Now, health officials across the country who had predicted that their extremely limited vaccine supply would double from next week are faced with the fact that their allocations will not increase immediately, dashing hopes of significantly expanding the vaccine. access for millions of elderly and at risk of medical conditions. Health officials in some cities and states have been made aware of the reality of the situation in recent days, while others remain in the dark.
Because the two authorized vaccines for emergency use in the United States are two-dose regimens, the initial policy of the Trump administration was to withhold second doses to protect against the possibility of manufacturing disruption. But that approach has changed in recent weeks, according to officials, who spoke on condition of anonymity because they were not authorized to discuss the matter. The result is that next week’s allocations will remain stable.
These officials were told that Operation Warp Speed, the Trump administration’s initiative to speed up vaccine and therapeutic development, stopped stockpiling second doses of the Pfizer-BioNTech vaccine late last year. , instead taking second doses directly off the production line. The last shots held in reserve of Moderna’s supply, meanwhile, began shipping over the weekend.
The change, in both cases, had to do with increased confidence in the supply chain, so that the leaders of Operation Warp Speed were confident they could reliably anticipate the availability of doses for booster injections – required three weeks later in the case of the Pfizer-BioNTech product and four weeks later as part of the Moderna protocol.
But it also meant there was no stockpile of second doses awaiting shipment, like Trump administration officials. suggested this week. Azar, in a Tuesday briefing, said: “Because we now have a constant rate of production, we can now ship all the doses that had been kept in physical reserve.” He explained the decision as part of the “next phase” of the country’s vaccination campaign.
Those who queue for their second injection are expected to receive them on time, as states still receive regular shipments of vaccine. But national and local authorities say they are angry and bewildered by the changes in leadership and the changing explanations of the offer.
HHS spokesman Michael Pratt confirmed in an email that the final supply of second doses had been released to States for ordering over the weekend, but did not respond to Azar’s comments this week, saying only, “Operation Warp Speed has kept a close eye on manufacturing and has always intended to transition from holding second doses in reserve as manufacturing stabilizes and we have gained in confidence in the ability of a constant flow of vaccines.
He also said states only ordered about 75% of what was available to them.
Azar’s comments follow a Jan. 8 announcement by President-elect Joe Biden’s transition team that his administration would decide to release all available doses, rather than keeping half in reserve for booster shots. Biden’s advisers said the move would be a way to speed up the distribution of the vaccine, which is rare across the country.
When Azar adopted the change four days later – after initially saying it was myopic and potentially unethical to put people at risk of missing their booster shot – he did not say that the original policy had already been removed or that the stock had been depleted. Signaling to states that they would soon see an increase in supply, he also urged them to start vaccinating adults 65 and older and those under 64 with a high-risk health condition. Officials in some states have adopted the directive, while others have said that suddenly putting hundreds of thousands more on the front lines will overwhelm them.
In subsequent conversations with state and local authorities, federal officials sought to temper these instructions, people who participated in the conversations said. Gustave F. Perna, COO of Operation Warp Speed, spoke directly with officials from at least two of the jurisdictions receiving vaccines, explaining that allocations would not increase and that they would not did not have to expand eligibility as they had previously been told, according to a health official who was not authorized to discuss the matter.
Oregon Health Director Patrick M. Allen was so disturbed by the realization that he wrote a letter to Azar on Thursday asking for an explanation.
“Earlier today, we were concerned when we found out that there were no additional doses available for allocation,” he said in the letter, which was reviewed by the Washington Post.
In a call with Perna earlier the same day, Allen wrote, the Four Star Army General “advised us that there was no reserve of doses and that we were already receiving full vaccines. .
“If this is true, this is extremely worrying and puts our plans to expand eligibility at serious risk,” Allen added. “These plans were made based on your statement about ‘releasing the entire supply’ you have in store. If this information is correct, we will not be able to start immunizing our vulnerable seniors on January 23, as planned. “
The revised instructions have caused other jurisdictions to delay the expansion of their priority groups. A state health official noted that the updated guidelines announced Tuesday for eligibility were not on the Centers for Disease Control and Prevention website, even though they were declared as federal policy by Azar and by Robert R. Redfield, the director of the CDC, in their remarks earlier this week. According to the original recommendations, adults 65 and older and essential frontline workers were to be the second priority group, known as phase 1b, after medical workers and residents and staff in long-term care facilities. duration.
But the issue of supply was of most concern to public health officials.
“States were shocked and surprised not to see an increase in their allocations, and when they asked for an explanation, some of them were told that there was not a large stockpile of second doses. on which to draw ”. said an official working with many states on immunization planning who spoke on condition of anonymity to recount sensitive conversations. “They thought they were getting more doses and they planned more doses and opened up until 65 and over, thinking they were getting more.”
In an email that reached some state officials on Friday morning, Christopher Sharpsten, a director of Operation Warp Speed, called it a “false rumor” that “the federal government is withholding vaccine doses in warehouses to guarantee a second dose / booster. “
But it was Azar who said on Tuesday that one of the changes in the government’s “next phase” of immunization was that “we release all of the supply that we have for states ordering, rather than keeping the second doses in physical reserve. “
There was further confusion. Another change Azar announced this week – to make the allocation of doses dependent on how quickly states administer them – would only take effect for two weeks, he said. But Connecticut Governor Ned Lamont (D) Thursday tweeted that federal authorities had informed the state that it would receive an additional 50,000 doses next week “as a reward for being among the fastest states” for getting gunfire. West Virginia, meanwhile, which is moving at the fastest pace based on CDC data, has not received additional doses, said Holli Nelson, a spokesperson for the state National Guard.
As a sign that the incentive structure may not last long, a senior Biden transition official, speaking on condition of anonymity to address the ongoing deliberations, said this week that the team had not viewed with kindness a system which “punishes the States”.