Unsanitized: Biden’s Vaccine Plan v. The COVID Variant

The biggest challenge right now is getting shots into arms before the mutation takes over and surges cases. This is The COVID-19 Daily Report for January 18, 2021.

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First Response

There are two parts to Joe Biden’s COVID response plans. The first, the American Rescue Plan, is a legislative action for economic relief and funding support. The second involves taking over what has been an uneven vaccine rollout. While this also requires funding—Biden has asked for well over $150 billion in the ARP—there’s also plenty of executive prerogative to shape the rollout and maximize distribution. In the past couple days the Biden team has been explaining their plans.

The urgency here has never been greater, for two reasons. First, the Trump administration really didn’t create a national vaccination strategy and apparently lied about what little role they did play. Second and far more important, the timeline for getting shots into arms has rapidly narrowed, due to the more transmissible variant B.1.1.7, which will become the predominant strain in the country by March, according to the CDC.

Despite all the bumps in the road, the U.S. has hit a seven-day rolling average of just under 900,000 daily doses, not far off of Biden’s stated 1 million per day pace. But with B.1.1.7 looming along with a certain surge of cases, we probably need something more like 2 million per day to really make a dent in the crisis.

There’s going to be a false dawn over the next month. Cases and hospitalizations have peaked and are coming down, while deaths have hit a plateau. But that will only last as long as B.1.1.7 is in the background. As soon as that becomes more of the primary way the virus is transmitted, those numbers will shoot back up. The only escape from that terrifying reality is either something like a lockdown, everyone being requisitioned N95 masks (which they use), or a mass mobilization of vaccines.

Read all of our Unsanitized reports

So what is Biden planning to do? He has outlined a plan that includes opening up mobile clinics in underserved communities and increasing availability of vaccines at local pharmacies, the combination of which would put access within geographical reach of almost everyone. He would deploy FEMA and the National Guard to help put this distribution network together.

The National Association of Chain Drug Stores claims that they could administer 100 million shots in a month, blowing away Biden’s benchmark of 100 million in 100 days. I was on a call with the NACDS the other day, where officials stressed their “deep experience with vaccinating America.” But looking at the one program that has been entrusted to chain drug stores so far, an effort with CVS and Walgreens to vaccinate nursing homes, I have to be skeptical in their abilities to rapidly turn their for-profit stores into free vaccination clinics. The CVS/Walgreens plan stalled out of the gate, yet NACDS senior vice president Kathleen Yeager had the gall to say that they were doing a “phenomenal job” at nursing homes.

Distribution is clearly something Biden’s team has thought a lot about, and that’s been the main bottleneck to this point, though it’s in the process of untangling. But we’re about to hit a bigger bottleneck with supply. As of a little over a week ago, states had only used about 29 percent of their supply. That number is now up to 46 percent, and with more efficient delivery networks coming on line, we’re going to hit a supply squeeze without some new stockpile of doses on the way.

Hopes were dashed on this a couple times over the past few days. It became clear that there was no federal reserve of vaccines like the Trump administration had been intimating, letting down states that were relying on a big release of doses. I’ve heard from people who’ve received their first shot and been told that they cannot schedule the second because of uncertainty with supply.

A much bigger issue is the apparent slowdown at Moderna. In the new year, production has dropped 36 percent. If Moderna were to hit its promised allocation for the U.S. of 100 million doses by the end of March, it would need to be making 1.1 million doses per day. It’s making about 303,000 in January. There appear to be supply chain issues with some of the materials that go into the vaccine.

Incoming CDC director Rochelle Walensky expressed confidence that there would be enough supply to meet the 100 million in 100 days goal. But again, that’s not going to be enough to prevent a severely dangerous and economically ruinous situation in the spring, thanks to B.1.1.7. We need twice that, and supplies are short.

The Biden administration will be using the Defense Production Act to try to alleviate some supply problems, though that will take time to ramp up. One possible ray of hope on the supply side is the ability to squeeze an extra dose out of Pfizer’s shipment of vaccine vials. But that only works if you use “low dead-space” syringes that don’t waste medicine, and the government’s shipments of syringes are often “high dead-space.” It’s unclear which company is supplying high dead-space syringes; the government has contracted with several supply firms, like Smiths Medical and Retractable.

But this leads to two problems. First, getting the high dead-space syringes out of production so that every Pfizer vial can yield six doses instead of five, instantly increasing supply by 20 percent; second, making sure all distributors have enough low dead-space syringes, since the government has only been giving out five syringes per vial. This is one place the Defense Production Act can come in, to make syringes.

So it’s a scramble. We knew that the Trump administration would leave a mess; that was built in. The B.1.1.7 variant added a severe degree of urgency to the Biden team to really get this completely fixed, streamlined, and moving at double speed, in a matter of weeks.

Number of Vaccine Doses Given

14.3 million as of Sunday, up from 11.9 million on Friday. See above.

Today I Learned

  • Finally it is stated clearly: premature reopening in late spring led to a surge in cases and our current predicament. Unsaid: the lack of state and local aid in the CARES Act was a major factor in this. (New York Times)
  • Conventions will likely return, but quotidian business travel probably isn’t coming back. (Wall Street Journal)
  • Trader Joe’s is now paying staff to get the vaccine. (USA Today)
  • Fatalities from the vaccine seem confined to Norway; maybe it’s a bad batch. (Bloomberg)
  • Speaking of which, anti-vaxxer groups got PPP loans. (Washington Post)
  • It would be very positive if banks loosened lending in an equitable fashion, anticipating a brighter economic outlook. (New York Times)
  • The recent COVID relief bill gave banks a break on problem loans anyway. (American Banker)
  • What has the pandemic and all the screen time done to our eyes? (New York Magazine)
  • Check out the absolutely terrible $300 rich guy PPE helmet. (SF Gate)

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