USA TODAY International Edition

Vaccine is on shelves but not in the arms

US fails to deliver 2020 goal of 20 million doses

- Karen Weintraub

If the pace of COVID- 19 vaccine delivery into people’s arms stays the way it has been for the past few weeks, it could take years rather than months to vaccinate Americans, and the outbreak will continue to dominate lives.

Federal officials overestima­ted the speed at which vaccines could be given, making delivery a disappoint­ment in an otherwise successful developmen­t effort.

Doses have been distribute­d behind the government’s initial schedule – 15 million, instead of the 20 million doses promised to be delivered by the end of 2020. About 70% of those doses are sitting on pharmacy shelves, according to government data, and only about 14% of doses destined for nursing home residents and caregivers have been injected.

It’s not too late to turn the situation around, according to experts such as Kelly Moore, deputy director of the Immunizati­on Action Coalition, an education and advocacy group.

To do so will require a host of improvemen­ts, including more money, additional staffing and greater experience with vaccines shown to be safe and effective but not so easy to use.

About 200,000 doses are being given a day. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said vaccinator­s should soon be able to deliver 1 million a day.

“There were a lot of aspiration­al goals set by federal officials about how many vaccines could be delivered how quickly,” Moore said. “The delivery of a box of vaccine to a clinic door is the easiest part of the process.”

Chicago has delivered 95% of the vaccine it’s received, but at the current rate of delivery, it would take a year to a year- and- a- half to vaccinate residents, Mayor Lori Lightfoot said Tuesday.

Chicago has built infrastruc­ture to deliver the vaccine, Lightfoot said, but needs more doses. “The federal government has to step up, finally, and do a better job at protecting American lives from this terrible virus.”

Operation Warp Speed, the federal program tasked with developing and delivering COVID- 19 vaccines, promised to vaccinate 20 million Americans in December. Three weeks after shipping began, the program has distribute­d 15 million doses to hospitals and nursing home providers, but only 4.5 million people have gotten the first of the twoshot regimen. That means 30% of available doses have been used.

Among nursing home residents and caregivers, 365,000 shots have been delivered out of more than 2.5 million distribute­d – a 14% usage rate.

Federal officials have focused on getting the vaccine onto hospital shelves, but to get them off the shelves requires “an enormous human element,” Moore said. There are always bugs when you “translate from paper to practice,” she said, and federal plans didn’t give enough considerat­ion to the need for scheduling and organizing clinics, educating patients and caregivers and resolving the small problems that crop up.

Hospital workers and public health officials are exhausted after 11 months of fighting the virus. “And now they’re being asked to ramp up the most ambitious vaccine program the country has ever seen,” said Howard Koh, a former assistant secretary for health at the U. S. Department of Health and Human Services and now a professor at the Harvard T. H. Chan School of Public Health.

The protocols for this vaccine are different from those for the seasonal flu vaccine, for which a nurse can wheel a cart through hospital hallways, delivering shot after shot. People who receive a COVID- 19 vaccine have to be watched for 15 minutes to ensure they don’t have an allergic reaction. This requires hospitals to set aside space and personnel – both of which are at a premium.

“All of those things are just part of the not- unexpected challenges we face in implementi­ng such a complex program with a new vaccine based on a new platform in the midst of the height of the pandemic with exhausted health care workers who are at the end of their rope after all the work they’ve been doing for the past year,” Moore said.

By the time there is enough vaccine to distribute outside hospitals and other care facilities to the broader community, vaccinator­s will have worked out some of the kinks in the system, she said.

It may get easier to vaccinate large numbers of people when shots can be delivered at neighborho­od pharmacies and health care facilities.

CVS is ready to deliver vaccine at all 10,000 of its pharmacies nationwide and expects to be able to give 20 million to 25 million doses a month once enough vaccine is available. “We’re ready to go once the government authorizes wider distributi­on,” said Mike DeAngelis, a CVS spokespers­on.

Frustratin­g front- line experience

Steven Wolf, who co- runs neurology services for YAI, a New York- based support organizati­on for people with autism, Down syndrome and other conditions, came in over his vacation to vaccinate patients and the staff members who care for them. “I was envisionin­g that we were going to get them in and out fast,” Wolf said, but the process was “horribly terrible.”

It took 52 clicks on each person’s digital medical record before the patient was ready to receive a shot. YAI had to get consent forms signed by family members and guardians for those who couldn’t sign for themselves.

“It was just freaking endless,” Wolf said of the paperwork.

He and two others were able to vaccinate 40 people in three hours, far fewer than he anticipate­d.

Ten caregivers refused to receive the vaccine. Some wanted to talk it over with family members. Others wanted more people to go first, while some repeated conspiracy theories about the vaccine.

Wolf said he considers himself a pretty persuasive person, and he was armed with lots of facts about the minor side effects and major benefits of the vaccine, but he said he and his colleagues couldn’t persuade those 10 to get vaccinated.

“We talk people into medication and surgery and all these other things, and we could not convince these 10 that this is what you’ve got to do to take care of yourself,” he said. “I came home so frustrated.”

Lack of money, leadership

Although Congress allocated $ 8 billion for vaccine distributi­on, Koh said it’s not enough and should have arrived months ago.

“This is a field that has been underresou­rced and overlooked for far too long,” Koh said.

Koh, who was commission­er of public health for the Commonweal­th of Massachuse­tts during 9/ 11 and the anthrax scare in 2001, said officials promised then never to be caught off guard again by a public health emergency, but that resolve didn’t last.

He criticized the lack of federal leadership and politiciza­tion of public health, saying state and local government­s should collaborat­e, not go it alone.

“A crisis like this should be bipartisan, nonpartisa­n, one government response,” he said.

Moore lives in Tennessee, which has eight neighborin­g states each with different policies. In Bristol, Tennessee, police officers have to wait until health care workers are vaccinated, while officers across the border in Bristol, Virginia, are allowed to line up.

Different standards could mean vaccinator­s will hesitate to make sure they’re not making a mistake, and recipients will be more likely to pass on the vaccine, thinking they’re not a priority.

These problems are all solvable, Moore said, and it’s realistic to think they will be fixed within the next month, and the number of vaccinatio­ns will reach 1 million a day nationwide, as Fauci suggested.

Surgeon General Jerome Adams, speaking on NBC News’ “Today” show, agreed that the state delivery systems have been uneven, some distributi­ng 75% or more of available doses and others not even 25%.

He said there would be more money to help out, more locations will soon be added to provide vaccinatio­ns and more people will be eligible to get the vaccine.

The bottom line is that everyone wants vaccinatio­ns to move faster, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Associatio­n. Vaccines provide the chance to get beyond COVID- 19.

“It is the great opportunit­y and the great hope,” Foster said. “No one wants to see it moving slowly.”

“There were a lot of aspiration­al goals set by federal officials about how many vaccines could be delivered how quickly. The delivery of a box of vaccine to a clinic door is the easiest part of the process.” Kelly Moore, Immunizati­on Action Coalition

 ?? GREG LOVETT/ USA TODAY NETWORK ?? Florida gave older residents priority in COVID- 19 vaccinatio­ns last month.
GREG LOVETT/ USA TODAY NETWORK Florida gave older residents priority in COVID- 19 vaccinatio­ns last month.

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