The three biggest priorties right now should be: Vaccinate, Vaccinate, Vaccinate

December 30, 2020 By Alan Salzberg

Here's the good news: 

     1) the two approved vaccines are quite effective (see my last post);

     2) The US has ordered enough to vaccinate everyone, with plenty to spare; and 

     3) the AstraZeneca vaccine, approved today in the UK, appears to be equally effective regarding severe cases (see, giving us an option that allows for higher temperature and longer-term storage.

The bad news is we are doing an awful job of vaccinating, with no hope in sight.  

The first COVID vaccine in the US was given more than 2 weeks ago, on December 14, in New York (see here).  Prior to that, we had months to devise a distribution and vaccination plan.  So now, on December 30, how are we doing?

As of yesterday 2.3 million vaccination shots have been given in the US (see this map of shots by location).  That there have not been more is not due to lack of product--we have more than 11 million doses on hand, so, even holding back one (which is a mistake if we know we are getting more before 3 weeks), we could have administered more than twice as many.  Why didn't we?  Because we do not have our act together.

You think 2.3 million doses seems like a lot? Let's do some simple math.  First, let's assume the ramp up was a full week and that the 2.3 million shots were basically all given in the last 8 days.  That means we gave around 300,000 shots per day.  At that rate, to inoculate 300 million people once, we need 1,000 days, or 3 years.  For the two-shot regimen, we need 6 years.  That doesn't work.  We'd prevent a small number of COVID deaths but the disease would run its course well before most people are vaccinated.

How about the Biden 100 million shots in 100 day plan?  That is better but it doesn't work either.  That's 600 days for the required 600 million shots, or more than a year and a half. 

If you think that despite the national crisis, the distribution is up to the states, and your state is doing fine, think again!  The best states, in terms of vaccinations right now (North Dakota and West Virginia), are at less than 2%.  That means a couple of years at least.  NY, the first state to perform a vaccination, is still at less than 1%.  I checked New York's vaccination plan here but I'll save you the bother of clicking through--New York has no vaccination plan.  Their "phased distribution" only goes as far as Phase I.  It does not even include the most vulnerable 75+ population unless they are in nursing homes.  Phase II, III, etc?  They don't exist. 

So, both nationally and at the state level, what's clear is that we need a leap of several times our current level of vaccinations.  We are going to have the vaccine.  We just need to distribute it.

Can it be done?  Well, Israel (socialized medicine) is doing it.  They have given a shot to 6% of their population in 9 days, and, yesterday alone, more than 1.5% of their population got shots (see ).  They are using the same super-cold storage Pfizer vaccine that we are using.

Here are a few ideas for how we can get the vaccine out (some of which can be done together):

1) Stop all testing (except when medically necessary) and convert every testing center to a vaccination center.  We are doing about 2 million tests a day.  Someone able to administer a COVID test can do a shot, and as many of the testing sites are hospitals and medical facilities, required staff are, or can be, present for rare complications.  As shots are faster, we can probably do triple the number of shots as we can tests.  That gets us to 6 million shots a day.  With that, we'd be done in 100 days.  If we can only double it due to supply constraints, we're still done by July (by which time we're sure to have more than the required 600 million doses). 

2) Parallel processing of Pfizer/moderna vaccine.  Right now, we are using much less vaccine than we have supplied.  Let's continue to give priority to health workers and older people but also rollout and use every drop of vaccine we have by giving extra supply to the 16-64 age group.  

3) Give the AZ vaccine to everyone under 60.  The US is buying 500 million doses of this vaccine (hopefully soon to be approved in the US).  The AstraZeneca vaccine does not have the storage requirements of the Moderna and Pfizer vaccine, and is being produced very quickly, allowing for a simpler and wider distribution than the Pfizer and Moderna cold-storage vaccines.  It appears to be a little less effective (although still equally effective at preventing hospitalization/severe COVID), so let's give it to the under 60 population.  This could allow for faster distribution and gets us to herd immunity, or something close to it, in a few months.  

4) Encourage people who have had COVID to go to the back of the line.  There is a lot of evidence that getting COVID provides lasting protection against re-infection, even more effective than the best vaccines.  And around 60 million Americans have already gotten COVID.  Doing this could easily save a month or more in terms of reaching herd immunity.  Of course, this would need to be entirely voluntary, especially considering the fact that most of the people who have gotten COVID were never tested (and thus not officially confirmed).

Any other ideas?