The Morning Jolt

Health Care

The Disappearing Vaccine Doses

A woman receives the second dose of the Moderna coronavirus vaccine in Sarasota, Florida, February 10, 2021. (Shannon Stapleton/Reuters)

On the menu today: The problems in the vaccine rollout don’t make sense. We know how many manufacturers are sending to the states, and we know how many vaccines are ending up in arms. And somewhere along the line, a whole bunch of vaccines just . . . seem to disappear.

Is the Issue of Missing Vaccines Just a Matter of States Setting Aside Second Doses?

As of this morning, according to the New York Times, Moderna and Pfizer have shipped more than 70 million doses to the states, and somehow the states have gotten only 52.8 million of those shots into peoples’ arms. The Bloomberg chart has a slightly better figure, showing states have administered 54.6 million doses, out of roughly the same total.

That leaves anywhere from 15.4 to 17.2 million doses either in transit or sitting on shelves somewhere. The country is vaccinating about 1.67 million people per day according to the Times data, 1.69 million per day on the Bloomberg chart.

If Pfizer and Moderna stopped delivering new doses, we could keep vaccinating people at the current rate for nine days using the Bloomberg data, ten days using the Times data.

Why are so many FDA-approved, manufacturer-distributed vaccines sitting in the supply chain instead of getting into peoples’ bloodstreams? Some of the problem might be weather delays, particularly this week across the Midwest. But that doesn’t quite explain the gap between doses distributed and doses administered, which has slowly crept down from about 20 million doses at the start of the month.

The SARS-CoV-2 virus is always mutating, and most mutations won’t make that much of a difference in how it works. But mutations that make it more contagious or virulent matter a lot, and we’re detecting more mutations making the virus potentially worse. (This doesn’t necessarily mean the pace of mutation is changing, so much as we’re doing more tests and detecting more mutations. Also, mutations that make the virus less contagious are less likely to get noticed and recorded, because those versions of the virus will spread less.) Some virologists are fuming that society is letting up on its mitigation measures, letting the virus metaphorically get up off the mat after we’ve dealt it some tough punches.

The question is more pressing than ever: Where are those unused vaccine doses, and what is stopping states from getting them into arms quicker? Yesterday brought the news that the Biden administration is offering to set up 100 federally supported vaccination sites by the end of February, but those sites wouldn’t come with any additional doses of the vaccine. States would have to provide the federal sites with doses from their existing supply, and at least for now, states are saying they don’t have the doses to spare.

If the problem facing us genuinely is a lack of people and places to vaccinate, with roughly 15 to 17 million doses sitting on shelves, then federally run vaccination sites would help pick up the pace. But locality after locality and state after state keep describing the same problem. They lack enough doses to meet demand; they don’t lack trained personnel or spaces to conduct vaccinations.

In New Jersey:

Bergen County’s decision to stop sharing its COVID-19 vaccines with municipal health departments is not sitting well in Ridgewood.

The village posted a note on its website on Feb. 7 telling residents they must seek appointments for vaccinations elsewhere. Ridgewood had set up its own vaccination clinic after what Mayor Susan Knudsen called months of planning and a “tremendous” quantity of resources, but the clinic is now unused because the town has no vaccines to give out.

Paramus posted a similar note on its website the same day, letting residents know that the local Health Department would not be receiving any vaccines.

“I’m sure if there was enough to go around, they’d love to give it to the community,” said Mayor Richard LaBarbiera. “We’re more than happy to give them out.”

That article mentions that Bergen County is receiving about 2,000 doses a week. The county has “more than 190,000 older adults.” If they started vaccinating “older adults” in mid-December, at this pace the county will be done vaccinating older adults by October . . . of 2022.

In Montana:

The VA has about 45,000 Montana veterans enrolled in the health care system. It receives 600 vaccines each week, and clinics are scheduled based on when they get doses. The VA calls eligible veterans to sign them up for a slot.

Currently, the VA is only offering vaccines to people 75 and older or with specific medical conditions. If you don’t fall into one of those categories, don’t worry about not getting an appointment. As long as you’re enrolled through the MTVAHCS, you are on the list and will eventually get a call.

We are two months into the vaccination process, and the Veterans Administration still doesn’t have enough doses to prioritize a healthy 74-year-old veteran? For a long while, I was in the “just vaccinate anyone you can, even the pizza guy, because each vaccinated person gets us closer to herd immunity.” I don’t even mind vaccinating prisoners in jails, because the virus spreads quickly in those locations and they don’t have options for social distancing. But some of these cases are ridiculous.

In Michigan:

A large scale COVID-19 vaccine clinic in Grand Rapids is prepared to give shots to tens of thousands of people each day, but current supply is limiting that reality.

In the three weeks since it opened, 13,000 people have received the vaccine there, but clinic operators say it could be vaccinating up to 50,000 people a day (between first and second doses). Last week, there was no available supply at all.

“It’s very frustrating when we have a week like last week where we had no vaccines to give and so we were closed,” said Mark VanDyke of Spectrum Health, who has been running the clinic’s day-to-day operations.

Elsewhere in Michigan:

A significant reduction in Michigan’s Pfizer COVID-19 vaccine allocation forced Beaumont Health was forced to cancel 1,884 second dose appointments scheduled for Feb. 18, the health system said Monday.

The decrease in allotment was unexpected, the health system said Monday, and staff is working to automatically reschedule all canceled appointments to one week later at the same time and on the same day of the week.

In Massachusetts:

After administering 285,000 doses last week, Massachusetts is now ranked third in the country when it comes to shots administered per capita. However, some people say they are feeling frustrated that the state’s plan is not meeting their needs.

According to Bruce Murphy, the Yarmouth Health Director, the Cape has only received 975 doses. Much too few for the 26,000 residents over the age of 75.

Barnstable County has been shuffling their weekly allotment between different towns and Murphy is pushing the state to open a mass vaccination site at Cape Cod Community College. The closest site now is located at Fenway Park and Gillette Stadium.

In Alabama:

Mass vaccine sites in eight cities across Alabama combined to give more than 76,000 doses of COVID-19 vaccines this week as the state looked to surge its delivery.

But some of those sites may not open at all next week, or will operate at a lower capacity than they did this week.

Alabama State Health Officer Dr. Scott Harris said Friday that the state doesn’t get allocated enough doses every week to supply those drive-thru clinics at the same rates, and that some of the sites may choose not to run the drive-thru clinics next week.

In Illinois:

Mercyhealth canceled more than 1,000 COVID-19 vaccination appointments Monday after the hospital system said it received zero first-dose vaccines for this week.

Mercyhealth, just like many other hospital systems across the country, request vaccine doses from state health departments and it’s up to those departments to allocate a number of vaccine doses.

According to Mercyhealth, it received zero first-dose vaccines for 605 patients in Winnebago County and 470 patients in Rock County, Wisconsin. As a result, it canceled appointments for patients scheduled to be vaccinated in Rockford and Janesville.

“Hospitals make weekly requests for vaccine, and the state allocates and ships the COVID-19 vaccine,” Mercyhealth said in a news release Monday. “Mercyhealth is hopeful to receive the requested amount, but it may or may not be granted by the state.

Why is the distribution process so opaque? Why are states unable or unwilling to share how many doses they receive from manufacturers each week, and which counties or communities they’re sending them to? Why are state governments this “black box” where manufacturers send in a steady torrent of vaccines, but only a slow trickle comes out?

Judging by this account in the Washington Post, a chunk of those 15.4 million to 17 million doses may be second doses that state authorities have set aside for those who received the first dose:

The federal government sends second doses to states on a schedule based on when first doses go out the door — not when the shots are put into arms. In Maryland’s system, that means second doses can sit unused for two weeks. A slow use of first doses can result in an even larger glut of second doses shipped and waiting to be used.

“A dose sitting on a loading dock is not a second dose by any measure, except the Maryland health secretary is calling it that,” Rosapepe told acting health secretary Dennis Schrader at last week’s hearing. “Hoarding doses for three or four weeks just isn’t good public health policy.”

But Schrader defended the practice, noting each second dose is specifically paired with a first dose: “When we give a first dose to an individual, we feel ethically compelled to make sure that person gets their second dose.”

Schrader said using doses earmarked as second shots to provide people with their first shots could gum up the flow of doses later, potentially creating a shortfall.

In Virginia, [state vaccine coordinator Danny] said the decision to hold first doses in reserve led to a backlog of 360,000 second doses.

Nobody wants someone to get their second dose later than they should. But both the Trump administration and the Biden administration told states they shouldn’t be holding doses in reserve for future use. The Biden administration insists they’ve made states guarantees about how many doses to expect three weeks down the road, which should make holding back doses unnecessary.

The New York Times noticed something we covered back on February 4 — that governors, feeling pressure from the public, are expanding eligibility, but the supply isn’t expanding with it. All that does is allow people to make appointments further in the future. Maybe having a date offers people some peace of mind. But keep in mind, vaccinations started December 15. We’re two months into this process. “We’ll get back to you someday on when we can give you a date for an appointment” is a pretty frustrating answer.

ADDENDUM: The Editors of NR call for the National Guard to leave Capitol Hill:

These troops have done their duty admirably, but it’s time to go home. New security protocols may be necessary at the Capitol — certainly the police should be better prepared for protests that might run out of control — but they should be carefully thought-through and calibrated. And they shouldn’t include a tall razor-wire fence that symbolically separates our elected representatives from the people they serve.

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