The rollout of the COVID-19 vaccine in New York State and elsewhere has been marred by confusion and limited supplies of vaccines. In New York, the state portal does not provide an easy way for people to identify all the locations that have the vaccine, or to sign-up, other than for sites operated by the state. State vaccine locations ran out of reservation availability within two days of when eligibility was extended to those 65 or older, even though reservations were scheduled on the site from late January through much of April.
Both the State and Federal responses to date have suffered from a lack of clear explanations of the roadmap for administering vaccines. Instead, the Trump administration’s messaging focused on the success of Operation Warp Speed in developing effective vaccines. But, the administration never provided clear guidance or support to states and localities about the distribution process. Nor did it provide the public with a clear and realistic explanation of how long to expect the process to take or of milestones along the way. Finally, by recommending in mid-January to states that they open vaccine eligibility to those over 65 and to many categories of workers, the Trump Administration created a huge excess of demand over supply, resulting in overwhelming public anxiety and frustration. The Biden Administration compounded the error by promoting the same policy.
In New York State, vaccine distribution policy seemed to lurch from one approach to another, again without a roadmap. Initially, responsibility for distribution was assigned to a set of regional hospital centers. Then counties were told that they would be given a role. In actuality, distribution to those over 65 was assigned to a small number of state-operated mass vaccination centers, leaving older residents of much of the state with no easily accessible locations to receive vaccines. Most recently, Governor Cuomo has said that some pharmacy chains would carry significant responsibility for administering vaccines to senior citizens. Given that New York, like other places, has had at least six months to put together and communicate a strategy, the State’s ineptitude has been surprising.
Although the State’s response could have been better, the fundamental limitation on access is the amount of vaccine available from the Federal Government. Governor Cuomo pointed out that the actual availability of the COVID vaccine from the Federal Government has fallen far short of what was initially promised. He wrote in his NYS Coronovirus Update on January 15th, “We want to get shots in arms as fast as possible, but our biggest constraint at the moment is the limited vaccine supply from the federal government. We have our distribution network up and running and are working to expand it every day—but we can only vaccinate as many New Yorkers as we have supply for. ”
The difficulties resulting from the scarcity of vaccine availability have been exacerbated by variations in the number of injections made available by the Federal Government on a week to week basis. New York City reported on January 20th that it rescheduled 23,000 vaccine appointments because of delays in receiving vaccines. Because of the uncertainty about the number of doses arriving from one week to the next, those responsible for scheduling vaccination appointments face uncertainties in the number of shots that they will actually receive.
The Biden Administration has made two recent changes in the Federal Government’s approach to vaccine distribution. First, it has increased available doses from 8.5 to 10 million per week. Second, it has committed to providing information about future dosage availability to states three weeks ahead, to allow for orderly planning.
But, delivering COVID-19 vaccine doses at a 10 million per week rate is far short of what would be needed to assure that all those adults who want the vaccine could receive it by early fall. For New York, which has 6.1% of the nation’s population, available doses would increase to about 610,000 per week.
Since two doses must be reserved for each person receiving a COVID vaccine, the state can only allocate half of the 610,000 doses each week for first dose recipients. Given that about 5.8 million of the seven million residents currently eligible have not yet received even a single dose, at least nineteen weeks would be required to provide the first dose to everyone eligible now – the process would not be completed until mid-June.
Providing vaccine to all 15,300,000 New York residents 18 years old or older would take even more time – six and one-half months after the current group of eligible residents is vaccinated. The process would not be completed until the end of 2021. Coincidentally, if that number of New York’s residents is vaccinated, the state would achieve so-called “herd immunity,” the level at which infections would be unlikely to spread within the population.
The consequences of the current slow pace of vaccinations are stark. Deaths from COVID have exceeded 4,000 in recent days, while the economy again weakened in December as additional limits on in-person businesses like restaurants, fitness centers, and the like were imposed in some places because of the increased spread of COVID-19. Allowing the disease to continue to infect people at high rates for the next year and a half would create an unacceptable human toll while continuing to devastate the economy.
Some political leaders have expressed the belief that the United States could achieve herd immunity – 80% of the population vaccinated – by early Fall. To achieve this within eight and one-half months – the beginning of October – would require the pace of vaccinations to increase substantially.
How the Rate of Vaccinations could be Increased
President Biden’s action to increase vaccine dose shipments to 10 million a week is a modest start to what is needed to achieve herd immunity by the fall. But, existing commitments from vaccine manufacturers Moderna and Pfizer could put us much closer to the goal than the current pace suggests. Both companies have made substantial commitments to produce large volumes of the COVID vaccine by Summer. The Trump Administration had contracted with each firm to produce 200 million doses of vaccine by the end of June in Modena’s case, and with Pfizer by the end of July. Four hundred million doses by the end of July would be enough to vaccinate 200 million Americans – more than 75% of what would be needed to achieve herd immunity.
To inoculate 200 million Americans in six months would require that more than 15.5 million shots be administered each week if production and distribution were at a constant level during the period. In reality, vaccine availability is expected to gradually increase, with more shots delivered on a weekly basis later in the period.
Much of the Biden Administration’s strategy focuses on supporting state and local distribution efforts and on ensuring the availability of needed materials such as syringes and the like, but to achieve herd immunity by the fall, the Administration must work with manufacturers to increase the supply substantially from the current rate.
Although Pfizer and Moderna are the only producers of currently approved vaccines, others are currently being evaluated in clinical trials. Among the vaccine in development, several received funding from the Federal Government along with commitments to purchase hundreds of millions of doses. Dr. Anthony Fauci, the President’s top advisor on COVID-19 recently stated that two vaccines are likely to submit clinical trial data to the FDA within weeks.
The first is the Oxford/Astra-Zeneca vaccine, which has been approved in six nations. The vaccine has shown mixed results in trials, ranging from 62% to 90% effective in trials, depending on the method of administration. However, more data on the vaccine’s performance for those over the age of 55 is needed before the vaccine could receive approval in the United States.
Johnson & Johnson is also likely to submit trial results within weeks. The Johnson & Johnson vaccine, if approved for administration of a single dose per patient would have a significant benefit in potentially providing more people with immunity quickly. However, J & J is also testing the vaccine with the administration of two doses per patient, so at this point, it is uncertain which method might be approved.
If these two vaccines receive FDA approval soon, the benefits could be substantial. For example, if the manufacturers were able to achieve production levels equal to the current producers, the time required to achieve herd immunity could be cut in half. If Johnson & Johnson’s vaccine were to be approved with the administration of a single dose, the time could be even shorter.
Although the development and approval of two vaccines to combat COVID-19 is a substantial achievement, the distribution of vaccines has gotten off to a slow start. Both the Federal Government and New York State failed to lay out clear roadmaps for vaccine distribution, appearing to develop distribution strategies that lurched from approach to approach.
Because the Federal government encouraged states to open up vaccine eligibility to all those who were 65 years old or older along with relatively large groups of workers who have jobs that require direct interpersonal contact, the demand for COVID vaccine is far greater than the supply.
Without a substantial increase in the rate of vaccine production, the United States is in for a prolonged period of high levels of infections, hospitalizations, and deaths. Unemployment will remain high, particularly in industries that require direct personal interactions, like restaurants, travel, and amusement establishments. Activities like education and health care will continue to be disrupted by restrictions needed to slow the spread of infection
Increased vaccine production through the Spring and Summer would relieve the current demand/supply imbalance. But distribution challenges and potential production material shortages could slow the process. The new Administration’s proposals to provide more support for states and localities that will be delivering the vaccines to recipients would help ensure that the sorely needed vaccine reaches the public more quickly.