A new virus dilemma for Biden: how to deal with a looming vaccine glut

Biden administration officials predict that, in mid-May or earlier, supply of coronavirus vaccines exceeds demand in the United States and they are in front of the dilemma of what to do with impending remains when the vaccine shortage becomes a glut.

President Joe Biden has pledged that by the end of May there will be enough doses to immunize the country’s estimated 260 million adults. But the government has secured commitments with manufacturers so that between that date and the end of July, they will provide enough vaccines for 400 million people, about 70 million more than the entire population of the country.

One question that has important implications is whether to keep, modify or redirect these commands, not only in terms of the country’s efforts to contain the virus, but also in terms of the timeline to end the pandemic. Of the vaccine doses administered worldwide, about three-quarters went to just ten countries. At least thirty countries have not given the vaccine to one person.

In addition, global shortages threaten to worsen as countries and regions reduce vaccine exports. As infections rise in India, which had been a major vaccine distributor, that country is now withholding the roughly 2.4 million doses that a private company makes there daily. This is followed by the decision taken this week by the European Union to manage emergency legislation to curb vaccine exports for the next six weeks.

Officials in the Biden administration who lean toward glut in the United States hint at unmet need and growing uncertainty: Children and teens are yet to be vaccinated, and no one knows if or when immunity could disappear. This, for which perhaps tens of millions of booster doses would be mandatory.

“Above all, we want to be part of the global solution,” White House press secretary Jen Psaki said this week. But he added, “There are still a number of unpredictable factors that we need to best plan for, including virus variants and their impact, which vaccine will be most effective and which will work best in children. “

Vaccine manufacturers and some senior federal officials say Decisions need to be made in a few weeks on what to do with additional orders or the uncertainty could slow down production lines. The manufacturing process can take up to ten weeks and it takes time to make changes for a foreign market. Another obstacle is the regulatory rules governing vaccine shipments, as well as the limited storage time of the active compound in the vaccine.

All these variables threaten to complicate what went relatively well for the Biden administration. In part, thanks to the active help of the federal government for several months, vaccine makers have steadily increased production and states have secured new doses as soon as the government can issue them.

Where to go from here is the subject of much debate.

Clinical trials to find out which vaccines work for children and adolescents across the country are underway and are unlikely to be completed at exactly the same time. For example, Moderna and Pfizer expect interim results by the end of spring on how their vaccines would work in more than 30 million adolescents nationwide. But, at least Moderna, he doesn’t expect results from children under 12 before the start of the school year next fall..

The government could keep the doses of these two manufacturers while awaiting its results, only to realize that a better option is another vaccine whose trials began later (like that of Johnson & Johnson).

If one or more of the three licensed vaccines are found to provide protection against COVID-19 for only a short time, tens of millions of additional booster doses would be needed. But we don’t know when that answer will come either.

Federal health officials have also spoken of canceling or scaling some orders from Moderna and Pfizer in exchange for the promise of a new supply of this drop in pediatric doses or vials of a new vaccine that has been redesigned against variants of rapid spread.

There is some pressure for this to happen from manufacturers, whose vaccines are in high demand in other high-income countries. But it would also deprive federal authorities of the power to decide which countries will receive the excess doses, as well as of the humanitarian and diplomatic merit they would have in sending the vaccine to the countries that need it most.

For all these reasons, according to senior officials, the government is leaning to keep the doses it has requested and then, at some point, direct the surplus to other countries in bilateral agreements or give it to COVAX., an international non-profit organization supported by the World Health Organization that aims to coordinate the equitable distribution of vaccines. The Biden government has already donated $ 4 billion for this international management.

Biden stressed that his top priority is to protect Americans, but there is growing pressure to share American reserves. The country has requested one billion doses from the three federally licensed manufacturers and AstraZeneca, whose vaccine for emergency use is not yet approved in the United States but has been certified in more than 70 countries. Recently, he announced that he was negotiating a deal with Johnson & Johnson to get enough doses to protect another 100 million.

The total supply would be enough to immunize 650 million people, nearly double the country’s population. The United States, which has the highest death toll from COVID-19 in the world, has already fully immunized 14% of its population.

“Having faced the really difficult situation that we have experienced in our own country, where there have been over 535,000 deaths, it is clear that in the future we will have a surplus of vaccines and of course , we plan to make this vaccine available to countries that need itAnthony Fauci, the government’s senior infectious disease specialist, said Wednesday at a White House press conference.

Fauci argued the turning point would come in early May, when the Biden administration wants states to vaccinate all adults. In an interview this week, he noted that this will likely be when anyone who wants to can get the shot.

Some people will not want to be vaccinated, even though the number seems to be decreasing. According to a survey carried out this month by the Pew Research Center, 69% of the population want to be vaccinated or have already been.

However, although Johnson & Johnson lags behind other manufacturers, its technology promises high mass production as it can deliver many more doses per batch.

Later this year, when Merck & Co. is expected to start producing Johnson & Johnson’s vaccine, the company could generate 100 million doses per month (the same that Pfizer and Moderna together supply per month). The White House celebrated the Johnson & Johnson-Merck deal, but as production catches up, those doses may be part of a growing surplus or be destined for export.

One option is to ship the frozen vaccine to be manufactured at the Merck plant overseas, where it can be packaged at a much lower price.. According to the authorities, Of the $ 10 the federal government has agreed to pay for each dose of Johnson & Johnson, the active compound itself is only worth 30 cents. The rest is what is called the cost of filling and packaging.

If US regulators approve AstraZeneca, there will be even more vaccines. Authorities expect around 50 million doses to be ready for delivery in May.

Still, officials in the Biden administration are worried about the AstraZeneca vaccine. It appears to be more or less as effective as Johnson & Johnson, but requires an extra dose, which makes implementation difficult. Some health authorities fear that, as enough doses are already in preparation to immunize all adults who wish to be vaccinated, the introduction of a fourth vaccine will only confuse the population.

© The New York Times