The Vaccine Rollout Hits Some Bumps

Listen to this episode

S1: From the very beginning, the secretary of Health and Human Services, Alex Azar, he’s been bullish about a covid vaccine, channeling this what murie energy like back in October, he went on Meet the Press, got grilled about rising coronavirus case loads and pushed back by saying, listen, we’ll have a vaccine soon.

S2: Look, the Pfizer CEO just announced that by the end of November, he thinks they may be submitting an application for a vaccine 10 months after this pandemic hit our shores.

Advertisement

S3: This is incredible, historic news, Chuck, that we ought to be celebrating and have back then, he was hinting that 100 million doses could be available by the end of the year. But within weeks, his numbers had started to change, even though his energy hadn’t because of President Trump’s founding and leadership of Operation Warp Speed.

S2: Even as we face daunting epidemiological trends around the country, we have reasons for optimism.

S1: This is testimony Azar gave on Capitol Hill back before Thanksgiving.

S2: By the end of December, we expect to have about 40 million doses of these two vaccines available for distribution pending FDA authorization.

S1: So within a few weeks, an estimated 100 million doses had been slashed to 40 million. And by December, Azar was revising downward again, predicting 20 million doses by the end of the year. Then vaccine distribution began. Now, you heard in those earlier pieces many governors complaining that about their vaccine allotments being cut back. That’s when Azar went on Good Morning America from quarantine to revise his estimates one more time. Can you break through that logjam? Is it going to get fixed?

Advertisement
Advertisement
Advertisement
Advertisement
Advertisement

S4: So there’s nothing actually to fix. There was some misunderstanding from certain of our governors. So we will have 20 million doses available for vaccination during this month.

S1: And great to hear what FDR did there. He was asked, are we going to have 20 million people vaccinated by the end of the year? And in response, he said we’ll have 20 million doses available by December 31st. The number of shots that it actually made it into a person, it totaled about three million. Yeah, it’s still off by a factor of quite a bit. I called up Apoorva Mandibular from The New York Times because I wanted someone to explain to me what happened here.

Advertisement

S5: I think one thing that happened is we didn’t really plan for that last step, the last mile as people refer to it. What do you mean by that? Well, so the vaccines have to be shipped out and they’re going all over the country and they’re getting to where they need to be stored in an OK way. But once they get there, the plan to get them to people who need it to actually inject it into people’s arms, that’s the part that really did not seem to have been figured out at all.

S3: Today on the show, 2021 ushered in a lot of cautious optimism when it came to covid-19, but Apoorva is going to break down the challenges ahead and why a new coronavirus variant makes distributing these vaccines more important than ever. I’m Mary Harris. You’re listening to what next? Stick with us.

Advertisement
Advertisement

S1: When a poor vote looks at this slow vaccine rollout, the first thing she wants you and me to do is take a deep breath because she expected some problems, says we all should have.

Advertisement
Advertisement
Advertisement

S5: Oh, God, yes. Yeah. I guess I am an optimist. I think these are starting troubles. These are people sort of being caught with their pants down saying I don’t know what to do next, but I think they’ll figure that out. And I don’t think it’ll still be as fast as we need it to be. But it will be faster than it is now for me.

S1: I guess what stands out is, you know, I expected smaller states or 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 infrastructure. And, you know, there was an article, I think, in the Times Union which laid out the basically New York has been practicing to distribute vaccine, you know, with federal grant money in emergency preparedness way for years. And now that we actually have a vaccine to get out there, this group hasn’t been activated. It’s just bizarre.

Advertisement

S5: Yeah, there are a lot of things that are baffling and that don’t really make sense, given that we knew vaccines were coming, given that we had months really to think about how exactly this could work. It’s not as if, you know, the vaccines came all of a sudden. It’s it’s, I think, just 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.

S1: Yeah. I mean, one city council member was tweeting that, you know, we’re only vaccinating people during business hours in New York City and not really on weekends, not on holidays, but that because this is a warlike situation, we should be vaccinating 24/7. And it was interesting because I was like I didn’t I hadn’t thought about that. Maybe someone should be called up to get their vaccination at 3:00 in the morning. But I was like, oh, maybe that is the kind of thinking we need to do.

Advertisement
Advertisement
Advertisement
Advertisement
Advertisement

S5: I mean, ideally, we’d all have an app or something, right? I mean, you would put in like your your date of birth, your health conditions, etc, 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 you would go and get your vaccine.

S1: I love that idea. Like standing in a digital line.

S5: Exactly right. It makes so much sense. We have apps. Why can we not do this? And we had time to make an app like this and to get it all figured out. And also, I think right now the right people are not getting it, even where they do have extra doses. There isn’t really a good system to figure out, OK, we’ve vaccinated like the front line workers and the the nursing homes and now we have extra doses. Let’s make sure we get it to people with diabetes or obesity, whoever is next in the the line for a highest risk. Instead, they’re being given out word of mouth to whomever whoever has the connections to show up to the right place and get vaccinated. And that becomes extremely inequitable. It becomes really an issue of who has connections, who has money and who’s got, you know, who knows who.

Advertisement

S1: You may have heard these stories about people outside of the priority groups getting access to vaccines. Sometimes it’s a little random, like the guy in Washington, D.C., who got the vaccine simply because he showed up at a pharmacy at the right time when they had a little leftover. Sometimes it’s less random, like when workers at a New York City Children’s Hospital snuck into a vaccine line simply because they could.

Advertisement
Advertisement
Advertisement

S5: It’s happening on a massive scale. It’s happening at entire university, an academic center levels. So we’re talking hundreds and thousands of people getting vaccinated ahead of other people who really need it.

S1: Yeah, yeah. My friend was like, yeah, my friend who’s a librarian at University of Virginia is getting vaccinated. And I was like, ha, I guess you can make the argument that they need to go to work and is that doesn’t seem right.

Advertisement

S5: But OK, that’s a lot of what’s going on. There are a lot of academics and grad students and students who have zero contact with patients who never see anybody with covid, who are just like the rest of us, in other words, but simply because they are connected to one of these universities or medical centers or hospitals that have access to vaccines they’re cutting in line. I just can’t go into a lot of detail about who, what, when, where, because this is a story I’m working on a moment. But yes, it’s happening across the board. It’s happening at multiple institutions.

S1: And is it just that the vaccines are. Sort of sitting on a shelf and so the institutions will say, well, we had to get it out there. So, you know, these people were available as a put and we didn’t know about the other people who maybe needed it.

Advertisement

S6: I think that will be their excuse. But honestly, of course, they know about these other people, their patients. So I think that will be the excuse that we had. We had to use these doses before they go bad. And you may have heard the there are more doses in every vial than there than we originally planned for, just a sort of a quirk of the production process where they always pack a little bit extra. And in this case, instead of five doses, sometimes people have had as many as eight doses in a mile. And so you have all this 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.

Advertisement
Advertisement
Advertisement
Advertisement

S1: Some people have advocated for just getting rid of the rules and seeing how it’s playing out now, like, OK, 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?

S5: That idea would make sense if we had any kind of system that took racial inequities into account, but it doesn’t.

S1: That idea also doesn’t take into account how the virus is spreading through workplaces, multigenerational households, prisons. It’s not only an issue of fairness, it’s an issue of inoculating the vectors for this disease.

S5: I think this is the kind of thing exactly the public health infrastructure was built for, to come up with ways of making this process equitable and efficient. The problem, I think, has been the 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 one of the things that has happened in this pandemic, not just for this, but for everything, is that 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.

S1: Hmm. There’s another idea that’s gained some traction. This public health expert, Ashish Jha, argued in The Washington Post that maybe we should just be giving people one dose of the vaccine. You know, a lot of them require two doses. And if we just give one dose, it’ll get us far enough that. It will protect more people, more people will have access, and it’s become even more important because in the last few weeks we’ve seen this new variant of covid that’s more transmissible.

Advertisement
Advertisement
Advertisement
Advertisement

S5: I wonder what you thought when you read that Asheesh Chai’s very smart person, but I’m not sure I agree with him here. And that’s partly because there are a lot of virologists who know exactly how viral evolution works, who think that’s a terrible idea. That’s because we don’t know how effective the vaccine is after one dose, but it’s probably less effective. So let’s say if the vaccine is ninety five percent effective after two doses, we’re looking at maybe eighty five percent. But then with this new variant, there’s also a particular set of deletions that makes the the new variant a little less susceptible to the vaccines, little a little less subject to the immune response. So now we’re looking at maybe another 10 percent less, something like that. These are numbers I’m just making up just to give a sense of how the vaccine will be much less effective than the ninety five percent with the two doses in a lab. This is exactly how you actually get a virus to mutate, to study it. You put it under selective pressure where it has some repressive force, but not so much that it’s completely dead. You see what mutations the virus gains that allow it to survive. So it would be like we are doing that experiment across millions and billions of people and giving the virus free reign to come up with fantastic mutations that allow it to survive longer or transmit better or any number of advantageous mutations that could gain. So I think is actually an extremely dangerous proposition.

S1: Late Monday, the FDA issued a statement essentially agreeing with Apoorva Takir, saying there just isn’t sufficient evidence for reducing vaccine doses, that it could, in fact, be counterproductive. But Apoorva acknowledges all these decisions have trade offs, tradeoffs. We’re not going to find out about until after the fact trade offs we are being forced to make partially because of mismanagement and partially because we’re under the gun. That new variant, the one that was detected in the U.K., it could supercharge the next coronavirus wave.

Advertisement
Advertisement
Advertisement

S5: Absolutely. I mean, it’s really a race. We are racing to vaccinate as many people as possible before the virus changes so much that the vaccine is no longer effective.

S7: After the break, how the new coronavirus variant raises the stakes on everything we do next.

S1: Let’s talk about the new video, because I feel like it kind of snuck in there right before the holidays, like if you could just give me a basic 101 on the new variant and like, exactly what it does because I think people get confused about it.

S5: Yeah. So, you know, we know that viruses mutate just a very natural process. Every time the virus divides, it could make mistakes. Some of those mistakes will be inconsequential. They won’t really change the virus at all in any significant way. And 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 twenty three mutations that are different from the original variant that was in Wuhan. And what has been somewhat concerning is that this variant is has 17 mutations that are different from its most recent ancestor. So as a Galip, it was a huge leap and it took yeah, it took on a lot of mutations 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.

S1: One of the other mutations in this coronavirus variant is one that makes the virus a little bit stronger, better able to hold off our immune systems. It may even make our vaccines less effective. All that means covid is going to be harder to contain. And more people being infected means more chances for the virus to mutate.

Advertisement
Advertisement
Advertisement

S5: Again, it means that we’ll need to be even more careful than we are being now in order to have any chance of stopping it. And I don’t think that’s likely right, given how Americans have been reacting to even the restrictions that are being or were being proposed.

S1: Well, given how everyone reacted like when the UK put in new restrictions because of the variant, you saw that rush of people going to the train station looking to go home for Christmas. And to me, I was just like how we talk about this is an American thing. And certainly this virus was politicized in America in a way that it wasn’t other places. But that instinct to just protect yourself or protect what you think you need versus, you know, lockdown, stay at home. It’s strong.

S5: And I think one of the things that both countries had in common is leadership that was giving mixed messages that had a very inconsistent set of guidelines. One day the virus is dangerous. The next day it’s not. One day we need restrictions. The next day we don’t. One day masks a great thing to wear. The next day, the president does mask less. So there’s a lot of confusion and people don’t know what to believe. I think as the numbers have gone up in the United States, two very strange opposing things have happened. One is that more and more people are aware of somebody who’s gotten sick. But at the same time, it’s been a year and some people who have been careful have not seen the reward for their good behavior. They haven’t seen the virus go away. They haven’t seen the restrictions lift in a way that would make them comfortable to run around. And so they’re angry and they’re tired and don’t want to comply anymore. So we’re just at this psychologically bad place where people don’t want to be under any restrictions. And yet we’re facing a much more serious adversary.

Advertisement
Advertisement
Advertisement

S1: And we’ve seen that this new variant, it’s popped up in Colorado and California and Florida. So we know it’s here, but we just don’t know how widely spread it is.

S5: I think the best estimates are still that it’s just starting because the U.S. has not sequenced that many viral genomes. But we’ve sequenced enough that people I really respect, like Trevor Bedford at the University of Washington in Seattle, has estimated that it’s probably still under one percent of the total cases, maybe around point five 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 and probably by March took about three months in the UK and probably will take about that amount of time here. By March or so, it’ll become the predominant variant in the United States.

S1: Is there any way to stop that? Because part of part of what stood out to me about your reporting and looking at what you were writing here was you talked about how regular lockdowns weren’t enough to suppress this variant. And it made me think, oh, God, can we can we even do anything here?

S5: Well, it really depends what we mean by lockdown, right? I mean, in the United Kingdom, they had schools open and the schools were not actually using all of. The tools at our disposal, like the kids were not masked, they weren’t necessarily doing social distancing within the schools. So that’s number one, right. There could have been a big contributor. And I think some of the data are indicating that, especially in older kids, that was a big contributor. And also a lot of people still weren’t wearing masks. So they were still going out to eat. They were still visiting family. They were still getting together in pubs. And it’s similar in the in the US. Even when we talk about lockdowns here, what are we really talking about? Most states have had indoor dining open. More states have had weddings and funerals and big parties still go on. And there’s still many people who refuse to wear masks regularly. And malls were open and we’ve had Thanksgiving and Christmas. So we’re not really talking about having had 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. So there is a lot of room for improvement, I guess, is what I’m saying. We know what to do to retard the speed with which this virus spreads. And we just have to put those things into actual action, not just talk about them.

Advertisement
Advertisement
Advertisement

S1: So how much of all of this can we really expect a new administration, the Biden administration, to start to fix? I mean, Joe Biden has said he wants to have one hundred million doses of vaccine out there by his 100th day in office. Do you think that’s actually even reasonable to expect given what’s happened over the last month?

S5: It may be. I mean, I think you said start to fix, and that’s really key. They’re not going to fix, but they will at least start to fix. The new incoming CDC director, Rochelle Walensky, is extremely smart and extremely capable. And I could see that she could ramp up the sequencing effort, for example. And if we do, the kinds of precautions know put impose the kinds of lockdown type measures that we have to 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 one hundred million in one hundred days is feasible. It seemed feasible actually when we were talking about 20 million by the end of the year. 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.

S1: If we’re really disciplined, what is the most important thing you think to fix first?

S5: The very first absolutely critical thing we have to do is get the numbers of infections down. None of this, nothing about this, the new variant, the vaccines, none of this is going to make a difference, even if we get everything else right. If the virus is still spreading the way that it is now. Every single person that the virus infects is a chance for it to pick up new mutations. So we are basically giving the virus so many chances to become more dangerous. And we’re also putting such enormous strain on our health care system and it may buckle under in a way that it never recovers from. So I’m not when I look at the future, when I look at the next few months, it’s hard to imagine a positive scenario emerging unless the numbers go down.

Advertisement
Advertisement
Advertisement

S1: So funny you started this and you were such an optimist, and I feel like I’ve made you a pessimist.

S8: Thanks a lot, Apoorva Mandibular.

S7: Thank you so much for joining me. Thank you for having me. It’s my pleasure. Apoorva Mandaville is a health and science reporter with The New York Times. And that’s the show. What Next is produced by Davis Land, Daniel Hewitt, Elena Schwartz and Mary Wilson. Frannie Kelley is helping making all of this work. Alicia Montgomery and Allison Benedikt have the fairy dust that make it all hang together in the end. And I’m Mary Harris. You can find me over on Twitter. I’m at Mary’s desk. And in the meantime, I’ll meet you back here tomorrow.