If the COVID-19 vaccine rollout seems chaotic and incomprehensible, with numbers that don’t add up and allocations that don’t make sense, you’re not alone.
Even people who study this for a living are at a loss.
“None of us know what’s going on,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
He has been trying to understand how figures from the Centers for Disease Control and Prevention, the White House and the states fit together, but can’t.
“I don’t understand why there’s not more transparency,” he said. “They could easily hold a webinar every day to go through the numbers – this is how many boxes we shipped, this is how many boxes are coming next week. The more they don’t do that, the more acrimony that’s created between states and the federal government.”
Overall, the trends are positive but the pace will need to intensify significantly to meet deadlines the White House announced this week.
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Since Jan. 25, COVID-19 vaccine distribution from the federal government has increased 57%. As of this week, it’s up to 13.5 million doses shipped per week.
“We are on track to have enough vaccine supply for 300 million Americans by the end of July,” Jeff Zients, White House COVID-19 response coordinator, said in a task force briefing Wednesday.
To get the scheduled two doses of the authorized vaccines to 300 million people, distribution from the federal government will need to ramp up by about one-third. At the current level, it would take until September.
Given how fast things have been increasing, that seemsfeasible. However, no actual data on future increases has been announced by the White House.
So, what happened? Why are there questions about supply and deliveries?
If things appear to be on track, why is there so much chaos at the state level, with long lines, people unable to get appointments and clinics closing due to lack of vaccine?
There are several reasons. One is a lack of federal transparency about vaccine supply and shipments and continued fluctuation of vaccine deliveries, all of which confuse and confound states.
Public health officials are frustrated over an ongoing lack of clarity. It’s impossible to know exactly how much vaccine is being shipped and to where and to whom it’s been administered – information they need to plan.
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Vaccine is delivered, and tallied, through several separate programs, including ones for states, nursing homes and long-term care facilities, Federally Qualified Health Centers and private pharmacies. Some doses are controlled by states themselves and some by federal programs.
The National Governors Association sent a public letter to President Joe Biden this week asking for more clarity, including “visibility into the federal vaccination efforts at the facility level happening in our borders.”
The letter cited “the anxiety created by the demand and supply of the vaccine,” and asked for better reporting to avoid confusion.
This didn’t help, either: Some states decided to play by their own rules
States also shoulder a share of the blame. Experts say they opened up vaccinations to ever-widening groups too quickly, even though supplies were in short supply.
“We knew all along there would be a limited number of doses at the beginning and we would have to prioritize,” said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. “Somewhere in there the vaccine got overpromised.”
That hasn’t always happened.
The CDC’s Advisory Committee on Immunization Practices spent months creating a carefully-designed series of vaccine eligibility tiers from the most vulnerable to the least.
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Some state officials promptly ignored the recommendations and began opening up vaccination to broader groups of people, said Plescia.
The ACIP guidelines from December said frontline heath care workers and long-term care facility residents would be first in line, in what was known as Phase 1a. Next could come frontline essential workers and people 75 and older, in Phase 1b. People 65 and older and people with high-risk medical conditions would be in a larger Phase 1c.
Just one week after the first COVID-19 vaccine was distributed, Florida Gov. Ron DeSantis overrode the ACIP guidelines and unilaterally declared his state was prioritizing people 65 and older.
That resulted in long lines, seniors waiting overnight for vaccine, crashing appointment websites and general chaos as Florida’s more than 4 million seniors clamored to get vaccinated.
What needs to happen now to fix this? Let’s start with honest messaging.
Currently, in 35 states plus the District of Columbia, people 65 and older can seek an appointment, according to the White House. But other states haven’t moved beyond vaccinating essential workers and those 75 and above.
Wisconsin’s legislature is debating this week whether to add teachers to phase 1a.
Early finger-pointing that states were going too slow may have driven the rush for speed and bypassing of the guidelines. In any case, he said, vaccine got overpromised.
“We suddenly skipped through the ACIP guidelines and told all these people they were eligible, he said. “I don’t know if that was the most judicious thing to do. It probably would have been better if we’d held our ground.”
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Other states, such as Georgia, have held the line, said Glen Nowak, director of the University of Georgia’s Center for Health and Risk Communications and a former communication director for the National Immunization Program at the CDC.
The governor there has been consistent saying there isn’t yet enough vaccine for the first priority groups so he’s not going to open it up yet. “He’s saying, ‘I hear you, I want to do that. but we don’t have enough vaccine right now,'” Nowak said.
To make the rollout not seem like it’s out of control, states need to manage expectations. “Broadening it isn’t going to help, it’s going to make things worse,” he said.
What’s needed are honest messages that this process can’t happen overnight. While not everyone will get the vaccine immediately, everyone will get vaccine eventually, said Dr. Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group, and editor-in-chief of the journal Vaccine.
“The cure is tincture of time,” he said. Though he did acknowledge, “That’s easy for me to say now that I’ve now gotten both my doses.”
Where Operation Warp Speed fell short: ‘A huge communications failure’
A big part of the problem, since before the first doses of vaccine were shipped, has been the lack of clear, consistent communication, experts say. That’s made the job of explaining what’s happening now with vaccine supply even harder.
Even the man who played a key role in making COVID-19 vaccines possible, Moncef Slaoui, says messaging was a major failure of Operation Warp Speed’s otherwise stellar work.
“It was a huge communications failure, honestly,” Slaoui said of the rollout at a recent New York Academies of Science conference.
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There was no way everyone in America was going to be immunized immediately, he said, but that message didn’t get out. Millions of Americans have expressed anger and frustration about something that Slaoui and his team thought they had clearly explained.
“Every single time we said, ‘We will produce enough vaccine doses to immunize the U.S. population by the summer of 2021.’ It is understood in that statement that it’s going to take six, seven months to have enough vaccine to immunize everybody,” he said. “But, in fact, I think we should have communicated much, much better that there will not be enough vaccine for everybody immediately.”
It’s going to take time to overcome that deficit of trust and information, said Dr. Kelly Moore, deputy director of the nonprofit Immunization Action Coalition.
“We will never recapture the opportunities that were lost to build a solid foundation for the vaccination program before vaccines began rolling out,” she said, “but we’re getting back on track and the signs give me hope.”
Contact Elizabeth Weise at [email protected]