At the end of a week when more vaccination sites seem to be closing than opening (due to lack of the vaccine), Dr. Tony Fauci exhibited unbridled enthusiasm for vaccine availability by April.
His exact words are, “If you look at the projection, I would imagine by the time we get to April, that will be what I would call, for [lack] of better wording, ‘open season,’” Fauci told NBC’s “Today” show. “Namely, virtually anybody and everybody in any category could start to get vaccinated.” Remarkably, the media is accepting that estimation.
That is barely a month and a half away. It seems wildly optimistic given where we are at right now, given we are immunizing only 1.6 million people per day. And while this number of vaccinations is in line with Biden administration projections, it vacillates greatly.
Supply of vaccine is the real issue now since, for the first time, doses administered are consistently outpacing doses distributed. This has depleted all remaining reserves of vaccine, however, and it is Fauci’s hope that this should change soon. Weekly vaccine doses being sent to states has increased by 28 percent to 11 million doses a week since mid January, according to White House COVID-19 coordinator Jeffrey Zients. He hopes that by next week that number will increase again by another five percent.
Low dead space syringes are crucial to getting more vaccine doses per vial.
These estimates are based on improved production numbers from the vaccine manufacturers. Pfizer and Moderna had initially promised to increase the delivery of vaccine to 100 million doses each (200M total, enough to immunize 100M individuals) by the end of March. Pfizer added 20 million doses to their estimates, but that is because they got approval from regulators to increase the count of doses per vial by 20% because vaccinators can squeeze six or even seven doses out of vials that were supposed to contain just five. This estimate depends, however, on having the specialized syringes needed to get the additional doses out of the bottle. This is an issue.
In a similar vein, Moderna is requesting that U.S. regulators approve filling the entire volume of their vials with vaccine, which could yield another 5 doses or 15 per vial. According to the New York Times, if this proposal is approved, it could theoretically allow Moderna to ship tens of millions of additional doses by the end of March.
If all this is achieved and actually gets the additional vaccine into arms, it would be enough to vaccinate 225M individuals by the end of June. This is close to the entire adult population of the U.S. (~240M).
The other wild card is improved distribution. I recently complained about the dysfunctional administration system which is driving people insane as they try to arrange an appointment. Dr. Fauci also commented that more vaccines will be going directly to 6,500 retail pharmacies and community health centers serving hard-to-reach groups such as homeless people, migrant workers, and public housing residents. These populations will be the most difficult to get vaccinated.
The one thing that rings true even if these numbers are not achieved — more vaccine and more places distributing it will definitely improve access.
Pandemic Pondering 
Dr. Baker Thank you for your clear explanation of what is happening! I read the state of Michigan reduced the number of vaccines going to the health systems 50/50 split to 60/40. Mi will begin using SVI “Social Vulnerability index” to distribute vaccines. You can check your county out by looking it up on this website. https://svi.cdc.gov (ref. article below from 2/13/2021)
https://record.umich.edu/articles/new-state-allocation-strategy-limits-u-m-vaccine-rollout/
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I’m not so sure I agree with your statement “… hard-to-reach groups such as homeless people, migrant workers, and public housing residents. These populations will be the most difficult to get vaccinated.”
I may be wrong, but I suspect that the majority of homeless people and residents of public housing are clustered in urban areas where they are relatively concentrated and where hospitals, healthcare clinics, and public health professionals are most often found. Migrant workers, while moving around from jobsite to jobsite are a moving target, they too live in relatively easily-identified communities.
I personally think the most difficult people to get vaccinated are the people who live in rural areas where hospitals and clinics are many miles away; some may be many hours distant, even by automobile. In other word, people in the backwoods and flyover country. These are also the people that we hear the least about, as if the public health community considers them an afterthought at most, something I’ve directly encountered in my years in the profession.
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Was not my statement. Came from government. I think it varies across the country and certainly the areas you point out need to be addressed was well.
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Yes, of course. I get it that this is government’s take on it and not your position, which I suppose is my point: The spokespersons are following the lead of the public health community, which as I noted is decidedly biased in favor of urban populations. And I base this on 25 years of experience in the public health profession. IMHO, we need a new set of leadership in public health that more accurately represents the diversity of our nation.
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