The noise about fixing the Covid-19 vaccine rollout: can we get 100 million vaccine doses out in the next 100 days.

President-elect Biden outlined his plan on Friday for fixing America’s Covid-19 vaccine rollout. 

Clearly the current vaccine initiative has been less than adequate. The biggest problem has been turning the entire distribution of the COVID-19 vaccines over to underfunded, overburdened state and local agencies. This has led to a fragmented, poorly co-ordinated and under funded rollout. The mix of problems is not consistent even from state to state and even in local areas.

At the core of President-elect Biden’s proposal is greater federal involvement in distribution. In contrast, the Trump administration was against a bigger federal role — even characterizing any intervention in state distribution programs as a federal intrusion.

Given the general concern in the population that the vaccine rollout has not been adequate, even HHS Secretary Azar has changed directions and suggested a broader distribution of all the vaccine stocks currently available.  There is general consensus that vaccination is the only real way out of this pandemic.

The U.S. vaccine delivery process has been as disappointing as the vaccine development was successful. The government promised 40 million doses and 20 million people vaccinated by the end of 2020; two weeks into 2021, 31 million doses of vaccine have been delivered, but only 11 million Americans have received at least the first dose of a vaccine, according to federal data. 

While it is reassuring that even at these delayed vaccination rates, the country could still achieve the 70-plus percent vaccination rate necessary for herd immunity and suppression of new infections by the end of the summer, every week of delay means more people infected and more deaths.

Biden’s plan promises, “the full strength of the federal government, in partnership with state, local, and private organizations, for a truly national vaccine plan.” The full proposal can be read here, but the key points include: more support to states and local governments, a boost in vaccine production, better communication about the vaccines, an education and awareness campaign, and more. He reiterated his promise to have 100 million vaccine doses delivered in his first 100 days in office.

• More involvement by the federal government in getting vaccine doses to people. That includes new vaccination centers, mobile vaccination units in underserved communities, reimbursement of states’ National Guard deployments, and expanding vaccine availability in pharmacies. 
• Boosting the supply of vaccines: Biden says he will use the Defense Production Act to boost the manufacture of vaccines and related supplies.

• Improved communication with states so they can receive fundamental information such as when and how much vaccine they can expect to get. This has been a big complaint from states today.

• Expanded vaccine eligibility: Biden calls for expanding vaccine eligibility to include everyone 65 and older as well as frontline essential workers, including teachers, first responders, and grocery store employees. Several states have already moved in this direction.

• Mobilize a larger public health workforce: Biden vows to hire and use a larger public health workforce to help deploy the vaccine across the country. He’ll also take other steps, like allowing retired medical professions who aren’t currently licensed under state law to help administer vaccines “with appropriate training.”
• Launch a national public education campaign to help convince people to get vaccinated and address vaccine hesitancy.

The plan has defined objectives and goes well beyond the current federal efforts to deliver the vaccine in that last step to individuals. It could be more effective in fixing supply chain problems, if the use of federal powers can address bottlenecks. And if a a public education campaign can actually convince Americans to get vaccinated, we are all better off.

The issue is, of course, whether any of this can get implemented properly. Are the current failures the result of policy decisions or fundamental issues with the United States health care system?  Can the new president get support for the $400 billion COVID-19 plan from Congress? Even with Democratic majorities in both houses, he might face opposition to the high price tag. And even with more money and federal intervention, can we get more vaccine produced?  

If he pulls off his pledge of “over 100 million vaccinated in 100 days,” Biden has a chance to show that federal leadership can truly make a difference. If not, there will likely be significant disillusionment among those who voted for him in hope of a change. Regardless, at least we won’t have to listen to Adm. Brett Giroir whine,“The federal government doesn’t invade Texas or Montana to provide shots to people.”