How US can bolster COVID vaccine roll-out after ‘chaotic’ start

Washington, DC – Over the past 10 months of despair and hardship wrought by the COVID-19 pandemic in the United States, the prospect of an effective vaccine was always seen as the light at the end of the tunnel.

That hope appeared to materialise last month when US health authorities approved two vaccines for emergency use across the country.

But weeks after the US Food and Drug Administration (FDA) cleared the Pfizer-BioNTech and Moderna vaccines, public health experts say immunisation efforts have been glacially slow and haphazard.

“The roll-out of the vaccine has been slower than expected, but it’s also frankly been chaotic,” said Kevin Schulman, a professor at the Stanford University School of Medicine in California.

Schulman, who serves as director of industry partnerships and education for Stanford’s Clinical Excellence Research Center, recently published a paper outlining the need for an effective public awareness campaign to promote the vaccine.

So far, there has been no national push to counter misinformation and answer concerns about immunisation. A recent Gallup poll showed that only 65 percent of Americans are willing to take the vaccine, and the acceptance drops to 62 percent in the non-white population.

But that is only one in a long list of challenges facing inoculation efforts.

In the absence of centralised planning, clear federal guidelines, databases of people who should be vaccinated first and the infrastructure needed for mass immunisation, the US is falling far behind the goals it had set for the first weeks of vaccinations.

Missed target

Government officials had said they hoped to inoculate 20 million people by the end of 2020. But as of January 15, just over 12.2 million people had received their first dose of the two-shot vaccine, according to the US Centers for Disease Control and Prevention (CDC).

The CDC did not return Al Jazeera’s request for comment on the vaccine roll-out.

In an interview with NBC News on Friday, US Health and Human Services (HSS) Secretary Alex Azar, who resigned a day later over President Donald Trump’s handling of the Capitol riots, appeared to blame states for the slow delivery of the vaccine.

“We’ve had tremendous success having these incredibly effective vaccines – 38 million doses of vaccine available, 31 million shipped and distributed already; we’re up over 12 million shots at arms,” Azar said.

“We’ve had some governors that have been overly prescriptive and restrictive in the groups of people that they’re trying to get vaccines out to.”

The now-former HSS secretary said the federal government’s “call” to governors has been to administer the vaccine to everyone over the age of 65 and anyone with pre-existing medical conditions to “protect the vulnerable”.

However, in the same interview, Azar acknowledged reports that there were no reserve stockpiles of second doses of the vaccine, contradicting earlier statements that the second shots are in reserve.

He said he was confident that the “ongoing production” will be able to “provide the second dose for people”, however. The HHS Department did not respond to Al Jazeera’s request for comment over the weekend.

But Schulman decried a lack of planning in the months prior to the FDA approval.

“This is all stuff that should have been worked out months ago – about how we were going to develop lists, how to prioritise people for the vaccine, and then how are we going to physically set up immunisation clinics,” he told Al Jazeera.

“Those conversations are going on now, but they could have been going on for months.”

Biden’s plan

US President-elect Joe Biden, who will be inaugurated on January 20, has called the roll-out of the vaccine a “dismal failure thus far”, pledging to establish a fast-moving immunisation campaign that would deliver 100 million shots in the administration’s first 100 days in office.

“Our plan is as clear as it is bold – get more people vaccinated for free, create more places for them to get vaccinated, mobilise more medical teams to get the shots in people’s arms, increase supply and get it out the door as soon as possible,” Biden said in a speech on Friday.

Mouhanad Hammami, chief health strategist in Michigan’s Wayne County, home to the city of Detroit, said he is “very optimistic” about Biden’s plan – and, in particular, the promise to make the vaccines more readily available.

“There are plans to increase the supply to states and eventually us and other health systems and not to hold off on those vaccines, which will help tremendously,” Hammami told Al Jazeera.

“I hope that also there is consideration for funding to increase capacity. With more vaccines, you will need more people to vaccinate; you will need a system that can accommodate that increase in supply.”

Hammami said he expects that authorising other vaccines, including the Oxford-AstraZeneca shot that the United Kingdom approved in late December, would help address the issue of supply.

The federal government had initially given the impression that it has millions of vaccine doses in reserve. But Azar’s acknowledgement on Friday that the stockpiles are depleted confirms that supply is becoming an issue.

The US had ordered a total of 400 million doses of the Pfizer-BioNTech and Moderna vaccines by the end of 2020 – enough to vaccinate 200 million of a population of 328 million. But the timeline for delivering the doses is unclear.

In May 2020, the US government also pre-ordered 300 million doses of the Oxford-AstraZeneca vaccine, which is still going through the approval process.

$20bn for vaccine distribution

On Friday, Biden said he would allocate $20bn of his $1.9 trillion COVID-19 relief package to the vaccine distribution plan.

The funds would help establish federally-backed vaccination centres and mobile clinics and assist states and local health systems to deliver the vaccine – logistical support that would be needed to administer one million vaccines daily.

“Knowing that not all states and jurisdictions have the resources to scale vaccinations at the pace this crisis demands, the Biden-Harris administration will leverage federal resources and emergency contracting authorities to launch new vaccination sites and to expand state and local efforts across the country,” the Biden transition team said in a statement on Friday.

The Infectious Diseases Society of America (IDSA), a Washington-based advocacy group of health experts who specialise in infectious diseases, voiced support for Biden’s call for increased funding for the vaccination effort.

“The incoming Administration’s proposal comes at a pivotal moment, and we recommend further comprehensive measures to realize its goals,” the group said in a statement. “To ensure vaccine access to those most at risk, expansion must be rapidly phased in with adequate resources and capacities.”

Congressman Frank Pallone, the chair of the House Energy and Commerce Committee, which oversees public health, also lauded Biden’s plan for pushing to provide “additional resources and assistance” to combat the virus, “including for lifesaving vaccine distribution”.

“These investments will protect the health of the American people and help us crush this virus so we can rebuild our economy,” Pallone said in a statement.

Priority stages

Michigan’s Wayne County has been one of the hardest hit parts of the country, with the virus killing nearly 4,000 people of a population 1.7 million.

Hammami said the unprecedented magnitude of the vaccination campaign has forced health experts and authorities to tackle challenges on the go. “It’s kind of like building the plane as we’re trying to fly with it,” he said.

The two main local challenges, Hammami said, are vaccine availability and figuring out how to move from one priority group to another to get as many people as possible inoculated.

The county had administered more than 40,000 doses by mid-January, and Michigan Governor Gretchen Whitmer is seeking permission from federal officials to buy 100,000 doses of the Pfizer vaccine directly from the manufacturer to address a “two-week lag” in supply.

The CDC has recommended vaccinating people in stages based on their jobs, age and medical condition. In the first phase, vaccines have been going to healthcare workers – who are easy to identify, locate and access through the health facilities they work for.

But as many states and counties are moving to the second phase – people over the age of 65 and front-line essential workers – they are struggling to build databases of individuals who should be vaccinated now.

Hammami added that reluctance to take the vaccine complicates planning efforts as it is not always clear how many people within a particular vaccine priority group are actually willing to get the shot.

Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who is advising the Biden transition, has called for loosening adherence to the priority groups to make sure that vaccines are administered, not lingering in storage.

“If you have a dose, give it, and don’t be so rigid as to those early designations,” Fauci told NBC’s Today show on Friday.

Fauci added in a separate interview on Sunday that Biden’s promise to deliver 100 million vaccine doses in his first 100 days in office is “absolutely a doable thing”.

Greater awareness

Schulman, of Stanford, said another problem is that private and public health systems “don’t necessarily synchronise at all” – but said it is too late to try to build public infrastructure to administer the vaccine.

Instead, he called for empowering existing networks with increased funding and logistical support.

Ultimately, if the US is to get the pandemic under control, vaccine supplies must be available and public health authorities must develop public awareness campaigns to encourage people to get the shots.

“The two tragedies would be to get people to come in because we think we’re going to have the vaccine available, and we don’t have it available because we didn’t get our shipments,” Schulman said.

“And the worst tragedy would be to find out that we have the vaccine available so we can administer it, but we don’t have enough people to vaccinate.”