If the introduction of the COVID-19 vaccine seems messy and incomprehensible, with numbers that don’t add up and assignments that don’t make sense, you are not alone.
Even people who study this for a living are at a loss.
“Neither of us know what’s going on,” said Dr. Amesh Adalja, a senior scientist at the Johns Hopkins Center for Health Security.
He’s tried to understand how numbers from the Centers for Disease Control and Prevention, the White House, and the States fit together, but he can’t.
“I don’t understand why there isn’t more transparency,” he said. “You could easily do a webinar every day to go over the numbers – so many boxes we’ve shipped, so many boxes are coming next week. The more they don’t do that, the more sharpness there is between the states and the federal government. “
Overall, the trends are positive, but the pace needs to be stepped up significantly to meet the deadlines announced by the White House this week.
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Since January 25, the federal government’s COVID-19 vaccine distribution has increased 57%. Starting this week, up to 13.5 million cans will be shipped per week.
“We are well on our way to providing vaccines to 300 million Americans by the end of July,” Jeff Zients, COVID-19 response coordinator for the White House, said at a task force press conference Wednesday.
In order to bring the planned two doses of the approved vaccines to 300 million people, the distribution by the federal government must be increased by about a third. At the current level, it would take until September.
Given the speed at which things have increased, it would seem sopossible. However, the White House has not released any actual data on future increases.
So what happened Why are there questions about delivery and delivery?
If things seem to be on the right track, why is there so much chaos at the state level with long lines, people unable to close appointments and clinics due to a lack of vaccines?
There are several reasons. On the one hand, there is a lack of federal transparency regarding vaccine supply and deliveries, as well as persistent fluctuations in vaccine deliveries, which confuse and confuse all states.
Public health officials are frustrated with the ongoing ambiguity. It is impossible to know exactly how much vaccine is being shipped and where and to whom it has been given – information to plan.
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The vaccine is delivered and evaluated through several separate programs, including programs for states, nursing homes and long-term care facilities, state-qualified health centers, and private pharmacies. Some doses are controlled by the states themselves and others by federal programs.
The National Governors Association this week sent a public letter to President Joe Biden requesting clarification, including “an insight into federal vaccination efforts at the facility level within our borders.”
The letter quoted “the anxiety caused by the demand and supply of the vaccine” and asked for better reporting to avoid confusion.
That didn’t help either: some states have decided to play by their own rules
States also bear some of the blame. Experts say they opened vaccinations too quickly to larger and larger groups, even though supplies were scarce.
“We knew all along that there would be a limited number of doses to start with and that we had to prioritize,” said Dr. Marcus Plescia, Chief Medical Officer of the Association of State and Territorial Health Officials. “Somewhere there, the vaccine was over-promised.”
It hasn’t always happened.
The CDC’s Advisory Committee on Immunization Practices has spent months creating a carefully crafted series of eligibility levels, from the most vulnerable to the least at risk.
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Some state officials promptly ignored the recommendations and began opening up vaccination to wider populations, Plescia said.
The December ACIP guidelines stated that health workers would be on the front lines and residents of long-term care facilities would come first in what is known as Phase 1a. Next, in Phase 1b, key workers and people aged 75 and over could come on the front lines. People aged 65 and over and people with high-risk diseases would be in a larger phase 1c.
Just a week after the first COVID-19 vaccine was distributed, Florida Governor Ron DeSantis has overridden ACIP guidelines and unilaterally declared that his state will prioritize people 65 and over.
That resulted in long lines, seniors waiting overnight for vaccinations, crashing appointment websites, and general chaos as Florida’s more than 4 million seniors requested vaccinations.
What has to happen now to fix this? Let’s start with honest news.
Currently, according to the White House in 35 states and the District of Columbia, people 65 and over can make an appointment. But other states have not gone beyond vaccinating key workers and those aged 75 and over.
Wisconsin’s lawmakers are debating whether to add teachers to Phase 1a this week.
Pointing the finger early that states were too slow may have sparked the rush for speed and policy circumvention. In any case, he said, the vaccine was over-promised.
“We suddenly skipped the ACIP guidelines and told all these people that they were eligible,” he said. “I don’t know if that was the most sensible thing. It would probably have been better if we had asserted ourselves.”
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Other states such as Georgia have resisted widespread expansion of vaccinations, said Glen Nowak, director of the University of Georgia’s Center for Health and Risk Communications and former communications director for the CDC’s National Immunization Program.
The governor there has consistently said that there is not enough vaccine for the first priority groups, so he will not open it yet. “He says, ‘I hear you, I want to do that. But we don’t have enough vaccine right now,” said Nowak.
To keep the rollout from spiraling out of control, states must manage expectations. “Enlargement is not going to help, it will make things worse,” he said.
What is needed are honest messages that this process cannot happen overnight. While not everyone will get the vaccine right away, everyone will eventually get the vaccine, said Dr. Gregory Poland, Director of the Mayo Clinic Vaccine Research Group and Editor-in-Chief of Vaccine magazine.
“The cure is tincture of time,” he said. Although he acknowledged, “It’s easy for me to say now that I’ve got both doses.”
Where Operation Warp Speed came up short: “A major communication error”
A big part of the problem since the first doses of the vaccine were shipped has been the lack of clear, consistent communication, according to experts. That makes it even more difficult to explain what is happening to the vaccine supply now.
Even the man who played a key role in making COVID-19 vaccines possible, Moncef Slaoui, says messaging has been a grave failure of the otherwise stellar work of Operation Warp Speed.
“It was honestly a big communication mistake,” 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 would be vaccinated right away, he said, but that news never got out. Millions of Americans have expressed anger and frustration over something Slaoui and his team believed they had made clear.
“Each time we said, ‘We will produce enough doses of vaccine to immunize the US population by summer 2021.’ What is understood in that statement is that it will take six, seven months to get enough vaccine to immunize everyone, ”he said. “But in fact, I think we should have communicated much, much better that there won’t be enough vaccine for everyone right away.”
It will take time to overcome this trust and information deficit, said Dr. Kelly Moore, associate director of the nonprofit Immunization Action Coalition.
“We will never again take the chance we had to lay a solid foundation for the vaccination program before the vaccines were introduced,” she said, “but we are getting back on track and the signs give me hope.”
Contact Elizabeth Weise at [email protected]