Hundreds of thousands more US Covid deaths possible amid vaccine chaos
Scant funding and scattered logistics have slowed distribution process as coronavirus case numbers rise, painting a dire picture for the future
America had no trouble hitting the appalling milestone of 20m coronavirus cases, but reaching the federal government’s own target of vaccinating 20 million people by the end of 2020 proved a huge problem. Just under 3 million Americans were vaccinated by the time the crystal-encrusted ball dropped in New York’s almost-deserted Times Square at midnight on New Year’s Eve to mark the end of a hellish year. Now US distribution of the vaccine is being routinely described as “chaos”, with criticism that inept officials are “botching” efforts. More than 10,000 people died in the US in the last three days of 2020 alone, to bring the national death toll close to 350,000 so far, including the worst 24-hour toll of the whole pandemic when more than 3,700 people died last Wednesday, according to Johns Hopkins University data. So vaccines are the big hope for fighting the outbreak. But experts are warning that hundreds of thousands more deaths are possible if the inoculation process doesn’t get quickly and solidly on track. “Basically, the federal government is botching the vaccine rollout,” said Ashish Jha, dean of Brown University’s school of public health. “They thought their job ends when the vaccine arrives in the states, and there’s really no well-delineated plan.”
He added: “What America is suffering through is the consequence of incompetence in federal leadership – the entire pandemic has been marred by a group of people, not just Donald Trump – who don’t understand how things work and can’t get something to work effectively.” Jha noted that he was not including top US infectious disease expert Dr Anthony Fauci or White House coronavirus taskforce coordinator Dr Deborah Birx among this group. If the rollout continues at the current pace, Jha said, it could take “many, many months and years” to fulfill vaccination goals for the nation. And if this delay continues for months, it could cause the US to lose “several hundred thousand more people”, he warned. An NBC analysis earlier this week found that at this present vaccination rate, “it would take almost 10 years to inoculate enough Americans to get the pandemic under control”. The breakthrough new vaccines coming on stream so far in the west from Pfizer/BioNTech, Moderna and Oxford University/AstraZeneca are lifesavers, with more still in trial. “The vaccine looks like it can reduce the risk of … symptomatic Covid,” said Bruce Y Lee, professor at Cuny graduate school of public health and health policy in New York.
But he warned: “Every week, two week, three-week delay, while the cases are pushing up further, is costing lives – and especially if we’re talking about healthcare professionals.” The state of vaccines being administered to the public in many US areas stems from a combination of scant funding and scattered logistics. Public health in the US is chronically under-funded. Local and state officials had long warned federal authorities that they required more than $8bn in additional money to build an infrastructure to get shots into arms. Instead, the White House gave states just $340m for vaccination preparations. For months, some congressional legislators chafed at providing more money for vaccine distribution. It wasn’t until last Sunday, when the delayed new coronavirus aid bill was signed by Trump, that an additional $8bn in funding came through, Stat News explained. More money to states won’t fully solve the problem, however. Experts said that a unified, national plan is necessary to address logistical snags.
“Not enough doses have been produced and distributed,” said Lee, who is also executive director of public health informatics, computational and operations research at Cuny. “Of the doses that have been distributed, the majority have not been administered. They’re either getting [caught] up in the supply chain ... or not getting administered, which is not too surprising, because there hasn’t been a clear, coordinated national plan.” The federal government’s decision to put the initiative onto states as to how they would administer the vaccine doses to people has exacerbated these problems. The Pfizer/BioNetch vaccine must be stored between -112F (-80C) and -94F (-70C), while Moderna’s jab needs to be stored at about -4F (-20C) – meaning that localities may struggle to find adequate freezer capacity.
Also lacking is federal coordination over vaccine accessories such as syringes, needles and alcohol swabs. “We have to remember, earlier this year, testing went awry because we ran out of cotton swabs,” Lee pointed out. Numerous reports across the US paint a picture of haphazard or limited rollout. Texas residents have complained that providers aren’t picking up the phone when they call for information, that official websites were hard to navigate – and that they didn’t know where to get the vaccine, reported Dallas ABC affiliate WFAA-TV. In Florida, where those 65 and up can also start getting vaccinated, senior citizens were seen camping out overnight for the jab. Terry Beth Hadler, 69, queued up in a parking lot overnight with hundreds of others outside the Bonita Springs library in south-west Florida.
She waited 14 hours, and told the Associated Press that a fight almost broke out before daybreak on Tuesday, when some people cut in line. “I’m afraid that the event was a super-spreader, I was petrified,” Hadler said. Near Miami, seniors overwhelmed phone lines and a health department website in an often futile attempt to get vaccination appointments, the South Florida Sun-Sentinel reported. New York City, the world coronavirus hotspot back in the early spring, is also suffering from sluggish distribution. The city has received more than 340,000 doses but administered only about 88,000, The New York Times reported Friday.
No one denies it’s challenging to execute a massive vaccination campaign in the midst of a public health crisis that has overwhelmed health personnel and services in many parts of the nation. Claire Hannan, head of the Association of Immunization Managers, said in an emailed statement: “Doses distributed to hospitals will not be administered overnight. Hospitals are moving at a very deliberate pace. Providers need to be trained and healthcare personnel need to receive education about the vaccine.” She added: “Hospitals are also stretched very thin right now, we’re asking for a lot of their time, resources, space, energy and effort to coordinate vaccine clinics, they have to approach vaccination in the midst of caring for patients.”
The pressure is intense.
“We are expecting to move at lightning speed, and I think they’re actually moving at a very good pace given that this is a completely new vaccine,” Jessica Justman, associate professor of medicine in epidemiology at Columbia Mailman school of public health. That’s not to say that delays, even if expected, shouldn’t be immediately addressed. Both facts are true: delays were virtually inevitable, but they will cost lives, she noted. “Hundreds of thousands of people are dying and the rollout of the vaccine needs to happen as quickly as possible,” Justman said. Some public health experts believe that the US needs to take a more innovative approach, including looking to the UK’s latest plan which aims to get as many people their first dose as possible, rather than holding back doses in order to ensure ready amounts of the initially-scarce supplies for administering the second required shot to the same people a few weeks after their first shot.
“In the UK, they are spacing out the amount of time between the first dose and the second dose, which is a very creative idea,” Justman said. “I trust that the UK would not make that decision without having data to back that up.” Brown’s Jha said that science showing efficacy with a single dose isn’t as strong, presenting a dilemma. The US could keep following its present approach – unwilling to take any scientific risks and operating “exactly by the book” on vaccine dispensing or seeing whether something novel works to stem the crisis. “I think the UK approach in getting a single dose out there is the right approach,” Jha said. “In my mind, it is far more reasonable given the state of play that we are in, that we’ve got to move on this.” On Friday, however, Fauci came out against following the UK model to delay second shots in order to deliver to more people the partial protection conferred by a single dose.
Meanwhile, some states’ decision to prioritize senior citizens above non-healthcare essential workers, which is in opposition to federal recommendations, might create logistical challenges. However, “in terms of getting the vaccine out and into arms as quickly as possible, this may not be such a bad thing”, Hannan said. She added: “States have not had sufficient time or resources to set these systems up, so there will be hiccups. But again, the bottom line, every day that vaccine is going into arms is a success.” Brown’s Jha said the US could get back on track. Even amid the suffering, he concluded: “I think you can make a moderate set of changes, and I think you can get this fixed.”
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