They include multiple phases and sub-phases, and require the collection of personal information and outside certification of medical conditions or type of employment. And some hospitals serve patients in multiple jurisdictions—for example, at state borders—and lack certainty about how to apply conflicting guidelines. For example, like most states, Massachusetts and Connecticut are prioritizing first responders and nursing home residents, but Massachusetts also includes prisoners, home healthcare workers, and the homeless in its first phase.
Some argue that a simplified focus on age would be a faster path to national immunity than forcing providers to work through a complex calculus that might also include occupation and health risks. US surgeon general Jerome Adams says vaccine distributors should be ready to skip down the priority list to administer vaccines to whoever will take them—but doing that efficiently requires a dramatically different logistical plan than the one states have set up for the first rounds of vaccinations.
Another challenge has proven to be the refusal of certain high-priority individuals, including healthcare workers and first responders, to be vaccinated. Health experts fear that this will continue to be an issue as more and more of the general population become eligible to be inoculated. The recent pandemic relief bill includes funding for vaccine education, but fighting misinformation about the pandemic has proven difficult, to say the least. Experts say a unified message from public figures about the importance of taking Covid-19 seriously, thus far not forthcoming, would help.
Dispelling worries about cost is also important, given surprise charges for Covid-19 testing; lawmakers have so far allocated $25 billion in an attempt to ensure no one needs to pay to be vaccinated. Past vaccine campaigns have also turned to incentives, including cash payments, to reach national immunity, but the efficacy of such strategies is debatable.