6 reasons America's vaccination mess is about to get better

Andrew Romano
·West Coast Correspondent
·13 min read

For weeks, the news about America’s slow, sloppy COVID-19 vaccination rollout has been dispiriting. There’s been too much demand and too little supply, with seniors struggling to schedule shots and providers forced to cancel appointments. At the same time, roughly half of the distributed doses haven’t even been administered.

Yet, as President Biden’s COVID-19 response team held its first press briefing Wednesday, signs of improvement were beginning to emerge.

“I know many Americans are anxious and eager to get vaccinated,” said Biden coronavirus adviser Andy Slavitt. “We are taking this issue on with urgency and purpose, despite not inheriting a fully developed strategy or infrastructure to make vaccines available to Americans.”

“It’s going to be a logistical challenge that exceeds anything we’ve ever tried in this country, but I think we can do that,” Biden said Monday. “I feel confident that by summer we’re going to be well on our way to heading toward herd immunity. I feel good about where we’re going, and I think we can get it done.”

Here are six reasons why you should expect the vaccination situation to keep getting better in the coming weeks.

1. Biden is now aiming for 1.5 million shots per day

Joe Biden
President Biden speaking about the coronavirus pandemic on Tuesday. (Doug Mills/Pool/Getty Images)

The president and his new COVID-19 response team leader Jeff Zients have been facing blowback for initially vowing to administer just 100 million shots in the president’s first 100 days.

As many critics have pointed out, vaccination was already approaching that pace (1 million daily shots) when Biden took office; now, one week later, it’s up to 1.3 million, on average.

In response, Biden has finally set his sights even higher. “I think with the grace of God . . . we’ll be able to get that to 1.5 million a day,” the president told reporters Monday. “That’s my hope.”

Pfizer and Moderna have each committed to delivering 100 million doses of their respective vaccines by the end of March, one month before the end of Biden’s first 100 days, and Pfizer recently announced that it will be able deliver an additional 20 million doses by then, bringing the total U.S. supply through March to 220 million doses.

So far, about 47 million doses of the two vaccines have been distributed; about 25 million have been administered, according to data from the Centers of Disease Control and Prevention.

In light of those numbers, the U.S. will have more than enough vaccine on hand to reach Biden’s new goal of 150 million additional shots between Jan. 20 and April 30. That, in turn, would be enough to fully vaccinate roughly 80 million Americans — or nearly double America’s entire population of senior citizens — by May. Both vaccines require two doses.

If this accelerated pace continues through the summer, about 180 million Americans could be fully vaccinated by the fall, or 70 percent of all eligible U.S. adults. Neither vaccine is approved for use in children under 16.

What’s more, there’s reason to believe that the U.S. — which, again, is already administering 1.3 million shots per day, despite a chaotic presidential transition — can get shots in arms even faster than that. Influenza vaccinations, by comparison, top out around 3 million shots per day, and if all the expected COVID-19 supply were used, the U.S. could soon average well over 2 million shots per day.

2. Short-term supply glitches are being resolved

Linda Schwamm
A resident of Mount Dora, Fla., receives a shot at a COVID-19 vaccination site. (Paul Hennessy/NurPhoto via Getty Images)

Part of the reason the U.S. vaccination rollout has seemed so hopeless in recent days is that some states haven’t had enough supply on hand to vaccinate all the eligible seniors who want to be immunized, causing websites to crash and appointments to be canceled.

But that problem may be temporary. On Jan. 13, the daily number of doses distributed to the states peaked at 1.7 million. At precisely the same time, the Trump administration told state governments that it would be releasing doses previously held in reserve for second shots and advised them to open eligibility to everyone 65 or older.

Demand surged. But counter to expectations, supply suddenly plummeted, falling day after day before bottoming out at 495,000 on the eve of Biden’s inauguration. For the first time, the number of doses administered in one 24-hour period actually exceeded the number of doses distributed.

It turns out the Trump administration had already been secretly releasing its so-called stockpile of second doses for weeks, temporarily inflating the supply numbers. By the time the states opened their eligibility floodgates, the reserves were exhausted. At the very moment states were expecting more shots, they got far, far less. Seniors suffered, and everybody else looked incompetent.

The latest trend lines, however, suggest that while demand remains sky-high, the stark shortages of the last week could be a thing of the past. Every day since Biden took office, more doses have been distributed than administered, and the number distributed has been rising even faster than the number administered. On Jan. 26, the number of vaccines being distributed on a single day hit a new high: 1.9 million.

Even more important, Slavitt announced at Wednesday’s briefing that the Biden administration has committed for the next three weeks to increasing the number of weekly doses distributed by 16 percent, guaranteeing that at least 10 million doses will reach the states during each of those weeks. This pledge, Slavitt explained, provides states with something they have lacked so far: the “visibility” and predictability they require to know how many vaccines are coming in and to keep commitments to partners and residents.

3. Longer-term supply is also increasing

A vial of Pfizer’s COVID-19 vaccine
A vial of Pfizer’s COVID-19 vaccine. (Jacquelyn Martin/Pool via Reuters)

Wednesday’s briefing also made it clear that the U.S. isn’t facing a long-term supply problem. Pfizer and Moderna are already under contract to deliver 200 million doses by the end of March and another 200 million doses by July. This week, Biden announced that his administration is on the cusp of securing an additional 200 million doses from Pfizer and Moderna over the summer. That would total 600 million doses — enough to fully vaccinate all 260 million Americans who are currently eligible and then some.

“This is a wartime effort,” Biden said on Tuesday.

And that’s just the supply of vaccines already approved for emergency use by the FDA. More are coming. Next week, Johnson & Johnson will release the results of phase III clinical trials for its highly anticipated vaccine, which is easier to transport than Pfizer’s and Moderna’s — and only requires a single dose.

Alex Gorsky, the company’s chairman and chief executive, said on a call with analysts this week that he is optimistic about the 45,000-person trial, noting that the results from a smaller, early-stage study were positive. “We are hopeful that’s a good precursor to the kind of efficacy and safety that we’ll see in a larger population,” Gorsky predicted. The J&J vaccine will likely be approved in February, and the company has pledged to deliver enough doses to fully vaccinate 100 million people by the end of June.

Likewise, when asked if the administration was considering using the Defense Production Act to compel other companies to manufacture additional doses of the vaccines, Zients confirmed that the idea is under discussion.

“400,000 people have died,” he said. “Everything is on the table across the whole supply chain. From low dead-space syringes to other pharmaceutical companies to anything we can do to increase the vaccine supply and the timing of the delivery ... and we will execute accordingly.”

4. More vaccinators and vaccination sites are coming, too

Health workers
Health workers prepare to administer COVID-19 vaccines at a new site in New York City. (Kena Betancur/AFP via Getty Images)

Another important nugget from the White House briefing: Zients said the Department of Health and Human Services would be amending the Public Readiness and Emergency Preparedness Act to recruit retired doctors and nurses to administer shots and permit doctors and other practitioners licensed in one state to administer shots across state lines.

On top of this, the Biden team is pursuing several other pathways to increase the number of places where Americans can get vaccinated and the number of people who can do the vaccinating: opening 100 new federal community vaccination centers in 100 days; activating FEMA (along with $1 billion in FEMA funding) to support state vaccination sites; sending vaccines directly to retail pharmacies; expanding the public-health workforce by 100,000 people and reimbursing governors who activate the National Guard to assist with vaccination.

5. Fauci has a plan for COVID-19 variants

Anthony Fauci
Dr. Anthony Fauci at a White House press briefing last week. (Alex Wong/Getty Images)

The current state of the U.S. pandemic is often framed as a race between the approved vaccines and the new, more transmissible coronavirus variants recently discovered in places such as the U.K., South Africa and Brazil. While existing vaccines can still work against small mutations, others can diminish their effectiveness.

Dr. Anthony Fauci, the nation’s top infectious disease expert and Biden’s top COVID-19 adviser, acknowledged the situation on Wednesday — but he also provided some much-needed perspective.

“The important question that people ask is what is the impact” of these variants on the effectiveness of the vaccines, Fauci said. With the U.K. variant, “what we’re seeing is a very slight if at all impact on vaccine-induced antibodies and very little impact on anything else. So we are covered with that.”

But “things get a bit more problematic when you go to [South Africa],” he continued. “In that regard, there is a moderate diminution ... in the in-vitro neutralization by vaccine-induced antibodies. However — and this is an important ‘however’ — it still is well within the cushion of protection. So you could diminish the vaccine-induced antibody efficacy by a few fold and still be well within the protected range of the vaccine.”

In other words, “the vaccines that we are using are still effective” against these variants, Fauci said. Maybe not 95 percent effective — but still very, very effective. The forthcoming Johnson & Johnson trial results may provide more proof to back this up, Fauci explained. “It’s going to be looking at efficacy not only in the United States, but also in South Africa and in Brazil,” he said. “What will we see is the relative efficacy” of the vaccine against those different variants.

The issue going forward, however, is “what the further evolution of this might be,” Fauci added — whether the virus might continue to mutate to the point where the current vaccines don’t offer enough protection.

Fauci assured listeners that the National Institutes of Health and the Center for Disease Control and Prevention are on the case.

“We will always want to be a step or two ahead of what might be a problem in the future,” Fauci said. So “the NIH will be collaborating with the CDC [and] monitoring in real time the effect of antibodies that we induce with the current vaccine and future vaccine as to what impact they have on the ability to neutralize these mutants. And as we see them getting further and further to a more vulnerable [place], that’s when we [start] making a version of the same vaccine that would in fact be directed specifically against the relevant mutant. All of that is going on in real time, literally as we speak.”

Fauci went on to say Moderna, Pfizer and others could have “boosts” ready to roll if and when vaccine-resistant variants take hold in the U.S.

6. Cases are declining fast

Merlin Pambuan
ICU nurse Merlin Pambuan leaves a hospital in Long Beach, Calif., where she spent 8 months recovering from the coronavirus. (Lucy Nicholson/Reuters/TPX Images of the Day)

Generally speaking, variants emerge and spread when infections are rampant. It’s possible that the U.S. might be passing the peak of the pandemic and heading toward a stage when the virus starts running out of people to infect.

To wit: new COVID-19 cases are down 33 percent over the last two weeks and hospitalizations have fallen 13 percent.

It’s worth pausing here to note that America’s mass vaccination effort has two overlapping goals. The first — because every other measure has clearly failed — is to stop the spread of the virus. The second is to vaccinate so many people that it won’t start spreading again.

These aren’t quite the same thing. Experts define “herd immunity” as the point when so many people gain protection that the pathogen can no longer easily spread from host to host. The gold standard, they say, will be getting about 75 percent of Americans (or 240 million people) fully vaccinated.

But there’s another, more immediate way to look at vaccination: It has the power to drastically alter the course of the pandemic even before 75 percent of Americans have received two shots.

So while our goal may be to reach herd immunity by fully vaccinating 240 million Americans, an estimated 90 million Americans have already been infected — and they have some immunity too. A new, five-month-long U.K. study found that previously infected participants were about 83 percent less likely to get infected than those who’d never had COVID-19; another recent study suggests that such protection could last for “years, maybe even decades.”

In short, there’s already a vast amount of immunity out there in America. Layer vaccination on top of that existing immunity and the virus starts to run out of people to infect sooner than you might think.

How soon? Nobody knows for sure. But a forecast by independent data scientist Youyang Gu, who has been using a data-driven approach with artificial intelligence to predict various aspects of the pandemic, suggests that as vaccination increases, cases could fall to half their current level by April and flatline by May. By July 10, we could reach a kind of combined herd immunity — 70 percent of Americans protected by either vaccination or infection.

All it would require, Gu estimates, is about 120 million Americans, or half of that 70 percent, to acquire immunity through vaccination. The other half would consist of Americans who acquired immunity through infection.

Is this plausible? At Biden’s pace of 1.5 million vaccinations per day, roughly 120 million Americans would be fully vaccinated by the middle of June — ahead of Gu’s forecasted schedule.

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