In a speech Friday from Wilmington, Del., President-elect Joe Biden will finally detail his plan to fix America’s troubled COVID-19 vaccine rollout, proposing to more than double the nation’s current investment in vaccination to $20 billion while partnering with states and localities to create community vaccination sites, invoking the Defense Production Act to boost vaccine supply and launching a new, 100,000-person public health force to assist with deployment.
At a moment when COVID-19 cases are rising in nearly every state and deaths are regularly topping 4,000 a day, Biden’s message is clear: Help is on the way.
In sharp contrast to President Trump, who has treated vaccination as the responsibility of individual states, Biden believes it is a national issue that demands federal resources and a federal plan.
President-elect Joe Biden takes off his mask on Thursday before presenting his plan to combat COVID-19 and boost the economy. (Alex Wong/Getty Images)
“This is going to be one of the most challenging operational efforts we’ve ever undertaken as a nation,” Biden said Thursday in a speech unveiling his larger $1.9 trillion COVID-19 “rescue” package, which includes his new, national vaccination program. “We’re going to have to move heaven and earth to get more people vaccinated; to create more places for them to get vaccinated; to mobilize more medical teams to get shots in people’s arms; to increase vaccine supply; and to get it out the door as fast as possible.”
It’s no secret that America’s vaccine rollout has been “a dismal failure thus far,” as Biden put it. When Trump launched Operation Warp Speed, his “Manhattan Project-style” development effort, the goal was to deliver 300 million doses by the end of 2020. Later his administration slashed that estimate to 40 million doses, then 20 million. By the time Dec. 31 finally rolled around, just 2.6 million shots had been administered.
Problems with every aspect of the U.S. vaccination campaign — shortages in the supply chain; lack of funding and coordination from the federal government; resource and eligibility bottlenecks at the state level; even vaccine resistance from medical workers — have slowed the process.
As a result, a mere 3.6 percent of Americans have received shots as of Jan. 14. For a sense of what’s achievable elsewhere, Israel is moving so fast that it has given shots to 16 percent of its combined population with Palestine even though it has caused controversy by refusing to vaccinate Palestinians.
Yet for all the justified concern over America’s rate of vaccination, signs of hope are starting to emerge as Biden prepares to take office. States are addressing the early distribution problems. Additional vaccines are in the pipeline. The federal government is adjusting, with more consequential changes to come.
And most important, the pace of vaccination is picking up.
A man receiving the Moderna COVID-19 vaccine in Arizona. (Cheney Orr/Bloomberg via Getty Images)
It’s worth pausing here to note that America’s mass COVID-19 vaccination effort actually 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 find enough potential hosts to spread. The gold standard, they say, will be getting about 75 percent of Americans (or 240 million people) fully vaccinated. Since both vaccines approved for use in the U.S. (Pfizer and Moderna) require two shots, about 480 million shots will need to be administered to achieve this kind of blanket immunity.
That will be a huge lift. Right now, the U.S. expects to have about 200 million Pfizer and Moderna doses by March and another 200 million by the middle of the summer; other vaccines are likely to follow. To distribute 480 million doses by, say, Sept. 1, we’d need to be administering them at a rate of roughly 2 million a day, every day of the week — and because we don’t know how the vaccines affect transmission, everyone would still need to mask up and maintain social distance measures the entire time.
From that angle, pessimism about vaccination seems justified. As of Jan. 14 — exactly one month after the first U.S. health care workers received their initial doses of the Pfizer vaccine — the U.S. has distributed a total of 30.6 million doses. Fewer than 12 million have been administered. That comes out to an average of 384,000 per day.
“Dismal,” as Biden put it.
Vaccination stations at the New Jersey Convention and Exposition Center. (Mark Kauzlarich/Bloomberg via Getty Images)
But there’s another, more immediate way to look at what vaccination has the power to do: drastically alter the course of the pandemic even before 75 percent of Americans have received two shots.
On that front, it’s reasonable to be at least somewhat optimistic. One week into its vaccination campaign, the U.S. was averaging 76,000 doses per day. A week later, that number had risen to 216,000. But now America is averaging 747,000 shots every 24 hours — a rate that has doubled in just the last week.
To put this in perspective, Biden’s big vaccination promise — to get 100 million shots into 100 million arms in his first 100 days — requires the U.S. to administer 1 million doses per day. America is already on track to hit that mark around the time Biden takes office on Jan. 20. No changes necessary.
Ideally, the pace of vaccinations will continue to accelerate under Biden; the American Hospital Association has called for 1.8 million shots per day, and Dr. Leana Wen, a public health expert and emergency physician, says the daily total should be closer to 3 million.
But in a practical sense, 100 million shots in 100 days could be enough to slow COVID-19 to a crawl.
There are two reasons for this. The first is that your immune system doesn’t wait for two shots before activating. In their clinical trials, Pfizer and Moderna tested two doses spaced three weeks (Pfizer) or four weeks (Moderna) apart. Both found that regimen to be safe and about 95 percent effective in preventing disease.
Yet both companies also reported that by the time participants showed up for their second shot, their first shot was already providing them with a high level of protection. In Moderna’s case, the first (or “primer”) shot appeared to be 92.1 percent efficacious in preventing COVID-19 after two weeks, well before volunteers received their “booster” injection on day 28. Pfizer’s results suggested similar immunity — higher than 80 percent — after 10 to 12 days.
This doesn’t mean Americans should skip their COVID-19 boosters. Far from it. But it does mean that nearly anyone who gets a primer in Biden’s first 100 days will be very unlikely to get sick starting about two weeks later.
Which brings us to the second reason for optimism. Our goal may be to reach herd immunity by fully vaccinating 240 million Americans. But an estimated 88 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.”
To be sure, natural immunity might eventually wane. Studies have yet to show whether the vaccines stop transmission as well as infection. New strains more capable of reinfection might emerge. And many Americans who’ve had COVID-19 will — and should — get vaccinated too.
A pharmacist prepares a syringe of the Pfizer-BioNTech vaccine in Arizona. (Cheney Orr/Bloomberg via Getty Images)
But the fact remains that 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 a layer of artificial intelligence to predict various aspects of the pandemic, suggests we could reach a kind of combined herd immunity — 70 percent of Americans protected by either vaccination or infection — by July 1.
Gu’s model doesn’t expect more than 200 million Americans to have received two shots by then. Rather, it estimates that about 27 percent of Americans, or 88 million people, currently have immunity via infection, and that by July 1 the trajectory of transmission will have increased this number to 36 percent, or 121 million. Likewise, the model estimates that while just 1.1 million Americans currently have immunity via vaccination — which takes hold, the model assumes, three weeks after the initial dose — a full 112 million (34 percent) will have it by the start of July.
That’s enough to give 70 percent of the population immunity of one sort or the other — and to force new daily cases to flatline. Gu’s forecast, which assumes that previously infected Americans will get vaccinated at the same rate as those who’ve never had COVID-19, shows infections plummeting to half their current level by March 1 and about 7 percent of their current level by May 1. This would translate to an average of about 15,000 new daily cases nationwide — lower than at any point since March 2020. Right now the U.S. is detecting an average of 246,000 cases per day.
Can America move this fast? Any model that makes predictions months in advance is subject to uncertainty, and in a disclaimer, Gu explains that “if vaccine rollout and uptake is quicker than estimated, then we may reach herd immunity sooner. If rollout and uptake is slower than estimated, we may reach herd immunity later.” Right now, Gu is estimating that new daily vaccinations — or first shots, to be more precise — will rise steadily until they peak in mid-March at around 2 million doses per day; he expects the U.S. to have administered about 210 million initial shots by the start of July. He calls this a “conservative vaccine rollout, with no major issues or halts,” noting that 2 million doses per day is “slightly lower than the peak vaccine distribution for influenza (~3 million doses per day).”
Boxes of Moderna vaccine vials in a cooler with dry ice at a Florida vaccination site. (Paul Hennessy/NurPhoto via Getty Images)
Whether a “conservative vaccine rollout” is actually achievable, however, remains to be seen. As one senior Biden administration official said on a call Thursday with reporters, “I think it’s clear that what we’re inheriting from the Trump administration is much worse than we could have imagined.”
But again: The U.S. is already on course to hit Biden’s target of 1 million shots per day. The question now is whether we’re putting policies in place that will further speed up vaccination.
That certainly seems possible. After Biden said last week that he intended to release all available vaccine vials rather than reserving half for booster shots, the Trump administration pivoted and decided to do the same — effectively doubling the available supply overnight.
Earlier this week, the Centers for Disease Control and Prevention issued new guidance recommending that states start vaccinating anyone 65 or older, as opposed to just frontline health care workers and residents of long-term-care facilities. This will vastly expand eligibility and ultimately simplify the strict prioritization rules that have led to bottlenecks.
A third vaccine, by Johnson & Johnson, looks like a promising candidate for approval, and it has the added advantages of requiring only a single dose and being easier to transport. Critical results from clinical trials are expected in as little as two weeks. Despite production delays, the company has pledged to deliver 100 million doses by the end of June. That would boost U.S. supply to roughly 500 million doses — enough to fully vaccinate three-quarters of the population by the fall. A fourth vaccine, by AstraZeneca, could be ready for review by April.
Meanwhile, states are starting to think bigger. Stadiums are being converted into mass vaccination centers; in Los Angeles, a site being readied at Dodger Stadium is expected to deliver 12,000 vaccinations a day. And at least 16 states and territories are now using the National Guard to give shots, drawing on doctors, nurses, medics and other troops with medical training.
Spc. Katherine Deskins (left) of the Nevada Army National Guard administers a Moderna COVID-19 vaccination to Clark County Fire Department Capt. Jasmine Ghazinour in Las Vegas on Thursday. (Ethan Miller/Getty Images)
There will, of course, be many, many bumps in the road ahead: tangled bureaucracies, crashing websites, administrative mixups, long lines, online misinformation, glitches in the supply chain, shortages of vaccinators, inequities in distribution, too much demand, too many holdouts.
The big picture, however, is fairly clear — and less pessimistic than prevailing opinion would have it. The ultimate goal of “one of the most challenging operational efforts we’ve ever undertaken as a nation” will be to extinguish the pandemic by vaccinating at least 75 percent of the population. Then and only then can America return to anything resembling normal. That day is still a long way off.
Yet when layered atop America’s broad existing foundation of immunity, vaccination can and likely will start to protect enough additional people to turn the tide of the pandemic a lot sooner than that. It won’t be the end of our battle against COVID-19. But it will be the beginning of the end.
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