Vaccine supply was already depleted when the Trump administration promised to release it

When Health and Human Services Secretary Alex Azar announced this week that the federal government would begin releasing doses of the coronavirus vaccine held in reserve for second injections, no such reserve existed, according to state and federal officials briefed on distribution plans. The Trump administration had already started shipping what was available from the end of December, taking the second doses straight from the production line.

Now, health officials across the country who had predicted their extremely limited vaccine supply to double from next week are faced with the reality that their allocations will not increase immediately, dashing hopes of dramatically expanding the eligibility of millions of elderly and at risk of medical conditions. Health officials in some cities and states have been told the reality of the situation in recent days, while others remain in the dark.

Health and Human Services Secretary Alex Azar speaks at a press conference on Operation Warp Speed ​​and the distribution of the COVID-19 vaccine on Tuesday, January 12. Associated Press / Patrick Semansky

Since the two vaccines licensed for emergency use in the United States are two-dose regimens, the Trump administration’s original policy 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 Operation Warp Speed ​​leaders were confident that they could reliably anticipate the availability of doses for booster injections – required three weeks later in the case of Pfizer-BioNTech. produced and four weeks later under the Moderna protocol.

But it also meant that there was no stockpile of second doses awaiting shipment, as 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.

HHS spokesman Michael Pratt confirmed that the final supply of second doses was released to States for order 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 move out of custody. second doses in reserve as manufacturing stabilizes and we gain confidence in the ability of a constant flow of vaccine.

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 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 he was short-sighted and potentially unethical by risking the availability of a recall – he didn’t say the original policy had already been removed. or that the stock had been exhausted. 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 disease. 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 allowances would not increase and that they would not did not have to expand eligibility as they had been told previously, according to a health official who was not authorized to discuss the matter.

Oregon health director Patrick M. Allen was so troubled 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 are already receiving the full amount. allocation of 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 on Tuesday were not on the Centers for Disease Control and Prevention website, even though they were declared federal policy by Azar and 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 that they did not see an increase in their allocations, and when asked for an explanation, some of them were informed that there was not a large stockpile of second doses to tap, ”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.”

There was further confusion. Another change in the distribution system Azar announced Tuesday – making dose allocation dependent on the timing of vaccinations in states – would only take effect for two weeks, he said on Tuesday. But Connecticut Gov. Ned Lamont (D) tweeted Thursday that federal officials have notified the state that it will receive an additional 50,000 doses next week “as a reward for being among the fastest states” for get gunshots. 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”.

“Previous

Related stories