U.S. Vaccine Provide: What to Know

The demand for vaccines is growing rapidly as the US grapples with a record death rate from Covid-19 and the threat of new, more contagious variants. After a slow start in December, many states and cities have rapidly accelerated vaccine delivery, expanded access to larger populations, and established mass testing sites.

But now there’s a new wrinkle: some mayors and governors say they have run out of vaccines available and have had to cancel appointments.

The Biden government has promised to revise the country’s volatile vaccination efforts, but there is only so much it can do to increase the supply available.

Here’s what you need to know.

There are simply not enough doses of approved vaccines to meet the huge demand. And that probably won’t change in the next few months.

The two approved vaccine companies, Moderna and Pfizer, each have promised to make 100 million doses of vaccine available to the United States by the end of March, or enough to give 100 million people the two needed vaccinations.

But that doesn’t mean that those 200 million cans are lying in a factory warehouse somewhere waiting to be shipped. Both companies produce the cans at full capacity and jointly dispense between 12 and 18 million cans per week.

As of Wednesday, nearly 36 million doses of the Pfizer and Moderna vaccines had been distributed to state and local governments. However, only about 16.5 million shots were given to patients.

However, if the local health authorities are better able to handle the distribution of vaccines, they will ultimately catch up with the limited supply. Some local officials, including those in New York City, said they had already reached this point and canceled appointments because they said they didn’t have enough.

Vaccine experts and the companies themselves have stated that applying the Defense Production Act will not add much to supply, at least in the short term, although any little bit could help. This is because production facilities are already full or almost full and there is a global race to develop vaccines that use a limited amount of resources.

Despite criticism of the Trump administration for not using the Defense Production Act more aggressively to stimulate production of test supplies and protective equipment, it used the act many times to give vaccine manufacturers priority access to suppliers of raw materials and equipment.

In a plan released Thursday, the Biden government announced that it would continue to use the law to increase supplies needed to make vaccines, as well as other materials needed to immunize tens of millions of people. Although the plan was few in detail, one example cited is to increase production of a special syringe that can squeeze six doses out of Pfizer vials that were originally supposed to contain five.

There are no vaccine reserves to speak of. For the most part, vaccines are shipped every week when they are made. (The exception is a small emergency supply that the Biden government has announced will continue.)

Last week, Alex M. Azar II, the outgoing Secretary for Health and Human Services, caused confusion when he announced that the federal government would release a reserve of vaccine doses. Many states have been told that an influx of vaccines is on the way that will allow more people to be vaccinated.

In his press conference, Mr Azar urged states to open their vaccination guidelines, saying they moved too slowly to use the doses they had already received. As a result, several governors, including Andrew M. Cuomo of New York, changed admissions rules to allow people 65 and older to have the vaccine.

However, last Friday, senior administration officials made it clear that all of those reserve doses were already earmarked as booster shots for people who had received the vaccine, and that Mr Azar was just setting out the logical extension of a distribution policy established by federal officials in December when supplies began. The release of the reserve doses would go to people who needed their second dose, not new groups of people who received their first shot.

In the future, Azar said, the government will switch to a new model: instead of sticking to a reserve of booster shots, every weekly shipment from the manufacturers would include doses for new people as well as second doses for those due for their booster shots. President Biden repeated this policy when he announced his vaccination schedule last week.

The Biden Administration

Updated

Jan. 21, 2021, 8:45 p.m. ET

Federal officials previously said they worked with states to find out who received a vaccine and when they were due for their booster shots, three weeks later for the Pfizer vaccine, and four weeks later for the Moderna vaccine.

They said that each weekly delivery gives priority to people who need their second dose that week, and what is left is used to vaccinate new people.

However, the plan relies on federal and state governments working together to specify exactly who has received a vaccine and what is needed from week to week. Many state governments have complained that they do not have the resources to carry out the vaccine distribution plan and the next few weeks will show how well the system works.

Biden’s new administration has vowed to revise the distribution to the states to give local officials more transparency on how much vaccine to expect in hopes of allowing states to better plan.

No, that probably won’t happen.

Last week, Michigan Governor Gretchen Whitmer asked the federal government for permission to buy 100,000 doses of vaccine directly from Pfizer. And on Monday, Mr. Cuomo wrote a letter to Pfizer asking the state to buy vaccines direct.

Pfizer and Moderna supplies have been fully drawn for at least the first quarter of this year, meaning a replacement vaccine is unlikely to be sold to individual states.

Additionally, the emergency approvals for the Pfizer and Moderna vaccines provide for the federal government to oversee distribution.

In a statement, a Pfizer spokeswoman said the company is “open to working with the US Department of Health on a distribution model that will allow as many Americans as possible to get access to our vaccine as soon as possible.” However, she noted that “before we can even think about direct sales to state governments, HHS would have to approve the proposal.”

A state official said Tuesday that the governor felt it was important to exhaust all of his options, no matter how unlikely they might be, and pointed to his efforts in March to buy fans direct from manufacturers – which sparked a bidding war between states he later criticized the federal government for refueling.

However, advisors to the Biden government have indicated that they are not in favor of such a move. On Monday, Dr. Celine Gounder, a pandemic advisor to Mr Biden during his change of presidency, said that if states could do separate deals, it would cause more problems than it would solve.

In an interview on CNBC, Dr. Gounder’s earlier criticism from Mr. Cuomo for bidding on ventilators. “I think this kind of approach to vaccine allocation will frankly lead to the same situation that he himself criticized last spring,” she said.

Yes, most likely.

At least three other vaccines are in late-stage clinical trials, and the success of any of those vaccines could mean millions more doses for US citizens by spring.

Johnson & Johnson is expected to announce the results of its vaccine study every day. If this is successful, the first doses could be available in the US by February. Although early production of the vaccine has lagged, the company has signed a contract to deliver 100 million doses of its single-dose vaccine by the end of June.

Results of studies with two-dose vaccines from AstraZeneca and Novavax could also be published by March and April. AstraZeneca has an agreement with the US government to supply 300 million doses and Novavax to supply 110 million doses.

Additionally, both Pfizer and Moderna state that their factories are adding and expanding capacity every week. They have signed contracts to deliver an additional 100 million doses of their vaccines each during the second quarter of this year.

It’s still not clear, though conservative, that there could be enough vaccines by the summer.

With no other vaccines approved, the United States has signed contracts with Pfizer and Moderna for a total of 400 million doses to be dispensed by the summer, or enough for 200 million people.

That’s pretty close to the American population of 260 million adults (the vaccines aren’t yet approved for children, although studies are ongoing).

But if other vaccines prove safe and effective – which experts believe is likely – millions of people could be vaccinated faster, possibly by late spring.

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