Frustration over vaccine rollout builds, as new variant reported in U.S. for first time

As frustration over the pace of the Covid-19 vaccine rollout continues to build, health officials in Colorado on Tuesday reported the first known U.S. case of the variant of Covid-19 discovered in the U.K.

The U.K. variant appears to be more transmissible than other variants of the virus seen to date, and has been detected in a number of countries worldwide. The Colorado case, who is currently in isolation, is a man in his 20s who has not left the country. The lack of a travel history means he contracted the virus in the U.S., suggesting undetected transmission of the new variant here.

The discovery will only add to the urgency of the Covid-19 vaccination campaign currently underway, which some public health experts have criticized as going too slowly. The Trump administration has shipped more than 11 million doses of the two available Covid-19 vaccines, but just over 2.1 million people nationwide have received a shot since vaccinations began December 14, according to data from the Centers for Disease Control and Prevention.

President-elect Joe Biden chastised the Trump administration for its slow rollout of the vaccine in a speech Tuesday. He warned that the administration’s effort to distribute and administer the vaccine is “not progressing as it should” and that if the pace of the vaccination effort continues “it’s going to take years, not months, to vaccinate the American people.”

He pledged to “move heaven and earth to get us going in the right direction,” and foreshadowed a number of policy efforts he’s likely to take in his first 100 days in office, including using the Defense Production Act to speed vaccine manufacturing, setting up a public health awareness campaign, and sending mobile vaccination units to hard-to-reach communities. Biden also reiterated his previous pledge to make sure 100 million doses of the Covid-19 vaccines are administered in his first 100 days in office.

He sought, however, to also temper expectations. 

“This will take more time than anyone would like and more time than the promises from the Trump administration have suggested,” Biden said. “This is going to be the greatest operational challenge we’ve ever faced as a nation but we are going to get it done. It’s going to take a vast new effort that is not yet underway.” 

In interviews earlier this month, Moncef Slaoui, the chief advisor for the vaccine development and distribution effort known as Operation Warp Speed, had pledged 20 million Americans would be inoculated against Covid-19 in December.

Michael Pratt, chief communications officer for Operation Warp Speed, insisted that the vaccine distribution effort is largely on schedule. He said that the projections Slaoui and others had previously shared referenced only the number of doses expected to be available by the end of the year, not the number of vaccinations slated for the first weeks of the rollout.

“Operation Warp Speed remains on track to have approximately 40 million doses of vaccine and allocate 20 million doses for first vaccinations by the end of December 2020, with distribution of the 20 million first doses spanning into the first week of January as states place orders for them,” Pratt said.

Pratt pointed to a lag in data reporting as part of the reason for the large gap between the number of vaccines delivered to states and those actually administered. However, state data compiled by the New York Times also show that most states have administered just a fraction of the vaccine doses they’ve received.

“We are below where we want to be,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CNN Monday. “Not being responsible myself for the rollout, I can’t personally guarantee that we’re going to catch up. I hope we do.”

Some vaccine experts, though, said they are not surprised by the speed of vaccine distribution so far.

“It had to go this way,” Paul Offit, a professor of pediatrics at Children’s Hospital of Philadelphia, told STAT. “We had to trip and fall and stumble and figure this out.”

Claire Hannan, executive director of the Association of Immunization Managers, said some of the gap between doses administered and delivered is likely due to a program run by CVS and Walgreens to vaccinate those in nursing homes. States participating in the program have to set aside 50% of their doses, which Hannan said could account for a share of the difference between doses shipped and doses administered nationally.

“I don’t think it’s bad,” she said of the pace of distribution so far. “I think it was always going to be like this. And I think that this is actually the easy part.”

The logistics of the rollout have been largely left up to states to navigate. States and local public health officials have warned for months that they would need more than $8 billion in additional funding to stand up the infrastructure needed to administer vaccines. The Trump administration instead provided states $340 million in funding to prepare for vaccinations. Congressional lawmakers also balked for months at appropriating additional funding for vaccine distribution, although the coronavirus stimulus package signed by President Trump on Sunday included $8 billion in funding for that effort.

“We’re trying to do everything on a shoestring, when really we need vast amounts of money invested. It’s been phenomenal, the needs that should have been taken care of six months ago, so we’re not continuing to build the system as we’re rolling it out,” said Ann Lewandowski of the Rural Wisconsin Health Cooperative.

“There appears to be no investment or plan in the last mile,” tweeted Ashish Jha, dean of the Brown University School of Public Health. “No effort from Feds to help states launch a real vaccination infrastructure. Did the Feds not know vaccines were coming? Shouldn’t planning around vaccination sites, etc not have happened in October or November?”

Some public health officials, including former CDC director Tom Frieden, have publicly blamed Operation Warp Speed leadership for the pace of the rollout. Warp Speed’s distribution efforts are led by Gus Perna, a military general and logistics expert who has no previous experience with vaccination campaigns.

“What happens when a vaccination program is run as a logistics program by White House appointees with zero experience with vaccination?” Frieden wrote on Twitter. “Doesn’t start well.”

Other public health leaders told STAT that a lack of communication with the federal government hampered their initial distribution efforts.

Anita Lundquist, executive director of pharmacy services at St. Croix Regional Medical Center in Wisconsin, said she didn’t know what kind of vaccine the center would receive, the number of doses, or the delivery time until the shipment arrived Monday. That uncertainty meant the hospital had to continually reschedule initial vaccine appointments for staff. It also meant hospital officials had to prepare plans for administering both the Pfizer and Moderna vaccines, which require different storage protocols.

At various points in December, the Wisconsin State Health department suggested St. Croix Regional Medical Center would receive 200 doses of the Pfizer vaccine. Instead, they received 100 doses of Moderna’s shots, less than one-quarter of what is needed to vaccinate all clinical staff.

Those waiting for vaccine deliveries have to rely on their health departments for updates, as the federal government’s Tiberius tracking system used nationwide to monitor the location of the doses can only be accessed through the state, said Lewandowski of the Rural Wisconsin Health Cooperative.

“The alerts aren’t working ideally, and the communication from CDC to the state is not ideal either,” said Lewandowski. One local hospital expected their vaccine on Christmas Eve, she said, only to find out after repeatedly emailing the state health department that the doses were delayed because the FedEx truck carrying them was involved in an accident.

Such last-minute delays have a significant impact on scheduling, especially as many healthcare systems plan vaccinations so staff have days off to recover from the side effects. “That all goes out the window,” said Lewandowski.

The snow storms on the East Coast last week also likely slowed down distribution. The Wisconsin state health department told hospitals there were delays getting the Moderna out on time, said Lundquist, meaning that hospitals expecting to receive the vaccine last Wednesday instead got their shipment on Monday or Tuesday.