This week, the Trump administration announced that it would release all the available COVID-19 vaccines from its stockpile to ensure more people over the age of 65 can get a shot. The move followed President-elect Joe Biden’s declaration last week that he would release all the existing doses of the COVID-19 vaccine in order to get more people vaccinated faster. Both plans raise lots of questions for health researchers and public health experts.
The two COVID-19 vaccines available in the U.S.—from Pfizer and Moderna—each require two doses to be effective. So far, doctors and nurses have been holding back one dose of the vaccine for every dose they administer in order to ensure that there is an available dose on hand when people come in for their second inoculation. However, some public health experts have suggested that all available vaccines should be administered as soon as possible. The concern with this latter approach is around supply. If there are any hiccups in vaccine production, that may mean that people who need a second dose will not get it within the prescribed time period.
Health experts worry that if second doses are delayed they may not be as effective. The current vaccine efficacy rates are based on subjects receiving a second dose three weeks (Pfizer) or four weeks (Moderna) after the first. Only one COVID-19 vaccine, from AstraZeneca, has tested spacing out its vaccine doses two to three months apart. It’s not clear what kind of protection a single dose of COVID-19 vaccine from Moderna or Pfizer offers before the booster is administered. Some experts are also concerned that an overly delayed second dose could lead to vaccine resistance.
Still, politicians around the world are considering prioritizing getting single doses into more arms over ensuring that everyone gets the two-dose regimen in the prescribed time. The U.K., for example, has decided to stretch the window for getting a second dose to 12 weeks, while the U.S. Food and Drug Administration has advised against changing the inoculation schedule. Biden’s team has not explicitly championed the first-dose approach, but it could end up employing it incidentally if the U.S. doesn’t get enough supply of the vaccine in a timely fashion.
As of Monday, more than 25 million vaccines had been distributed in the U.S., but only nine million doses had been dispensed, according to data from the Centers for Disease Control and Prevention. As president, Joe Biden has promised to vaccinate one million people per day within his first 100 days in office. It’s an ambitious goal given the current rate of vaccination and the overall disjointed pandemic response in the U.S.
Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes, isn’t sure that releasing more vaccines will help distribute them to more people. “I don’t think it’s as obvious as it seems at first blush,” he says.
There are two key questions that Bach says need answering. The first is whether Pfizer and Moderna have enough production capacity to ensure that people who get a first dose of their vaccines can get a second dose within the recommended time frame if healthcare providers stop holding a second dose in reserve. The second question, he says, is whether introducing more vaccine supply will overwhelm healthcare providers, giving them more vaccines than they can possibly administer. (In some places, vaccines are going to waste because hospitals can’t find enough people who are approved to get the vaccine.)
We need a tech platform
Hospitals have encountered myriad roadblocks during the vaccine rollout. These issues have arisen from a lack of coordination at the federal level. States, cities, and other localities have developed their own uncoordinated plans to distribute vaccines—all of which appear to be facing problems. “Not a single state is blowing through its stockpile [of vaccines],” Bach observes.
The American Hospital Association (AHA) highlighted some of the issues hospitals are facing with vaccine distribution in a recent open letter to Alex Azar, head of the Department of Health and Human Services.
“Throughout the country, we are hearing of issues that need to be addressed, including hearing that some hospitals received far less vaccine than they requested and needed, while others received more than they could use for Priority 1 individuals, but without an explanation for this mismatch,” reads the letter. The organization asked HHS whether it planned to assess each of the 64 local plans currently in operation to determine whether they will collectively ensure that 75% of Americans are vaccinated by May.
The organization also requested that HHS make clear how much progress is being made toward vaccination goals for each region, rather than giving broad status updates on how many vaccinations have been given in each state. The AHA also asked for better communication from HHS and a defined process for resolving issues as they arise.
“We need a digital vaccination platform,” says Dr. Leo Nissola, immunotherapy scientist and investigator at the National Convalescence Plasma Project. He says there needs to be a website that enables healthcare providers to follow specific guidelines for vaccination and convey necessary information like that described by the AHA. Such a website should also be able to connect Americans with convenient vaccines at CVS, Walgreens, and other pharmacies. He says that the lack of such a system has local hospitals turning to ad-hoc solutions such as using event-scheduling service Eventbrite.
“What’s next? Google Sheets?” he asks.
A vaccine rollout platform could potentially match hospitals with the correct number of doses or connect institutions that have surplus doses with those that don’t have enough. Already, HHS is using a system called Tiberius, created by Palantir, to allocate vaccines and track distribution. However, it’s not a public-facing platform. Only some data is shared through the CDC’s website.
“Biden’s team needs to hit the ground running and not miss the moment,” Nissola says. “Fingers crossed they have a beautiful master plan that they’re going to unveil on the first day.”