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There’s a popular saying among public health experts: “Vaccines don’t save lives. Vaccinations save lives.” The approval of the first coronavirus vaccines last month following an unprecedentedly fast development process gave the United States reason for hope amid the dire news of surging case numbers. But the pandemic can’t be brought to an end unless doses of the vaccines actually get to the people who need them.
So far, the vaccine rollout has moved much more slowly than expected. In October, the Trump administration said the U.S. could produce up to 100 million doses by the end of 2020. In mid-December, Vice President Mike Pence said the country was on track to vaccinate 20 million people by the end of the year. But as of Wednesday only about 5.3 million doses have been injected into patients nationwide.
For months, the main concern was that limited supply would be the main cause of delay. At the moment, however, logistical bottlenecks are causing vaccine doses that have been distributed to states to sit on shelves unused. According to Bloomberg, only eight states have used at least half of the doses they’ve received. Several have used less than a quarter, setting up the risk that a large portion of their vaccines may expire before it gets used.
Failure to speed up the pace of vaccinations could cause the pandemic to last months longer than is necessary and cost countless lives, experts say.
Why there’s debate
One of the most commonly cited reasons for the slow pace of vaccinations is the lack of a national strategy. As it did for testing and medical supplies, the Trump administration has left vaccine distribution up to the individual states. This has meant resource-strapped state and local health departments have had to create their own distribution plans — with wildly different levels of success. South Dakota, for example, has used 69 percent of its vaccine doses. Georgia has used just 21 percent. President Trump has blamed the states for the slow rollout, but experts say the federal government must play a larger role establishing distribution protocols and supporting states both financially and logistically.
Others have the opposite view. Overly rigorous standards are the main reason doses are stuck sitting on shelves, they argue. Rather than reserving the vaccine for health care workers and the elderly, states could focus on vaccinating as many people as possible. Some experts have called for rules limiting who can administer the vaccine and where to be drastically expanded to include more medical clinics and pharmacies across the country.
Distribution strategies should also plan for the likelihood that supply limitations become a major issue in the near future, experts say. Both the Pfizer and Moderna vaccines that are currently available in the U.S. require a second dose after several weeks to reach peak immunity. But some experts argue that delaying the second dose would provide at least some protection to twice as many people, which could significantly lower transmission rates. Others say there’s not enough data to determine how much immunity a single dose provides.
Another group argues that it’s far too early to call the U.S. vaccine rollout a failure. There were bound to be hiccups when launching such an enormous and unprecedented endeavor and the process should become more efficient over time, especially now that Congress has allocated billions of dollars to support vaccine distribution in its latest economic rescue package, they argue.
President-elect Joe Biden’s administration is expected to take a more active role in vaccine distribution as part of his pledge to administer 100 million doses in his first 100 days in office.
Two more promising vaccines are currently undergoing late-stage clinical trials in the U.S., and they could be approved for emergency use as soon as next month.
Biden’s leadership will help
“The grim coronavirus death toll might pass 400,000 by the time Joe Biden takes the oath of office on Jan. 20, although he’ll be taking over a vaccination crusade effort that hopefully will have learned from these many early mistakes, and we’ll suddenly have an engaged and activist government willing to call up the National Guard or other agencies to fill the gaps in distribution.” — Will Bunch, Philadelphia Inquirer
Limitations on who can get the vaccine need to be lifted
“Governors are being WAY too precious about who gets this vaccine. … This is a case where letting people just show up at a pharmacy to get it is a fine way [of] sorting it. Vulnerable people will show up, those who can wait will wait their turn. There is functionally no other way to do it successfully fast enough.” — Ryan Grim, The Intercept
The White House should establish strict rules that force states to be more efficient
“With thousands of Americans dying every day, there is no excuse for lifesaving vaccines languishing in freezers. The federal government needs to give states strict parameters for when their vaccine allocation must be administered before it’s diverted elsewhere. States, in turn, should impose similar requirements to their distribution sites: Use it, or lose it.” — Leana S. Wen, Washington Post
The second dose should be delayed to stretch limited supplies as far as possible
“We seemingly gain a LOT from delaying (for some) the second shot by a short interval (perhaps just a few weeks ). The risk to ‘reserving’ vast numbers of doses, while rampant spread occurs seems HIGHER than the alternative. Let's put logic & science ahead of dogma.” — Yale University health policy expert Howard Forman
Major pharmacy chains should be empowered to become vaccination super centers
“Standing up vaccination sites and encouraging people to go get the shot is expensive and takes time. The best option may be to rely more on private industry. National pharmacy chains like CVS and Walgreens have an agreement with the federal government to provide vaccines to long-term care facilities. The government should expand this program to help vaccinate all Americans.” — Former FDA Commissioner Scott Gottlieb, Wall Street Journal
The U.S. should form a national Vaccine Corps
“Federal and state leaders should consider a plan to summon a tremendous, yet untapped reservoir of talent and energy to help lead us out of the pandemic — college students. … While public health leaders know what must be done, their critical work could be supported by a national COVID-19 Vaccine Corps, a volunteer pool to help contact trace, inform, and support the logistics of distributing, administering, and tracking hundreds of millions of vaccine doses.” — Michael F. Collins and Marty T. Meehan, Boston Globe
Even with early hiccups, the vaccine rollout is an extraordinary success
“If we think of this as a race we are losing it will be far too easy NOT to see it for what it really is: the greatest accomplishment in vaccine science in history.” — Marc Seigel, Fox News
The rollout hasn’t been perfect, but it’s far from a disaster
“The US vaccine campaign is not a disaster. Rather, I think it is predictably mediocre (in ‘admin-speak,’ it meets expectations), but is a major achievement, given the fierce political headwinds and cynical rope-a-dope the Trump administration continues to play.” — Kent Sepkowitz, CNN
Delaying the second dose won’t solve logistical problems
“Scientists desperate to see more people inoculated quickly are already talking about forgoing second-dosage requirements, or cutting doses in half to make more shots available. But increasing the number of shots available won't help where there's a logjam in getting them injected.” — Editorial, USA Today
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