USA TODAY International Edition
Experts: US must pick up pace to hit July goal
Pledge of open vaccinations by summer may prove difficult
More people need to get vaccinated against COVID- 19 faster, USA TODAY’s panel of vaccine experts agree, and while President Joe Biden’s administration is making strides, there is concern that the pace isn’t increasing quickly enough.
In email and phone conversations, several members of a panel USA TODAY convenes every month to discuss vaccination progress said the rate of vaccinations needs to double over the next month, from nearly 1.5 million shots a day today to close to 3 million.
At today’s rate of vaccination, trees would be losing their leaves this fall by the time most American adults could be vaccinated.
A faster pace, which should be possible based on the promised supply, would allow Americans to enjoy Fourth of July picnics without much worry and adolescents to be vaccinated in time for the start of school.
The Biden administration pledged this week that enough vaccines would be available for 300 million Americans – 90% of the U. S. population – by the end of July.
It’s not clear, however, when or whether it would be feasible to vaccinate 2 million to 3 million people a day, as our panelists recommended.
Every month, USA TODAY convenes a panel of experts to address questions about the status of COVID- 19 vaccine development, manufacturing and distribution. This month, the panelists found that the country had taken one step forward, with the Biden administration pursuing more concrete actions to fight the pandemic, and one step back, with new variants that threaten vaccines and add urgency to the campaign.
Doubling the pace of shots would require some logistical fancy footwork: arranging for vaccinators and sites, providing reservation systems by phone and online, and programs to help people overcome vaccine hesitancy, among other things, said Vivian Riefberg, a professor of practice at the Darden School of Business at the University of Virginia.
“After we get the early acceptor vaccination, then we have to deal with the skeptics and the hesitant, and that’s going to take even more work.”
Dr. William Schaffner, Infectious disease expert at the Vanderbilt University School of Medicine
Arti Rai, a health law expert at Duke University Law School, isn’t convinced that the supply will be available for such a ramp- up.
Both the Pfizer- BioNTech and Moderna vaccines are made by encapsulating mRNA instructions inside a ball of fat. Making them is complicated, Rai noted, and the process can’t be scaled up on a dime.
“It’s not clear that any legal interventions by the Biden administration can speed up that process,” she said. “But the wise decision made early on to ‘ go big’ on public funding for production should incentivize firms to rapidly transfer even ‘ crown jewel’ knowledge to the fullest extent possible.”
And the process is going much more smoothly than it was a month ago when 75% of vaccines delivered to states were sitting on shelves.
Encouraging signs
Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai in New York City, said he is now more upbeat than ever about the rollout because his older neighbors have been vaccinated already.
Dr. Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group and editor- in- chief of the journal Vaccine, agreed. Two safe, effective vaccines have been administered to nearly 40 million Americans, and a third vaccine, by Johnson & Johnson, is expected to join them within a few weeks, he said.
The J& J vaccine might be a little less protective, Poland conceded, but the fact that it requires only one dose makes it the “perfect vaccine for a younger person, the perfect vaccine for a traveler, or someone who’s heard about side effects” and is concerned. One shot also would mean less chance for side effects.
Poland said he had an unpleasant experience after his own second dose, with fever, chills, headache, ringing in his ears and profound fatigue. The side effects went away after a few hours, but anyone who wants to avoid possibly having the symptoms twice might be happy with one shot and a slightly lower effectiveness rate, he said.
“For myself, whatever vaccine is available among these three – take it,” he said.
What worries Dr. William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee, is that not enough people will take them.
“After we get the early acceptor vaccination, then we have to deal with the skeptics and the hesitant, and that’s going to take even more work,” he said, noting that about 80% of people will need to be vaccinated to stop the virus from transmitting widely. “We’ve never done that with any vaccine in the United States.”
The 15 USA TODAY panelists who responded this month have expertise in a range of topics from virology to logistics. They remain optimistic the vast majority of Americans who want a vaccine will be able to get one by midsummer – but some have become more conservative in their estimates about the progress.
Every month since June, we have asked panelists what time they think it is on an imaginary clock that started
ticking at midnight more than a year ago when people were first infected with the new coronavirus. It will reach high noon when a vaccine is widely available to all Americans. Each month, we calculate the median time, the midpoint of their estimates.
Starting last June at 4 a. m., the clock moved forward an hour every month until November when it jumped ahead 90 minutes to 9: 30 a. m., buoyed by the results of the first two vaccine trials. In January, the clock inched ahead only 6 minutes, from 10: 30 a. m. to 10: 36 a. m. And now, in February, it gained only 9 minutes, creeping to 10: 45 – just 15 minutes past where it stood in December.
Varied views on variants
The new variants have added urgency to the push for vaccinations. If the virus isn’t brought under control soon, the experts worry, vaccines won’t be as useful as they could have been at reining in COVID- 19, and the pandemic will drag on even longer.
“One of the things these variants have done is send a shudder through the general population,” Schaffner said. “They’ve brought home once again that the virus is in charge – just as we thought that with the vaccine we were getting ahead of the virus.”
Rather than disappearing, the SARSCoV- 2 virus that causes COVID- 19 is likely to become a recurring problem, like the annual flu, he said.
“It brings home the fact that we’re going to have to live with this virus for the foreseeable future, not just months but years,” Schaffner said. “This virus is in the process of integrating itself into our ecosystem just as influenza has done.”
He and others reiterated the importance of not giving the virus any opportunities to mutate more. Instead, they said, Americans need to rein in the virus by wearing masks – even double- masking for extra protection – avoiding crowds, washing hands and getting vaccinated when possible.
The variants, said Prashant Yadav, a medical supply chain expert at the Center for Global Development, increase the need for speed in vaccination “to create a backstop against some of the new variants.”
It also requires the U. S. to think seriously about how it might adjust its manufacturing capacity in case new or modified vaccines are needed in the future, he said.
Pamela Bjorkman, a structural biologist at the California Institute of Technology, said she rolled her clock estimate back by 30 minutes this month be
cause of her fears that the new variants could slow down progress against COVID- 19.
And if vaccines don’t work as well against the variants and the virus continues to circulate, “there’s a risk you’ll select for the most virulent pathogen,” said Sam Halabi, a law professor at the University of Missouri and a scholar at the O’Neill Institute for National and Global Health Law at Georgetown University.
Others were concerned about the lack of information about the variants.
“We must increase surveillance,” said Poland of the Mayo Clinic. “This is a moving aircraft, and if we don’t know where we are in the sky, it’s hard to know where we’re going to land.”
The administration plans to increase sequencing tenfold, but the U. S. still lags behind in tracking them.
“I believe the variants are more widespread than we know,” said Riefberg, the business analyst. “Where we have information, we see variants increasing and this seems to suggest community spread.”
Still, several panelists said they are not overly concerned about variants.
Krammer, a virologist, said vaccines are still effective enough.
“We need to get prepared to be able to change vaccine strains if needed, but we are not at the point yet where that would be warranted,” he said.
Dr. Paul Offit, a pediatrician and head of the Vaccine Education Center at Children’s Hospital of Philadelphia, said he won’t worry unless people who are infected with the variants after vaccination get hospitalized and die. Short of that, he said, he’s comfortable assuming that current vaccines still protect against serious disease and death, which is their main goal.
Studies of antibodies suggest that vaccines aren’t as protective against the variants. But that ignores another aspect of the immune system, T cells, which will continue to prevent severe disease after vaccination, said Dr. Monica Gandhi, an infectious disease expert at the University of California- San Francisco.
And once the most vulnerable are protected by vaccines, in some ways it’s not a bad thing if a variant that is more contagious but not more deadly spreads widely, said Prakash Nagarkatti, an immunologist and vice president for research at the University of South Carolina in Columbia.
“I see a silver lining to these variants that spread faster,” he said, “in that they may provide herd immunity in the nonvulnerable population.”
Is enough being done?
A number of panelists said they are happy with what the Biden administration has done in its first month.
Riefberg said she has been impressed by the “clearer communications, consistent messaging on masks and other protective measures, decision to order more vaccine, establishing FEMAdriven mega- sites with a separate vaccine allocation, and a focus on Federally Qualified Community Health Centers to get to greater equity with underserved populations.”
Other panelists said the new administration has done the best it could after inheriting a difficult situation. They universally praised the science behind the vaccines, but several criticized the manufacturing and distribution plans laid during former President Donald Trump’s tenure.
“There was less vaccine initially, and clearly the deliveries were often not on time and didn’t deliver as much vaccine to the states and local locations as anticipated,” Schaffner said. “That’s smoothing itself out.”
But of course, no administration is perfect.
Riefberg and others said there still needs to be more clarity on the allocation of vaccines, and several panelists said they wished the administration would assert more control over the vaccination process, leaving less leeway to the states.
“I am still puzzled by the governors differing across the country in deciding how to follow this tier- based system,” Gandhi said.
Nagarkatti wants the administration to focus on prioritizing vaccines for the high- risk population of every state. “Currently, each state has its own set of priorities, and there are people with certain unique disabilities or disorders that are not listed under the current priorities,” he said.
A better approach would be to allow a patient’s primary care physician to set priorities, he said.
Peter Pitts, a former Food and Drug Administration associate commissioner for external relations, said the administration could be doing more to get out the message that vaccines are safe and effective. “Now it’s time to unleash the power of the bully pulpit,” he said.
Halabi said he fully supports the ambition of distributing the vaccine in an equitable manner, making sure that low- income people of color receive it and are protected against the virus. But that goal might also have some negative consequences.
“It’s admirable that there’s a concern about equity, but those are also populations that have shown the greatest hesitance,” Halabi said. “My concern is that it might result in wasted doses. They need to be doing everything they can to get the vaccine out.”
Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health, also said he’s concerned that not enough people will want to get vaccinated. “Now is the time to work with those who are uncertain – about 40% of the population – especially, to build trust with communities that are skeptical and have a history of not trusting government for good reasons,” he said.