How the United States came back from a bad start and set daily immunization records

WASHINGTON.- In medical centers and hospitals, in pharmacies, in schools and even on baseball diamonds, Monday to Sunday and at parties, the vaccination campaign in the United States has been accelerated to nearly three million injections per day. Since its launch in December, 101.8 million people (30% of the population) have received at least one dose, and among these, nearly 58 million are already fully vaccinated.

News of states expanding the range of citizens eligible for vaccination is frequent, reinforcing a feeling that, finally, the pace of this long and painful crisis is changing: New York began with about 30 people la last week and will do so with the over 16s starting this Tuesday; Texas has already extended coverage for all adults and most states will do so before the end of April.

“I don’t know of any expert in medicine, virology or vaccines who could have predicted that in a single year we would have three effective vaccines and that there would already be hundreds of millions of people vaccinated in the country. It is something miraculous and surprising ”, explains by telephone Dr. Robert Wachter, head of the department of medicine at the University of California.

The United States, which failed to contain the virus and has already exceeded the figure of 550,000 deaths, he demonstrated scientific and economic power in the vaccine race. The keys to success today combine multiple and diverse factors, ranging from the multi-million dollar injection of the federal government, which has dared to share the risks with the pharmaceutical industry, to a law that allows intervention in the production of factories dating from the Korean War, by unnatural alliances of rival companies. And by including some individual contributions like made in usa like that of country star Dolly Parton and, incidentally, a cherry on “America First” in commercial policy.

La llamada Operation Warp Speed (whose name refers to the science-fiction fantasy of traveling at speeds greater than the speed of light) has been, for even Donald Trump’s most critical pundits, a success for the Republican administration in erratic management of the pandemic. It consisted mainly of donate more than $ 10 billion to a group of pharmaceutical companies for research and development of these vaccines, with colossal pre-purchase agreements without any guarantee of effectiveness. For Amesh Adalja, an infectious disease specialist at the Johns Hopkins Bloomberg School of Public Health, “this is probably the factor that has made the biggest difference between the United States and many other countries, although the United Kingdom and Israel vaccinate faster. The government obtained doses of a vaccine when they still did not know if they would work and some are not even approved by the United States Drug Administration (FDA, in its acronym in English).

In July, for example, The executive announced the agreement to purchase 100 million doses of the vaccine developed by Pfizer-BioNTech for $ 1.95 billion, with the option to purchase an additional $ 500 million. Moderna is the one that received the most public funding. Promoted in collaboration with government researchers, it obtained $ 955 million for its development and $ 1,500 million for the manufacture, distribution and delivery of 100 million doses. (This is where Dolly Parton also put her grain of sand). Administration gave Johnson & Johnson over € 450m for development and 1,000 million for production and distribution, with an order of 100 million doses included in this amount. Astrazeneca and Oxford have injected 1,200 million for research, production and pre-ordering of 300 million doses. At Sanofi and GSK, 2,000 million. At Novavax, 1,600 million. The latter two are still waiting to produce their first vaccine on the market.

“It could have been a scandal if the vaccines hadn’t worked, but it worked,” says Dr Wachter.

The first batches were made with the help of the production defense law, a standard that dates from the Korean War (1950) and which grants the President of the United States the power to force companies to accept and prioritize contracts necessary for national defense. The pandemic prompted the White House to invoke it, first to speed up the production of masks and then to secure certain materials for the production of the vaccine.

Despite this, the first phase of distribution was disappointingly slow. Trump administration pledged to end 2020 with 20 million citizens vaccinated and the figure was barely over two and a half million. What experts call “the last mile of failed vaccination” – the stretch that goes from the vaccine to the person vaccinated. “There was a lot of emphasis on procurement, but then the distribution to states was not well planned, and neither the staff nor the funding to run it,” says Professor Adalja of Johns Hopkins.

With the new democratic administration, inaugurated on January 20, the United States stepped on the accelerator. On the one hand, it has stepped up aid to States and increased the number of federal vaccination centers and opted for the network of local pharmacies; on the other, the system as a whole and the authorities learned to do better after the first few months. Shortly after arriving at the White House, Moderna has announced it could deliver 200 million doses by the end of May, a month earlier than expected.

In addition, Biden’s team made two crucial decisions. He again reached for the law of defense of production to make it easier for Pfizer to get the machines needed to expand its Kalamazoo, Michigan plant and pressured a J&J supplier to work against the clock and recoup the company’s backlog due to the jam in the packaging part of the product. He also sponsored a unique alliance between this company and its rival, Merck, for the latter to participate in the manufacture of the former’s vaccine. According to Merck, the government will help with $ 269 million to adapt its facilities.

President Biden defined this competitor agreement as “the kind of collaborations we saw during World War II. The 100 million doses he promised in his first 100 days in the White House, a conservative calculated forecast, they arrived in the arms of the Americans weeks ago and will probably fulfill those 100 days of mandate by obtaining double what had been promised, 200 million doses. He estimates that there may be vaccines for everyone at the end of May and that July 4 will be something more than the commemoration of the Independence Day of the United States, the anniversary of this country: he hopes this will serve to celebrate the independence of the virus.

In this optimistic scenario, Pressure increases for Washington to help countries with supply problems. The United States administers the Pfizer, Moderna, and J&J vaccines, although they contain millions of doses of AstraZeneca, which has yet to be approved by the FDA. Dr Anthony Fauci, director of the Institute of Allergology and Infectious Diseases and a referral advisor to Trump and Biden, believes the United States could meet its needs without resorting to AstraZeneca units. For now, the government will export 2.5 million to Mexico and 1.5 million to Canada, its neighbors and partners in the trade agreement signed in the North Atlantic Treaty.

Biden has agreed to provide financial support to other companies, such as Indian company Biological E, to do more, in an agreement announced at the Quad Summit, a virtual meeting to address this issue in which the United States, India, Japan and Australia participated.

Vaccine diplomacy hasn’t gone much further so far. “If we have a surplus, we’re going to share it with the rest of the world,” Biden said last March. “First, we’ll make sure we can take care of the Americans, but then we’ll try to help the rest of the world,” he added.

With the current cruising speed, Americans’ immunization could reach 90% by the end of July, although the risks and challenges persist. “We always find 20% or 25% of the population reluctant to the vaccine, we also see specific failures in the system [como los 15 millones de dosis de J&J arruinados esta semana por un error humano] and we provide the vaccine during bank hours, when we should be doing it in 16 and 18 hours a day. It’s a race against the virus and its variants, ”says Gregory Poland, director of the Mayo Clinic’s vaccine research group, who is also an advisor to several pharmaceutical companies. “The other problem,” he adds, “is that every state does it differently. According to him, “the idea of ​​going from phase to phase and from group to group is intellectually interesting, but what you need are the first doses in the arms, the better.

Fatigue from this long year of pandemic and restrictions is the latest danger. Vaccination does not progress as quickly as the desire for normality and infections are on the rise again – at a rate of 65,000 cases per day last week-, nearing the peak of last summer, as many states have started to ease restrictions.

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