The United States is way, way behind administering doses of its two novel coronavirus vaccines. And some state leaders are beginning to panic that the supply of shots is running low—or even running out.
Reports of vaccine shortages are more smoke than fire, and probably reflect a misunderstanding of the underlying logistics on the part of state and local officials, along with a pattern of messy communication from the feds, experts said. And if the overall slow pace of vaccinations is definitely cause for concern, there is a silver lining in some of the reports of states running low.
Welcome to Rabbit Hole, where we dive deep on the biggest story. It’s for Beast Inside members only. Join up today.
ADVERTISEMENT
The Trump administration’s goal as it approved separate messenger-RNA vaccines from Pfizer and Moderna back in December was to give at least 20 million Americans their first shot of the two-shot vaccines before the end of 2020.
In reality, fewer than 11 million people had gotten their first dose by Sunday, according to the U.S. Centers for Disease Control and Prevention. About 1.6 million Americans had received both shots, the agency said.
Meanwhile, over 30 million doses had been distributed nationwide.
There’s at least one obvious fix to speed things up nationally, experts said. States could depend less on big corporations to do the hard work of getting shots in arms, and empower local pharmacists and their own National Guards, instead. Both the Trump and Biden administrations have hinted they want to do just that, but federal officials have yet to bring it to fruition.
If vaccination is ultimately a local problem, the failure to get doses into arms still flows from the top.
“The federal government has failed to provide support and clear guidance to the states, leaving all states to make it up as they go,” Irwin Redlener, the founding director of Columbia University’s National Center for Disaster Preparedness, told The Daily Beast.
Secretary of Health and Human Services Alex Azar announced on Tuesday that the government would release all doses of vaccines to state authorities as soon as they arrive from the manufacturers. It was a reversal of a previous policy of holding millions of doses in reserve in order to ensure every person who gets one dose also has access to a critical second dose three weeks later.
Experts for weeks have encouraged the policy change, arguing that steady production of doses made a reserve redundant. “Operation Warp Speed must stop hoarding vaccines—there’s no need to hold back half of the doses,” Tom Frieden, a former CDC director, tweeted. “Get them out fast!”
In fact, the feds had quietly begun drawing down their reserve of second doses several weeks ago in order to speed the extra vials to the states, The Washington Post reported on Friday.
When Azar made that policy change official on Tuesday, some states clearly expected to be able to quickly tap a backup supply of doses. “Last night, I received disturbing news,” Oregon Gov. Kate Brown tweeted on Friday. “States will not be receiving increased shipments of vaccines from the national stockpile next week, because there is no federal reserve of doses.”
But the numbers seem to paint a different picture than Brown did with her tweet. According to The New York Times’ tracker, which draws on CDC data, Oregon had only administered 44 percent of the doses it has received, resulting in 146,000 doses given and just 3.2 percent of its population receiving at least one shot by Sunday. The Oregon Health Authority did not respond to a request for comment.
Likewise, when New York City Mayor Bill de Blasio warned on Friday that the city could run out of vaccine as early as this week, he failed to acknowledge the upside of a local shortage. The fact that New York City wasn’t sitting on a lot of doses suggested it was not wasting many doses—and that it was doing a good job getting people to vaccination sites.
The looming shortage de Blasio perceived could be a hyperlocal issue. “I don’t know exactly what the mayor was talking about, but some places are working through past supply,” New York Gov. Andrew Cuomo said on Friday.
New York State health officials loosened eligibility requirements for vaccine recipients earlier this month after health workers threw out a few doses when they couldn’t find takers.
Statewide, New York by Sunday had used just 40 percent of the doses it received to give 3.5 percent of residents their first shot. New York City might be short on shots, but the state is not, if the government data is accurate. De Blasio’s office did not respond to a request for comment.
Of course, in many communities across the country, people aren’t even aware of how many doses are available locally, who’s eligible to get them, and how they would even go about setting up an appointment.
“Health-care providers do not always have accurate information for their patients,” Jennifer Reich, a University of Colorado sociologist who studies immunization, told The Daily Beast.
That confusion can translate into doses just sitting around and potentially spoiling. There have been reports of spoilage, including in New York, along with scenes of chaos as providers invited the public to come snag an extra vaccine dose before they spoiled at any given site.
While de Blasio and Brown’s alarm is perhaps understandable, the absence of big backup supply of shots isn’t the real reason authorities aren’t vaccinating people faster in many communities.
“The bottleneck is actually in delivering and administering doses into people,” Lawrence Gostin, a Georgetown University global health expert, told The Daily Beast. “It’s very clear there have been many more doses procured than there have been people vaccinated.”
Once doses are in the hands of state health departments, local policies determine who gets the doses first—and how quickly. In line with CDC guidance, all states and territories opted to prioritize frontline health workers, residents and staff of nursing homes and—with some variation in plans and timetables—the elderly.
But exactly how a state or territory goes about administering the shots is up to local officials. Different approaches have produced wildly different results. States such as Mississippi that have expanded the eligibility requirements for the early rounds of vaccinations have created what could amount to local shortages. More people are eligible to access a limited initial supply of doses.
The Northern Mariana Islands leads the pack in one metric: The tiny territory by Sunday had already used more than 4,900 doses, and 7 percent of the population had received at least one shot. And still, so far, the territory had still used up just 26 percent of the shots it had on hand.
Of the 50 states, West Virginia was among the best at getting shots in arms. Authorities in Charleston had overseen the use of about 134,000 shots, with 6.3 percent of residents receiving at least one dose. Having administered 65 percent of the doses it had received, West Virginia appeared to be working through its weekly allotments of vials faster than almost any other state or territory.
At the opposite end of the spectrum, the territories of Micronesia, the Marshall Islands, the U.S. Virgin Islands, and Guam seemed to have barely begun administering doses. Of the states, the Southern duo of Alabama and Georgia were doing the worst, using just 23 percent of their doses so far.
What makes the difference? Jeffrey Klausner, a professor of medicine and public health at UCLA who previously worked at the CDC, suggested four major factors. “The size of the state. The complexity of the health systems. The human resources available. And existing partnerships.”
That last factor could be key—and helps explain why West Virginia, despite its relative poverty and rickety transportation infrastructure, is doing so much better than other states. The Mountain State “is one of the only states to reject partnerships that relied on large corporate pharmacies for distribution,” Reich explained.
The CDC-administered Long-Term Care Program, which leans heavily on pharmacy giants CVS and Walgreens to administer doses at nursing homes, is proving inefficient in many states.
Instead of delegating solely to corporate pharmacies, West Virginia enlisted 50 independent pharmacies that have existing relationships with local nursing homes. Pharmacy staff travel to nursing homes to administer doses.
Which is not to say big pharmacies didn’t help to some extent. “We were pleased to answer West Virginia’s call when they asked us to help with their vaccination efforts,” a Walgreens spokesperson told The Daily Beast.
“During the week of Christmas, Walgreens pharmacy teams held vaccination clinics in 32 long-term care facilities across the state and will be returning to provide the second dose in those facilities,” the spokesperson added.
The CDC and CVS did not respond to requests for comment.
To get doses in the pharmacists’ hands, West Virginia also mobilized its National Guard. Planners set up five regional distribution hubs and assigned military truck-drivers to each hub. At some sites, Guard medics have helped pharmacists stick shots in arms, further speeding up vaccinations, according to Anthony Alberg, a University of South Carolina epidemiologist.
The initial phase of vaccinations at nursing homes went so smoothly that the Mountain State has already begun dosing one of its lower-priority groups: teachers.
It will be up to the Biden administration to help clarify federal vaccine-distribution policies and nudge the underperforming states toward better practices, starting with his inauguration on Wednesday. Last Thursday, Biden unveiled a $400-billion plan—subject to congressional approval—to speed up vaccinations.
“We will move heaven and Earth to get more people vaccinated, to create more places for them to get vaccinated, to mobilize more medical teams to get shots in peoples’ arms, and to increase vaccine supply and get it out the door as fast as possible,” Biden said.
Breaking up the state-level corporate monopolies on many states’ vaccination efforts might be a good place to start. It has worked for West Virginia.
But pay close attention to Biden’s aim to “get [shots] out the door as fast as possible.” As long as the feds ship doses quickly, there won’t ever be a national vaccine stockpile. And that’s a good thing, despite panicky tweets from state officials.
Doses are for arms, not warehouses.
