Vaccine launch stumbles when the ‘Hunger Games’ approach leaves states and counties to their own devices

Earlier this month, in Fort Myers, Florida, seniors spent a night in line outside a local health office for the chance to get their coronavirus vaccine. In Phoenix, computer failures sent health workers driving across the state to remote vaccination sites.

Although the reasons for the delays vary by state and county, the main causes boil down to two problems: the scarcity of supplies and the unpredictability of the size of remittances, say more than a dozen experts and health officials who spoke with CNN.

Meanwhile, there is concern among local and state health officials that the supply crisis leaves people who have taken a dose of the vaccine unable to get the second and last dose in time.

Some attribute the logistical nightmare to the lack of a central message from Operation Warp Speed, the federal initiative to inoculate Americans.

“It looks like the feds ‘plan stopped at the state’s borders, and states expected the feds’ plan to end up in people’s hands,” said Dr. Amy Compton-Phillips, clinical director of the Providence health care system, which includes 51 hospitals. CNN. “I think having a federal plan would absolutely preclude the ‘Hunger Games’ approach for each individual state, each county fighting for its own set of rules.”

President Joe Biden said he plans to increase vaccination in the coming weeks.

The pace of vaccination is accelerating. As of last week, the United States had administered about 462,000 doses a day. That went up to almost a million in the past week.

And the government has announced that while it remains committed, for now, to delivering 100 million doses in the first 100 days – an average of 1 million per day – it will increase weekly supplies, increase transparency and purchase additional vaccines from the two companies with circulating vaccines. , Pfizer and Moderna.

The aim of the plan is to fully vaccinate 300 million Americans by the end of the summer and obtain collective immunity, in which the percentage of the immunized population is so high that transmission from person to person is unlikely.

Vaccine demand exceeding supply

Noting the new dangerous variants, Hotez said that time is of the essence and stressed that other vaccines, in addition to the two versions in use, need to be authorized quickly.

“The variant seems to be accelerating and scaring everyone, including me,” said Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, Texas.

Both vaccine manufacturers – Pfizer and Moderna – say they are on track to supply the federal government with 200 million doses each by July 31, as defined in their contracts.

“Production and launches are not linear and we explain that we have successfully increased our production yields over time,” said a spokeswoman for Moderna.

Still, the day-to-day granular reality of putting vaccines in people’s arms has been a logistical nightmare for many providers across America.

Officials in Louisiana say they could be vaccinating more people if it weren’t for a major and far-reaching problem.

“We are simply limited by the supply we receive,” said Dr. Joseph Kanter, the state’s chief health officer and the chief physician of the state’s health department. “There is simply a lot more demand than the vaccine available. There are many more eligible people who want the vaccine than the vaccine we have to give ”.

Inside Atlanta’s Mercedes-Benz stadium, the mass vaccination center can vaccinate up to 2,000 people a day. But on Monday, there were only 150 appointments.

“We are preserving appointments for how many doses are available,” Sarah Apatov, a volunteer who was administering the doses, told CNN.

Health officials in Georgia said they are launching the vaccine as soon as possible. Dr. Lynn Paxton, district director of health for Fulton County, said her team has the capacity to vaccinate 50,000 people a week, but has had to settle for about 10,000.

“We have to be very careful about how we schedule our commitments,” she said. “And the important thing I want everyone to know is that we are by no means accumulating these doses of vaccine.”

Unpredictable shipments hinder planning

Some officials told CNN that the size of the dose shipments they received is totally out of step with expectations, hampering their efforts to plan properly.

“The things the federal government said it would do, which was to distribute vaccines to the states and give them a sense of how many doses they would receive based on the size of their population, that doesn’t seem to work the way they said,” said Jen Kates , senior vice president and director of global health and HIV policy at the Henry J. Kaiser Family Foundation. “States to counties at the facility have no predictability or visibility on the number of doses they will receive, whether in a week or two or even next month. “

Provpton Health’s Compton-Phillips said the planning challenges forced hospitals to refuse even people over 65 with heart disease.

“We are saying, ‘We are sorry, but we do not have a vaccine for you today and we are not sure what our supply will be and we are not sure when we will be able to administer it,'” she said. “So, it is a very uncomfortable position to be in.”

Lori Tremmel Freeman, of the National Association of Municipal and Municipal Health Officials, calls the situation “a world of uncertainty”.

“This becomes a tremendous problem when they are trying to plan mass vaccination clinics, drive-through clinics, scheduling for all these priority groups and … really getting things going,” she said.

In Washington State, a surprise change in plans is likely to force thousands of residents to find a new location to receive their second dose.

“We had a clinic in downtown Seattle that had been operating for the past few weeks, doing more than 2,200 immunizations a day,” said Compton-Phillips of Providence. “We heard last week that our allocation would be cut by 90 percent so that they could take the same amount of vaccine that the state is receiving and distribute it … How are we going to get dose two for everyone?”

Some state officials are so frustrated with the scarcity of supplies that they are taking advantage of second dose reserves.

Last week, Colorado Governor Jared Polis instructed providers “to use all the Moderna and Pfizer vaccines they have, including those that were designated as second doses to use as first doses this week.” The directive applies to people aged 70 and over.

Similarly, in Utah, authorities will reassign second doses for people who have not shown up to obtain them in a week as first doses.

In New York City, Mayor Bill de Blasio said Biden should order governments across the country to reassign second doses as first doses immediately.

“Start using them now,” he said on MSNBC, adding that sitting on them “doesn’t make sense”.

A former Trump administration official, who spoke on condition of anonymity due to the lack of authorization to comment publicly, said states that want a more predictable cadence of supply can solve the problem by stocking up on the vaccine for three or four weeks.

“But I don’t think local or state public health departments would like that, because the goal is to distribute the vaccine as quickly as possible,” said the official. “So in that environment where you are sending doses at the edges of them coming out of the lines, there is only inherent uncertainty.”