A Democratic senator and advocates at the left-leaning Center for American Progress (CAP) argued that the Trump administration is ill prepared to produce and deliver a vaccine in line with the president’s timeline, during a call with reporters on Thursday afternoon.
President Trump has pledged that all Americans will have a vaccine by April.
Sen. Patty Murray (D-Wash.), ranking member of the Senate Health, Education, Labor and Pensions Committee, said she has been calling for a comprehensive national plan to distribute a vaccine for months, but the administration has offered only “a few fragmented puzzle pieces.”
She said that while she was pleased to receive a plan, the HHS blueprint lacks answers to critical questions such as how to serve vaccines at low temperatures, how to scale up the work force to ensure there are enough professionals to administer the vaccine, and how to ensure that the vaccine will be “cost-free.”
“After watching similar promises on testing fall flat, we know details are really critical here,” Murray said.
The plan also touches on building partnership with communities of color but fails to explain “how to actually distribute vaccines in a way that addresses health disparities and prioritizes communities that are hardest hit by this crisis,” she added.
One thing that is clear in the plan is that the Department of Defense would have a leading role in the distribution of the vaccine, despite the CDC having “deep experience and expertise” in that realm.
Zeke Emanuel, MD, a senior fellow at CAP and vice provost for global initiatives at the University of Pennsylvania, argued that the projections that the Trump administration has put forward for vaccines are unrealistic. “Most Americans are not going to see a vaccine, even under optimal circumstance before … the end of the third quarter, early fourth quarter, of 2021,” he said.
He predicts that in order for the country to return to “normalcy,” America needs a vaccine that is around 75% effective and the country needs approximately two-thirds of the American public to get the vaccine — 220 million people — to achieve herd immunity.
The challenge, according to Emanuel, is that the supply of vaccine doses is limited.
First, the current leading vaccine candidates made by Moderna and Pfizer are “two-shot vaccines,” which means that instead of 220 million doses, a total of 440 million doses must be produced, shipped, and administered, he said.
Moderna estimates that it can produce about 20 million doses before year’s end, if its vaccine proves effective, and Pfizer, with the same caveat, projects it can make 25-50 million doses available. Again, because two doses of the vaccine are needed, this amounts to — if the lower estimate is chosen — roughly 22.5 million Americans who could receive the vaccine, Emanuel said.
And while details around who would be prioritized for a vaccine have yet to be decided, it is likely that those 22.5 million Americans would include selected healthcare workers, first responders, and “just a few other people,” Emanuel said.
Looking to 2021, leaders of the Operation Warp Speed team already revised an earlier estimate of producing 300 million doses by January 2021, by pushing that estimate forward 6 months.
But even if 300 million doses are produced by summer 2021, if two doses are required, that is enough vaccine for only 150 million people — “and that’s not going to get us to where we need to be for herd immunity,” Emanuel said.
He did, however, acknowledge that Johnson & Johnson has a one-dose vaccine and that the company believes it can produce 250 million doses. That product just entered phase I clinical trials this month.
Even under a best-case scenario with scientific development, “the Trump administration is very far behind in planning,” said Topher Spiro, vice president for health policy and a senior fellow for economic policy at CAP’s Action Fund.
The actual availability of ancillary supplies for vaccine distribution including glass vials, stoppers, needles, and syringes is “unknown,” he said.
“Due to a lack of urgency, it’s unlikely, in our judgment, that there will be enough supply for the population until well into next year,” Spiro added.
These concerns are not unfounded: Spiro noted that he and his colleagues have talked to manufacturers of these products and “it does not appear that enough supply has been secured.”
Given that it takes up to a year to add a new manufacturing line, and that the Trump administration did not engage with these manufacturers until the summer, Americans will be forced to wait until next summer for those supplies, Spiro said.
He also stressed the importance of leveraging the Defense Production Act to tap into “unused capacity” and ensure that they are matched with production needs.
He said the CDC’s new IT system for administering vaccines isn’t ready, “raising the possibility of a Healthcare.gov-style debacle,” a reference to the botched 2013 launch of the federal Obamacare exchange.
The new system has not yet completed “end-to-end” testing and states are currently having to decide whether to upgrade their own IT systems or to adopt the CDC’s, Spiro said.
He projected that vaccine distribution will cost $10 billion and administering the vaccine to uninsured individuals will cost another $1.5 billion.
He said the Trump administration’s lack of preparation will put an “unfunded mandate on states,” which are already short of money.