Unsanitized: The Vaccine Distribution Gaps

There’s a gap in transparency and a gap in funding. Plus, looking at the holiday travel stats. This is The COVID-19 Daily Report for November 30, 2020.

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First Response

Welcome back from the break. The coronavirus continues to rage out of control. Cases and deaths dropped over the weekend, but it was largely due to holiday reporting. That will come back with a vengeance this week and lead to some of the biggest numbers of the pandemic. And we’re not even at the point of factoring in the impact of millions of small gatherings for Thanksgiving around the country. We should all brace ourselves for a terrible December.

But let’s also focus on the positive developments. Moderna formally filed its application for an emergency use authorization in the U.S. and Europe today for its COVID vaccine. The statistics Moderna has been willing to give out are impressive: 94 percent effectiveness, nobody who received the vaccine getting severely ill, and no long-run safety effects.

Of course, “the statistics Moderna has been willing to give out” is key here, because we have not seen a full dataset from any of the early vaccine candidates. Science by corporate press release has come back to bite AstraZeneca pretty hard. The company will likely run another global trial, after their initial announcement of results showed a higher effectiveness rate for those who got half-strength for one of the two doses than for those who got two full shots. This turned out to be done erroneously (it was a manufacturing error to provide a half-shot), and it wasn’t initially disclosed. Also the age range of those who got full doses played a role.

Weirdly, AstraZeneca doesn’t expect this to hold up authorization for its vaccine in the UK and the EU. U.S. authorization will probably be delayed, because the FDA prefers to authorize with domestic data.

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But it should bring up a larger point. We are already pre-positioning shots around the country, adding special freezers to grocery store pharmacies, and preparing for immediate deployment of the vaccine. The anticipation is useful and correct. But it’s all based on a set of information that has been delivered through marketing documents meant to put the pharmaceutical firm in the best light. The FDA will see much more than that, of course. However, the need for a vaccine bordering on desperation, and the supplies positioned already, and the narrative in the public mind created that these are safe and effective vaccines has to all be weighing on the decision-makers.

These studies could be sent to medical journals for peer review. Even if that’s too much, there could be more transparency than a press release with promising numbers plastered on it. These companies are poised to make a lot of money, too much in fact (the World Trade Organization is correctly considering whether to waive patent protections for COVID-related medications, like vaccines). Expecting a modicum of transparency isn’t much to ask.

Meanwhile, the question of how states and cities are going to pull off distribution lingers. The Trump administration, to the extent there still is one that’s not trying to push through deregulation and hock the furniture on Craigslist, has completely disclaimed responsibility, pushing questions like eligibility for the initial vaccine allotment to the states. Autonomy is good, but the key point here is lack of funding. Chuck Schumer says it’ll take $30 billion to get the vaccine distributed.

It’s crazy that this is not the immediate topic in Congress right now, and it’s actually very depressing. You’d have thought gridlock wouldn’t last amid the survival of hundreds of thousands of citizens, but you’d be wrong. The price tag of $30 billion is a rounding error for the federal government. This should be like a disaster relief supplemental. Even if there are ideological differences on economic relief (there shouldn’t be), money to get a life-saving drug into the arms of people shouldn’t have any opposition. And yet Congress has little more than a week left in the lame duck session, and there’s no expectation of getting this funded. It’s as shocking an abdication of responsibility as we’ve seen in this crisis.

Doing the Math on Holiday Distancing

We’ve gotten through the holiday weekend, and it provided a natural experiment for how much of the country takes into account public health directives. The CDC was late on it, but it did encourage a lack of travel amid the raging pandemic. So who put their plans aside as a result?

Well, TSA tracks the number of people who go through their checkpoints daily. We have numbers through Sunday, spanning the busiest travel days of Thanksgiving: the Wednesday before, and the Saturday and Sunday after. These numbers were more elevated than at any time during the pandemic, but honestly not that much more elevated. On the Wednesday before Thanksgiving 2019, 2.62 million people took to the skies; this past Wednesday it was 1.07 million. On Saturday 2019, 2.64 million; last Saturday, 964,000. Sunday 2019, 2.88 million; yesterday, 1.17 million. That all tracks at about 39.4 percent of 2019 Thanksgiving traffic this year, and that was generally the ratio throughout the past holiday week.

Meanwhile, Black Friday in-person shopping was also significantly lower. Here the ask was just to buy things online instead of in a store, crammed in with other shoppers. It was a much lower-level ask. Online commerce set records, up 22 percent. In-store traffic fell 52 percent.

Put this all together and you get this fact: between 40 and 48 percent of the public disregards public health messages when they impinge on their daily lives and annual rituals. Frankly it’s a smaller number than I expected! But it’s hard to escape the fact that public health has been politicized, and these numbers are consistent with that result.

Days Without a Bailout Oversight Chair

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