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In October, Health and Human Services Secretary Alex Azar hinted that 100 million doses of the COVID-19 vaccine could be available by the end of the year. But within weeks, he slashed that number to 40 million. And by December, Azar was revising downward once more, predicting 20 million doses by the end of the month. Then, vaccine distribution actually began, and by Dec. 31, the number of shots that had actually made it to people’s arms totaled about … 3 million. Given how mind-bendingly quickly the vaccine was produced, why has distribution within the U.S. been such a flagging mess? To figure this out, I spoke with the New York Times’ Apoorva Mandavilli on Tuesday’s episode of What Next.* Mandavilli broke down the challenges of the inoculation effort and explained why the new coronavirus variant makes distributing these vaccines more important than ever. Our conversation has been edited and condensed for clarity.
Mary Harris: I expected states with more limited public health infrastructures to have challenges distributing this vaccine. But then we’re seeing complaints about places like New York, which has an incredibly robust public health system. There was an article in the Times Union that laid out how New York had been practicing to distribute vaccines with federal grant money for emergency preparedness purposes for years. And now that we actually have a vaccine to get out there, this group hasn’t been activated. It’s just bizarre.
Apoorva Mandavilli: There are a lot of things that are baffling and don’t really make sense, given that we knew vaccines were coming, given that we had months to think about how exactly this could work. It’s not as if the vaccines came all of a sudden. It’s an issue of people still not understanding how big a problem this is, how intractable it is, how much effort needs to go into figuring out every detail and every step and every single thing that can go wrong.
One New York City Council member was tweeting that we’re only vaccinating people during business hours in New York City and not really on weekends, not on holidays. And because this is a warlike situation, we should be vaccinating 24/7. I hadn’t thought about that, but maybe that is the kind of thinking we need to do.
Ideally we’d all have an app or something, right? You would put in your date of birth, your health conditions, etc., and you’d get a number based on what your risk factors are and you would be able to see how close you are to being vaccinated. You’d get a time and a date in a place to show up and go to get your vaccine.
Like standing in a digital line.
Why can we not do this? We had time to make an app like this and get it all figured out. Also, I think the right people are not getting it. There isn’t a good system to figure out a situation like: We’ve vaccinated front-line workers and nursing homes and now we have extra doses, let’s make sure we get it to people with diabetes or obesity, whoever else has the highest risk. Instead, they’re being given out word of mouth to whoever has the connections to show up to the right place and get vaccinated. That’s extremely inequitable. It becomes an issue of who has connections, who has money, who knows who. We’re talking hundreds and thousands of people getting vaccinated ahead of other people who really need it.
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Is it just that the vaccines are sitting on a shelf and so the institutions will say, Well, we had to get it out there, these people were available, and we didn’t know about the other people who maybe needed it?
I think that will be their excuse. But honestly, of course they know about these other people, their patients. And you may have heard that there are more doses in every vial than were originally planned for, just a quirk of the production process where they always pack a little bit extra. In this case, instead of five doses, sometimes people have had as many as eight doses in a vial. So you have all these extra doses and that’s great that they want to use that, but there has to be some thought put into where those extra doses go.
Some people have advocated for just getting rid of the rules, like, we just need to give the vaccine to anyone who wants it at this point. Do you feel like that idea is nuts or kind of makes sense given where we are?
That idea would make sense if we had any kind of system that took racial inequities into account, but we don’t.
I think this is exactly the kind of thing that public health infrastructure was built for, to come up with ways of making this process equitable and efficient. The problem, I think, has been that states have always relied on the federal government. States have a lot of power, but they have always looked to the federal government for guidance. And states have not received that guidance. So they are scrambling to figure out how to do a lot of things. And what you get is this extremely ad hoc mixture of approaches that aren’t always based on science or public health guidelines.
Could you give me a basic 101 on the new coronavirus variant and what it does?
We know that viruses mutate, a very natural process. Every time the virus divides, it could make mistakes. Some will give it a disadvantage and therefore will die out, and some will give it an advantage and may catch on. In this case, what happened is that this new variant has 23 mutations that are different from the variant that was in Wuhan. What has been somewhat concerning is that this variant has 17 mutations that are different from its most recent ancestor.
Which was a leap.
It was a huge leap. And we don’t know what all of those do yet, but we know that at least one of them has somehow given this virus the ability to spread faster. One of the other mutations in this new coronavirus makes the virus a little stronger and better able to hold off our immune systems. It may even make our vaccines less effective.
It’s going to infect more people. That means we all need to be even more careful than we are being right now in order to have any chance of stopping it. And I don’t think that’s likely, given how Americans have been reacting to even the restrictions that are being or were being proposed.
We’ve seen that this new variant has popped up in Colorado and California and Florida. So we know it’s here, but we just don’t know how widely it’s spread.
I think the best estimates are that it’s just starting because the U.S. has not sequenced that many viral genomes. But we’ve sequenced enough that people have estimated it’s probably still under 1 percent of the total cases, maybe around 0.5 percent. But because this is more transmissible, it’ll probably do exactly what it did in the U.K., which is quickly become the predominant form. It’ll take over probably by March—it took about three months in the U.K. and probably will take about that amount of time here.
Is there any way to stop that? Part of what stood out to me about your reporting was that you talked about how regular lockdowns weren’t enough to suppress this variant. It made me think, how can we can we even do anything here?
Well, it really depends what we mean by “lockdown,” right? In the United Kingdom, they had schools open and the schools were not actually using all of the tools at our disposal: The kids were not masked, and they weren’t necessarily doing social distancing. I think some of the data are indicating that, especially in older kids, that was a big contributor. Also, a lot of people still weren’t wearing masks, and they were still going out to eat, they were still visiting family, they were still getting together in pubs.
It’s similar in the U.S. Even when we talk about lockdowns here, what are we really talking about? Most states have had indoor dining open. Most states have had weddings and funerals and big parties going on. There are still many people who refuse to wear masks regularly. Malls were open, and we’ve had Thanksgiving and Christmas. So we’re not talking about any kind of a lockdown that would really stop things. I don’t think we’ve had one since the very early days in March. There is a lot of room for improvement. We know what to do to slow the speed with which this virus spreads. And we just have to put those things into actual action, not just talk about them.
How much of all of this can we really expect the new administration to start to fix? Joe Biden has said he wants to have 100 million doses of the vaccines out there by his 100th day in office. Do you think that’s reasonable to expect, given what’s happened over the past month?
I think they’re not going to fix all of it but they will at least start to fix it. The new incoming CDC director, Rochelle Walensky, is extremely smart and capable. I could see her ramping up the sequencing effort, for example. And if we impose the lockdown-type measures that we need, to buy ourselves a little bit of breathing room—things could improve if we fix some of these problems with getting the vaccines out to people who need them. Things could move a lot faster. I don’t know if 100 million in 100 days is feasible. And his claim didn’t really seem all that impressive, to be honest, because that is probably about where we would have ended up if things had been going OK. But if we fix all of the issues that are there now—and that’s a big if—we could get to something close to that in a few months. If we’re really disciplined.
What do you think is the most important thing to fix first?
The very first absolutely critical thing we have to do is get the numbers of infections down. None of this is going to make a difference if the virus is still spreading the way that it is now, even if we get everything else right. Every single person the virus infects is a chance for it to pick up a new mutation. So we are basically giving the virus so many chances to become more dangerous. We’re also putting such enormous strain on our health care system, and it may buckle under in such a way that it never recovers. It’s hard to imagine a positive scenario emerging unless the numbers go down.
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Correction, Jan. 5, 2021: Due to an editing error, this article originally misstated when this episode of What Next ran. It was Tuesday, not Wednesday.