States told to widen vaccine targets
New Trump policy moves to speed up shot distribution
WASHINGTON — The Trump administration, racing a surging COVID-19 death toll, instructed states Tuesday to immediately begin vaccinating every American 65 and older, as well as tens of millions of adults with medical conditions that put them at higher risk of dying from coronavirus infection.
The f ederal government will release all available doses of the vaccine instead of holding about half in reserve for second doses, Alex Azar, the secretary of Health and Human Services, said, adding that states should start allowing pharmacies and community health centers, which serve largely poor populations, to administer the shots.
The announcement came with a cudgel: States will lose their allocations, Azar warned, if they do not use up doses quickly. And starting in two weeks, state vaccine allocations will be based on the size of a state’s population of people 65 and older, not on the general population.
How Azar’s enforcement threat will work is unclear; in two weeks, Joe Biden will already have been sworn in as president.
“This next phase reflects the urgency of the situation we face,” Azar said.
“Every vaccine dose that is sitting in a warehouse rather than going into an arm could mean one more life lost or one more hospital bed occupied.”
The Trump policy shift was driven by vaccinations getting off to a slow start, though the pace has picked up considerably over the past week. It comes as some states have already begun vaccinating people 65 and older, leading to long lines and confusion over how to get a shot.
The new policy could exacerbate that confusion in states that have been following their own carefully laid timelines for getting the vaccine to various priority groups — including teachers, emergency responders, grocery store employees and other types of essential workers, whom Azar did not mention in his announcement. A federal health official said the administration envisions older Americans being vaccinated alongside essential workers, not before them.
Only a handful of states have already opened vaccination to everyone 65 and older, including Alaska, Florida, Michigan and Texas.
The Centers for Disease Control and Prevention recommended last month that after vaccinating health care workers and residents of long-term care facilities, states should vaccinate people older than 75 and certain “front-line” workers who cannot do their jobs from home. Only after that, the CDC advised, should states turn to people ages 65 to 74 and adults of all ages with high-risk medical conditions. The CDC recommendations were not binding, but many states have largely been following them while demand still far exceeds supply.
Azar said the incoming Biden administration would be briefed on the changes, though he added that Americans “operate with one government at a time, and this is the approach that we believe best fulfills the mission.”
Bi denis expected to announce details of his own vaccination plan — which will include federally supported mass vaccination clinics — this week. The Biden transition team declined to comment Tuesday on the new Trump policy. But a person familiar with the president-elect’s plans said Biden had also been planning to expand the universe of those who are eligible to be vaccinated.
The new distribution plan, first reported Tuesday by Axios, is a reversal for the Trump administration, which had been holding back roughly half its vaccine supply — millions of vials — to guarantee that second doses would be available. Azar said the administration always expected to make the shift when it was confident in the supply chain.
Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the Food and Drug Administration’s vaccine advisory panel, praised the administration’s decision, likening the current situation to the Titanic, where there were not enough lifeboats to save everyone, “and you have to decide who you are going to let on.”
Nearly 380,000 people have died from COVID-19 in the country since the start of the pandemic. In recent days, the number of daily deaths in the country has topped 4,000.
As of Monday, about 9 million people have received at least one dose of a COVID19 vaccine, the CDC said, far short of what the federal government initially promised. At least 151,000 people in the country had been fully vaccinated as of Jan. 8, according to a New York Times survey of all 50 states.
But Azar said the country was “on track” to reach the rate of 1 million vaccinations a day in a week or so. He said the perceived delay in using up doses is at least partly because of slow data collection.
The idea of using existing vaccine supplies for first doses has raised objections from some health workers and researchers, who worry that front-loading shots will raise the risk of second injections being delayed. Clinical studies testing the vaccines showed the shots were effective when administered in two-dose regimens on a strict schedule. And while some protection appears to kick in after the first shot, experts remain unsure of the extent of that protection, or how long it might last without the second dose to bolster its effects.
But others have argued the partial protection afforded by a single shot will save more lives in the meantime.