Whatever happened to the coronavirus vaccine tiers?
Dr. Jose Romero didn’t foresee this.
After months of careful planning, meetings and consultation that took over most weekends of the late fall and winter, the chair of the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices thought his group had a good framework in place.
It was clear from the beginning that coronavirus vaccines would be scarce at first, and there would have to be some sort of tiered allocation system.
States would distribute vaccines in phases, hitting the most vulnerable first, and making sure that health care workers were protected as soon as possible so they could in turn vaccinate, treat and protect patients.
And it started out that way, with the very few available doses of coronavirus vaccine and the frail residents of nursing homes, the people who worked there, and other health care workers. The next groups in line were carefully chosen with an eye to who is most at risk from Covid-19 for age, health or occupational reasons.
Some states moved to phases 1b, 1c and even Phase 2, adding people with underlying conditions, frontline and essential workers and other designated groups.
And now it’s March, and nearly every state has either abandoned or announced plans to completely dump that staged approach.
“This wasn’t what we were expecting,” Romero, who is secretary of health for Arkansas, told CNN.
President Joe Biden came into office in January with an immediate promise to get 100 million doses of vaccines into American arms within 100 days. On Wednesday, he promised to make it 200 million doses and his top staff have crowed about the speed of the rollout.
“Two hundred million shots in a hundred days — this is an unprecedented pace. No country has ever vaccinated this many people this fast,” White House Coronavirus Response Coordinator Jeff Zients told a news conference Friday. “And this effort will coincide with us reaching into harder-to-reach communities all across the country to keep up this pace and ensure and fairness. We are making progress.”
Biden told states to open vaccination to everyone 16 and older by May 1, and they’re jostling to do so weeks earlier.
While White House officials say they still want to focus on getting those most in danger from the virus vaccinated, in reality the focus has been on one thing: numbers.
“The problem is from the beginning there has been this dominant attention on how many people are getting vaccinated,” said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials (ASTHO).
“There is this intense pressure that we need to vaccinate as many people as possible,” Plescia told CNN.
“The only thing that states are being judged on is how many people are being vaccinated so if the state is really trying to be more judicious, and really thorough with some of the prioritized groups, they don’t really get any credit for that.”
It’s not easy to set and enforce priorities. People complain about line-jumpers, groups lobby to get their special interests — usually worthy special interests—accounted for, and it’s difficult to police who actually shows up to get immunized.
And vulnerable groups are often vulnerable for a reason — they don’t have the time, the proficiency with computers, the language skills or the motivation to navigate the various systems set up for accessing vaccines.
“The major concern has been for all of us — in an effort to get vaccine out and into arms are we neglecting those people that have had inequity in health care in the past,” said Romero.
“Are we making sure we are getting vaccines into the arms of people who have had high impact from Covid?”
It takes time and effort to find and recruit the marginalized. “If the states go after them, it slows down the process,” said Plescia. That’s time that could be used to vaccinate the eager, and keep the overall numbers up.
“This is a little bit of a byproduct of our culture, and a little bit of this individualistic, survival-of-the-fittest kind of approach,” Plescia said.
That might be all right, especially if it turns out that vaccinated people don’t spread the virus. That’s the hope, and public health experts are urging quick vaccination to stay ahead of the variants that may evolve into forms that can evade the protection offered by vaccines. Any vaccinated person is one more brick in the wall being built to stop the virus.
“There are people who are very enthusiastic and motivated to get out and get vaccinated,” Plescia said.
“We are seeing those people and they are lining up and dealing with all this stuff, persevering with all these different appointment systems. And my hope is that after that and there’s another wave of people who do want to get vaccinated, but they’re just not as aggressive about it. My concern is that we’re moving through this motivated group and then we’re going to hit some pretty serious vaccine hesitancy.”
The three authorized vaccines — made by Johnson & Johnson’s vaccine arm, Janssen, Moderna and Pfizer with its partner BioNTech — are being manufactured on the fly. Romero fears that if production gets held up, the current free-for-all will end up leaving the most vulnerable in the lurch.
“I worry that something will go wrong — that there will be production glitches or something will go awry for making glass vial or stoppers,” Romero said. It’s not a misplaced fear — federal sources told CNN earlier this month they expected J&J to fall short of its target for March. The White House announced Friday it would make it — just barely — after, according to corporate sources, overcoming issues at its fill-and-finish plants.
The rush to get vaccinated may slow soon, Plescia predicted.
“Living in the Southeast, I do think that we are starting to see some satisfaction of demand and demand is falling off,” he said. “I think this is the opportunity now for states, once they’ve cycled through that, I hope they can kind of circle back and say ‘OK, you know who did not get it yet,’ ” he said.
“And now we’re going to spend a little bit more time trying to find those people.”
