It has been just over a month since the U.S. began the most sweeping mass vaccination campaign in its history, and progress is already lagging far behind what federal officials had projected.
That problem will soon fall to president-elect Biden, who said on Thursday that the vaccine rollout had so far been a “dismal failure.”
Amid delays, the Trump administration changed course this week, ordering states to vastly expand vaccine eligibility, at the same time saying they would release stockpiles from a reserve. But on Friday, it emerged that the reserve did not exist, meaning no major inoculation surge is coming.
There won’t be a quick fix. Vaccination is in the hands of dozens of state and local health departments, many of them crumbling after years of chronic underfunding and a long 2020.
“These state and local public health officials are exhausted,” says Dr. Howard Koh, a professor at the T.H. Chan School of Public Health at Harvard University who served as an assistant secretary at the U.S. Department of Health and Human Services. “We’re asking that completely overstretched group of professionals to now ramp up and make the most ambitious vaccination campaign in U.S. history a reality in record time.”
On Friday, Biden announced proposals to marshal federal resources in support of a vaccination program. Those plans echoed suggestions that public health experts had made to Barron’s about what the incoming administration should do to get more shots in more arms. Here’s what they told us, and what Biden plans to do:
Simplify: “We can come up with the most elegant plan in the world, but our national ability to execute on these things is just not fantastic,” says Dr. Ashish Jha, dean of the School of Public Health at Brown University. “Simplicity, man. There’s nothing like simplicity.” The Centers for Disease Control and Prevention has set out a nuanced, multistep plan to prioritize vaccinations. But many states that stuck to those guidelines barely made a dent in their vaccine allocations. On Tuesday, federal health officials told states to begin allowing anyone older than 65 to get their first shot.
That new approach makes sense, says Dr. Cody Meissner, a professor of pediatrics at the Tufts University School of Medicine and a member of the Food and Drug Administration advisory panel that voted in favor of authorizing the Covid-19 vaccines. “What we should be doing is giving this vaccine to older people, and not trying to micromanage who is eligible to receive it,” he says. “The more restrictions you have on any vaccine, the less effective it’s going to be.”
Jha has argued for opening vaccinations to everyone over 55 in February, and then allocating doses to younger people through a lottery system. While the lottery may be a hard sell, the advice is clear: Getting shots in arms is the most important thing.
Target Hard to Reach Groups: That doesn’t mean that the government should give up on targeting people at greatest risk for serious illness. Covid-19 has killed Black and Hispanic Americans at far higher rates than whites, and health-care workers have died in large numbers. Jha has argued that simpler approaches, by their nature, will be harder for privileged groups to game, and as such be fairer.
But active outreach will also be necessary. “The more effort we put into speeding things up, the more risk we are at for widening disparities and blowing it on equity,” says Alison Buttenheim, a professor of nursing and health policy at the University of Pennsylvania School of Nursing. Even as states make vaccines available to wider populations, they need to continue to seek out high-risk categories. “A local health department …has to be nimble enough to do both of those things,” she says.
Send Money: State and local health authorities need money to administer the vaccines, experts say. The relief bill signed by President Donald Trump in December allocated $8.8 billion to support the vaccine rollout. Those checks need to arrive soon. The Biden administration says it is planning to spend another $20 billion.
And Send Vaccinators: While chatting with a state health official the other day, Jha asked what the official would have the federal government do to help his state’s vaccine rollout, if he could ask for anything. “That is easy,” the official said. “I’d have them send 5,000 vaccinators.”
The money to hire those vaccinators was already on its way, the official told Jha. But the process of hiring those people could take a month or six weeks. A federal deployment of vaccinators would save valuable time.
Biden said Friday that he planned to pay for National Guard troops to support vaccine distribution, and to set up federally supported vaccination centers around the country. He also said the federal government would help train more vaccinators and create a public health jobs program.
Create Another Warp Speed:Operation Warp Speed deserves credit for the fast development of Covid-19 vaccines. But it hasn’t focused on how to get those vaccines into people’s arms. Indeed, its leaders waited months to approve a plan to distribute and administer vaccines, The Wall Street Journal reported. “Warp Speed seems not to have thought as much about the last-mile distribution,” says Julie Swann, a professor of industrial and systems engineering at North Carolina State University. “There is a lot that has to come after it leaves the distribution center.”
Buttenheim says that what’s needed is another Warp Speed: “The same kind of laser-sharp focus that was put into vaccine development absolutely needs to be put into vaccine rollout.”
That office could help with messaging, information sharing, and coordination among local and state health departments. On Friday, Biden did announce a federal public education campaign, among other coordinating efforts. The Warp Speed effort, Buttenheim says, was extraordinary. “Let’s be as extraordinary on the last mile,” she says. “Vaccines don’t save lives. Vaccinations save lives.”
Write to Josh Nathan-Kazis at [email protected]