Looking past the first 100M shots
Biden’s COVID-19 team sets sights on bigger numbers
WASHINGTON — It sounded so ambitious at first blush: 100 million vaccination shots in 100 days.
Now, one month into his presidency, Joe Biden is on a glide path to attain that goal and pitching well beyond it to the far more ambitious and daunting mission of vaccinating all eligible adults against the coronavirus by the end of the summer.
Limited supply of the two approved COVID-19 vaccines has hampered the pace of vaccinations — and that was before last week’s extreme winter weather delayed the delivery of about 6 million doses. But the United States is on the verge of a supply breakthrough as manufacturing ramps up and with the expectation of a third vaccine becoming available in the coming weeks.
That means the act of delivering injections will soon be the dominant constraint, and it’s prompting the Biden administration to push to dramatically expand the universe of those
who will deliver injections and where Americans will meet them to get their shots.
“It’s one thing to have the vaccine, and it’s very different to get it in someone’s arms,” Biden said Friday as he toured Pfizer’s manufacturing plant in Portage, Michigan.
Since their approval in December, more than 75 million doses of the two-shot-regimen Moderna and Pfizer vaccines have been distributed, of which 63 million have been injected, reaching 13% of Americans. Nearly 45 million of those doses have been administered since Biden’s inauguration Jan. 20.
The pace of deliveries of those vaccines is about to take off. About 145 million doses are set for delivery in the next 5 ½ weeks, with an additional 200 million expected by the end of May and a further 200 million by the end of July.
That’s before the anticipated approval by the Food and Drug Administration for emergency use of a third vaccine, from Johnson & Johnson. The single-dose J&J vaccine is expected to help speed the path to immunity. But there is no massive stockpile of J&J doses ready to roll out on Day One.
“We’re going to be starting with only a few million in inventory,” White House COVID-19 coordinator Jeff Zients said this past week. Still, when combined with the anticipated increases in the other vaccines, the J&J doses could prove the pivotal advance in delivering enough shots for nearly all American adults by the end of June, at least a month earlier than currently anticipated.
The daily inoculation average climbed to 1.7 million shots per day last week, but as many as double that number of doses are soon expected to be available on average each day. The focus of Biden’s team is now quickly shifting to ensuring those doses can get used, though the administration has resisted the calls of some health experts to publicly set a “moonshot” target for how many daily doses it hopes to deliver.
Biden first set his target of 100 million doses in 100 days Dec. 8, days before the first vaccines received emergency use authorization. By Inauguration Day, it was clear the U.S. was on course to attain that goal.
Dr. Leana Wen, an emergency physician and public health professor at George Washington University, said she would like to see the administration commit to a more ambitious 3 million shotper-day target.
“I want to see them put that stake in the ground,” she said.
The current pace of vaccination dipped markedly in recent days as winter weather shuttered administration sites in Texas and across the South, and icy conditions stranded supplies at shipping hubs in Kentucky and Tennessee.
One-third of the delayed doses have already been delivered, Dr. Anthony Fauci, the nation’s top infectious disease specialist, announced Sunday. The White House anticipates that remaining delayed doses will be injected by March 1 and that the daily pace of vaccinations will continue to climb.
Much of the increase, according to data from the Centers for Disease Control and Prevention, comes from people receiving their second dose of the Moderna or Pfizer vaccine. The pace of firstdose vaccinations, meanwhile, has been largely steady over the past several weeks, hovering around an average of 900,000 shots per day.
Increasing both the rate of firstdose administrations and the rate of overall vaccinations will be key to achieving herd immunity — estimated to require vaccination of about 80% of the population — in hopes of ending the pandemic and curtailing the emergence of potentially even more dangerous “mutant” strains of the coronavirus.
That means keeping demand high. The administration has expressed concerns about public surveys showing that tens of millions of Americans are reluctant to get the vaccine and it is stepping up public outreach to overcome that hesitancy as the U.S. death toll nears 500,000.
Dr. Cyrus Shahpar, the White House COVID-19 data director, said the administration is “focused on going out to communities and making sure people know these vaccines are safe and how they can get them, with a goal of vaccinating nearly all Americans,.”
The administration has also turned its focus toward identifying new delivery paths for the vaccines beyond those already used by states, including federally run mass vaccination sites.”
When Dr. Stephanie Lum gave birth last month to her little girl, Ava, the only support person she had in the delivery room was her fiance.
As an OB-GYN at St. Luke’s Riverside Women’s Healthcare at the Anderson Campus, it was “refreshing,” she said, to have a more private birth experience.
“There is this wonderful intimacy of this family that’s growing just by itself,” Lum said. “To be completely honest, my fiance and I actually really liked that it was just the two of us in the room. There wasn’t a huge crowd. We delivered and there was a great time where it was just the three of us just kind of growing together as a family.”
Like many other life events, family planning has changed during the pandemic, including limits on the number of people allowed in delivery rooms. But the number of births in the Lehigh Valley in the wake of stay-at-home orders hasn’t exactly created a baby boom or bust, contrary to researchers’ expectations last spring.
Two of the region’s major health care centers, St. Luke’s University Health Network and Geisinger Health Center, have seen an uptick in births, but officials said it can’t be necessarily tied to the pandemic. Lehigh Valley Health Network is not seeing any unusual trends in births that could be connected to the pandemic, spokesperson Brian Downs said.
Last spring, some health care officials speculated there would be an increase in births at the end of 2020 and the start of this year, pointing to the stay-at-home orders.
Then, in June, researchers at the Brookings Institute published a study finding that the pandemic could lead to “a large, lasting baby bust” of 300,000-500,000 fewer births this year, citing the economic downturn. In December, they dialed back on their prediction and said births would probably fall toward the lower range of their estimate, 300,000 fewer births, as the labor market improved more quickly than anticipated.
Dr. Israel Zighelboim, network chairperson of obstetrics and gynecology at St. Luke’s, said there has been a sustained increase in deliveries there, but that may have more to do with the popularity of the network and how women are waiting longer to get pregnant.
“Historically and demographically, all those booms predicted on just people staying home after storms and after other natural disasters are more legends than
reality,” Zighelboim said, noting it’s more likely trending toward a baby bust.
December births at Geisinger were up at bit, said Dr. Juan Manuel Arreguin, but numbers this year are “more reflective of probably that increase that we were expecting.”
“Now that we know what COVID does, mostly, and now that we have more of a vaccine, I think that people are probably starting to get pregnant, because we’re definitely seeing our 2021 numbers starting to bump up a little bit more,” he said. “We’re seeing about an 8% increase.”
There have been a number of “walk-in” births by mothers who went without prenatal care, which he said could be somewhat attributed to those who lost their health insurance due to layoffs, or just a general concern over going to doctor’s offices.
“It is true that COVID in general has limited people’s ability to get prenatal care, whether that’s because they’re afraid of coming to the hospital, afraid of coming to the clinic,” Arreguin said.
There’s still a good bit of fear about the coronavirus and the vaccine, but Arreguin said research shows the vaccine is safe for pregnant women, women anticipating getting pregnant and
those nursing a newborn.
Mothers — and women in general might actually be a key to getting more people vaccinated.
“You know, moms in particular, they absolutely want to protect their kids, they want to protect their families,” he said, citing a public service announcement the center put out in Spanish to Latina moms, urging them to get vaccinated. “Because we know that if we can convince them, that it’s going to be easier to get their husband to get vaccinated or grandparents to get vaccinated … women are really the people that rule this world.”
Even though her delivery experience was made different by the pandemic, Lum said she enjoyed her pregnancy and urged others to do the same.
“Considering there was a global pandemic during my pregnancy, despite that, it’s still this wonderful time that you’re never really going to get back,” she said. “I love that she’s outside of me, but there are still days that I’ve missed her being inside. So that would probably be my biggest thing — to recognize and be safe, but still allow yourself to enjoy this time.”