The development of COVID-19 vaccines occurred at breakneck speed. The U.S. Food and Drug Administration authorized two vaccines for emergency use in December. The first doses were administered on December 14th. But just over a month later, as U.S. President Joseph Biden begins his new administration, there is an urgent need to step up efforts on vaccine distribution.
Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of President-elect Biden’s COVID-19 Advisory Board, helped guide the new Administration as it prepared to tackle the nation’s spiraling epidemic. This advisory group was dissolved once the President was formally inaugurated. As an epidemiologist and state public health official, Osterholm understands what is required to prepare for and distribute vaccines. HVP Editor Kristen Jill Abboud spoke with him recently about the most pressing challenges in accelerating COVID vaccine distribution in the U.S.
An edited version of the conversation appears below.
Was there an effective plan in place to deliver COVID vaccines from the federal government to the states, and then to people in priority groups?
There was absolutely no plan for how to address the last mile for delivering these vaccines. The previous administration required states to file a plan for how they would distribute the vaccine, but there were so many questions left unanswered. Who are the priority groups? How would they receive the vaccines? How many doses were needed? Then, there was no money to actually do this work. That was something the states were begging for. Right now, state and local health departments are so strapped for resources and people because they are already diverted to other parts of the COVID response, whether it be surveillance, contact tracing, etc. So, the vaccine arrived and there were still so many questions and very little direction and resources.
What other factors are contributing to the sluggish vaccine delivery in the U.S.?
These are difficult vaccines to deliver, in that you have two doses, so you have to keep track of that, and you also have the freezer requirements, especially for the Pfizer vaccine, which makes it even more complicated.
But what has happened in terms of distribution has been really misleading. The doses listed as distributed are really the number of doses Operation Warp Speed has allocated to a state at that point. Many times, that vaccine is still in a freezer back at Operation Warp Speed, it’s not even in the state’s hands. Also, often times the total number of doses administered lags behind by one or two days because of record keeping. So, if you look at those two numbers, they can be quite distant. However, they may not be accurate in terms of what is actually happening. That has been a real challenge and that is why the number of doses distributed and the number of doses administered are now getting much closer.
The other thing is that many of the initial doses, both first and second doses, had to be distributed to long-term care facilities. The CVS/Walgreens efforts really failed in the early days to rapidly respond. They just were not ready. In many states, long-term care facilities were very slow in the uptake and those doses just sat there, but that was because there was a federal contract with CVS and Walgreens. The states had virtually no control over that. So that was yet another challenge.
Is the situation improving?
All of those challenges are being addressed now. You’re going to see the numbers of doses coming in and doses going out get closer and closer each day.
President Biden has promised better management of the COVID response. What can and should be done first?
It is a combination of things. Funding is really going to be important. It’s not just funding for the state health departments, but it’s really about helping to move the money throughout the entire community. They need to be using community health centers, bringing in volunteers, and coordinating them. That’s a really important piece.
You can think of the state and local health departments as the air traffic controllers for the vaccine coming into the state and getting into people’s arms. They are also key to the education effort so that people know what these vaccines are all about. Right now, there is a lot of fear in the public about a vaccine from Operation Warp Speed, and we’ve done a really poor job of educating the public about what these vaccines are, what they’re not, and about their safety. That’s a huge issue at this point. We badly need a national education campaign.
What do you think of the plan to not reserve second doses of vaccines but instead vaccinate as many people with one dose as quickly as possible?
That never did happen—the previous administration said they were holding back second doses, but they didn’t. We are constantly going to be trying to adjust the number of first doses based on the number of doses coming into our states, so that we always account for the amount we need to finish up second doses. That will determine how much first dose activity will happen.
Let’s say I get a million doses and I have 450,000 people who need their second doses. That means I only have 550,000 people I can reach with the first dose. Then I have to make sure that a month from now, I have 550,000 second doses out of what’s coming in, which will then again determine how many people I can vaccinate with the first dose. That’s the process we’re in right now. It’s a matter of managing first and second doses from what is an ever-incoming volume of vaccine, which is why it is critical that the companies provide as accurate information as they possibly can about how many doses are expected today, next week, next month, and two months from now.
How does any of this change in light of the new SARS-CoV-2 variants that are circulating?
We’re going to be learning everyday as we go. We could be in a big hurt very soon if this B.1.1.7 isolate takes off. I think it could be a real challenge.
Do you think President Biden’s goal of administering 100 million vaccine doses in the first 100 days of his administration is feasible?
I do. I think it’s possible.
Interview by Kristen Jill Abboud