States readying for vaccine gush
U.S. to acquire 100 million additional single-shot doses
State and local health officials who have spent months rationing shots are now racing to be ready for a surge in supply — enough for every adult by the end of May, as President Joe Biden promised last week.
They’ve been advised to plan for between 22 million and 24 million doses a week by early April, an increase of as much as 50% from current allocations, according to two people familiar with the estimates who spoke on condition of anonymity because they were not authorized to discuss them.
Biden said Wednesday that his administration would purchase another 100 million doses of Johnson &
Johnson’s single-shot vaccine. The doses, expected to be delivered in the second half of the year, will position the country to inoculate children and provide booster shots if needed against new variants of the virus.
“If we have a surplus we’re going to share it with the rest of the world,” the president said during an event with pharmaceutical executives promoting his administration’s efforts to equip states with the supplies they need to end the pandemic.
With the order, the U.S. is expecting 200 million doses from Johnson & Johnson, which is enough for 200 million people. That’s on top of 300 million doses each from Pfizer Inc. and Moderna Inc., both of which have a twoshot vaccine. Altogether, it’s enough for 500 million people. There are currently about 330 million Americans.
Preparing for the expanding supply, state and local health officials said they want to avoid the obstacles that hindered the early rollout, as doses sat on shelves, sign-up systems crashed and eligibility rules confounded the public. The challenge is that all three problems persist to a degree, deepening questions about whether they will be able to navigate the next phase of the country’s immunization campaign.
The stakes are arguably higher now, with the effort to stem spread of virus variants and a new president who has made the pandemic his central focus. More supply will intensify pressure to address racial gaps that have opened in early vaccination data. And holes in coverage, whether of homebound elderly or people in homeless shelters, may become all the more glaring when there are more doses to go around.
Even as U.S. vaccinations speed up, uncertainty remains. Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, said in a briefing Wednesday that health officials are still unsure how long vaccine protection lasts.
Anthony Fauci, a Biden covid-19 adviser who leads the National Institute of Allergy and Infectious Diseases, said Wednesday that he expects high school students to be able to be vaccinated this fall but that studies on safety for several groups are ongoing.
NEW CHALLENGES
More vaccine supply will pose new challenges. Chief among them is addressing people’s hesitancy to get the shots, which could suppress demand and make it more difficult to achieve the high levels of immunity needed to stop the disease’s spread. States and other jurisdictions also need to have enough sites to receive the vaccines, as well as staffing to administer shots, record patient data and monitor for possible side effects.
“States are pulling out all the stops,” said James Blumenstock, senior vice president for pandemic response and recovery at the Association of State and Territorial Health Officials.
The central issues, he said, remain staffing, space and stuff — with stuff simply meaning the pharmaceutical product. The most vexing limitation, he said, “is still, and always has been, the stuff.”
Of 1,773 providers enrolled to administer vaccines in New Jersey, nearly 1,500 of them have yet to be tapped because there hasn’t been enough supply, said Margaret Fisher, a special adviser to New Jersey’s health commissioner. Each of the state’s six vaccine megasites has additional capacity. And residents ranging from retired nurses to pharmacy students, she said, stand ready to act as vaccinators.
Minnesota is poised to double the number of mass vaccination sites it is operating, said Kris Ehresmann, the state’s director of infectious-disease prevention. And the governor, Democrat Tim Walz, recently signed a bill into law allowing dentists to administer coronavirus vaccine doses.
Envisioning more supply in a period of scarcity involves some mental gymnastics, Ehresmann said.
“We’re trying to be thoughtful around prioritization,” she said. “But the more you prioritize, it limits the flow of vaccine in the system. And there’s going to come a point in the next few weeks where you’re like, ‘Hey, there’s all of a sudden tons of vaccine.’”
When that happens, state leaders vowed, they won’t be caught by surprise. Fifteen new mass-vaccination clinics, four of them mobile, are anticipated in Ohio, where Republican Gov. Mike DeWine said the state’s large hospital systems also have the capacity to expand. “We think we’re ready to go,” he said. “As fast as this vaccine comes into Ohio, we’re going to be able to get it out.”
In New York City, where multiple sites are already operating 24 hours a day, officials Tuesday said that they were seeking 2,000 additional staff members to administer vaccine doses and provide other support, with recruitment kicking off in some of the hardest-hit communities, including Staten Island and the Bronx.
In some places, the challenges of preparing for a surge in supply are compounded by changed plans about where it will go.
Under a new system headed by the insurance giant Blue Shield, California is sending 40% of all doses to its most vulnerable neighborhoods — part of an effort to immunize residents at greatest risk of the coronavirus and reopen the economy more quickly. Paul Simon, chief science officer for the Los Angeles County Department of Public Health, said he wasn’t sure whether the change would require the county to shuffle providers.
“We’ll need to get vaccine out quickly, and so I think some of the big health care systems that are already in the network can receive increasing supplies,” he said.
But ensuring that expanded supply reaches hard-hit groups requires foresight, he said, and not simply dumping more doses at mass sites or with major hospitals. He said the county plans to expand the number of mobile units capable of reaching into vulnerable communities, as well as “strike teams that can go out into various locations and vaccinate quickly.”
MIXED PICTURE
Biden’s pledged to amass enough vaccine by late May to inoculate every adult in the United States was greeted as a triumphant acceleration of a vaccination campaign that seemed to be faltering only weeks earlier.
But a closer look at the ramp-up offers a more mixed picture, one in which the new administration expanded and bulked up a vaccine production effort whose key elements were in place when Biden took over from President Donald Trump.
The Biden administration has taken two major steps that helped hasten vaccine production in the near term. Even before Biden was inaugurated, his aides determined that by invoking the Korean War-era Defense Production Act, the federal government could help Pfizer obtain the heavy machinery it needed to expand its plant in Kalamazoo, Mich. The Trump administration had repeatedly invoked that law, but its order for Pfizer covered only single-use supplies like plastic liners, not durable factory equipment.
Crucially, Biden’s top aides drove Johnson & Johnson to force a key subcontractor into round-the-clock operations so its vaccine could be bottled faster.
At the same time, though, Biden benefited from the waves of vaccine production that the Trump administration had set in motion. As Pfizer and Moderna found their manufacturing footing, they were able to double and triple the outputs from their factories.
Biden had been in office less than a month when Moderna announced that it could deliver 200 million doses by the end of May, a month earlier than scheduled, simply because it had become faster at production. Pfizer was able to shave off even more time, moving up the timetable to deliver its 200 million doses by a full two months, partly because of newfound efficiencies and partly because it was given credit for six doses per vial instead of five.
Still, corporate, state and federal officials agree that Biden’s White House has been more active than his predecessor’s in trying to build up the nation’s vaccine stock.
The new administration’s relationship with Pfizer is markedly better. Trump and his aides had accused the company of slow-walking its vaccine development to hurt Trump’s reelection bid. The company announced its vaccine was robustly effective on Nov. 9, nearly a week after Election Day, then filed its application for emergency use authorization on Nov. 20.
Biden’s aides started talking to Pfizer executives about what the company needed to make more doses even before Inauguration Day. When Biden traveled to Michigan on Feb. 19 to visit Pfizer’s plant, Albert Bourla, the company’s chief executive, praised the new administration as “a great ally,” saying officials had helped the company secure critical materials and equipment.
RELAXED GUIDELINES
As vaccine supplies are set to grow, federal health officials Wednesday substantially relaxed the government’s guidelines for visiting nursing home residents in person, saying that vaccinations and a slowing of coronavirus infections in the facilities warrants restoring indoor visits in most circumstances.
The nursing home guidance, the first federal advice on the subject since September, says “outdoor visitation is preferred,” even when a nursing home resident and family or friends are fully vaccinated against the coronavirus.
But acknowledging that weather or a resident’s poor health might make an outdoor visit impractical, the advice encourages nursing homes to permit indoor visits “at all times and for all residents,” regardless of whether people have been vaccinated, except for a few circumstances.
Those circumstances, federal officials say, include when a resident has not been fully immunized against the virus and lives at a nursing home in which fewer than 70% of those in the facility are fully vaccinated and coronavirus tests in the community show a high rate of local infections — greater than 10% of tests positive.
The guidance comes two days after the CDC issued separate advice Monday, sketching the outlines of what activities are considered safe for fully vaccinated Americans. That guidance gave such people greater freedom to socialize and engage in some normal daily activity. It said people two weeks past their final shots may visit indoors with unvaccinated members of a single household at low risk of severe disease, without wearing masks or keeping a safe distance.
Separately, Alaska has become the first state to drop eligibility requirements for covid-19 vaccines and allow anyone 16 or older who lives or works in the state to get vaccinated, Gov. Mike Dunleavy said Tuesday.
Dunleavy made the announcement after his own bout with covid-19, which he described as an inconvenience and said underscored his desire to be vaccinated. He said he did not become severely ill but did not want “to be laid up in the house again,” affect his family or possibly spread the virus to others.
He described expanding eligibility for vaccines in Alaska as a “game changer,” particularly with the summer tourist season looming and as the state seeks to rebuild its pandemic-tattered economy.
He said he respects those who do not wish to get a vaccination and wanted to relay his personal experience for those considering getting one. “I would ask that you give some due consideration,” the Republican said.
Dr. Anne Zink, the state’s chief medical officer, said officials were seeing open vaccination appointments and wanted to act to allow as many people who want a shot to get one. More appointments will be added as vaccine is moved around the state and additional doses come in, she said.
“This does feel like a gigantic milestone in so many ways to get to the point where we can offer protection for anyone who wants it in the state,” Zink said during a news conference with Dunleavy.
Alaska has led states in the percentage of its population to have received two doses of a covid-19 vaccine, according to the CDC Covid-19 Vaccine Tracker.
Information for this article was contributed by Isaac Stanley-Becker, Lena H. Sun and Amy Goldstein of The Washington Post; by Josh Wingrove and Riley Griffin of Bloomberg News; by Sharon LaFraniere of The New York Times; and by Becky Bohrer of The Associated Press.