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The transition team of President-elect Biden has taken its first step to reexamine the distribution of Covid-19 vaccines put in place by the Trump administration. Instead of keeping half the doses in reserve to make sure that every person who received their first dose can receive their second dose, the transition said Friday that it would release the vast majority of available doses of authorized vaccines at once.

It’s a great start. But it is also only a start.

The argument to hold back the second dose was not without merit at a time of limited supply of the vaccines, developed by Pfizer and its partner BioNTech, as well as Moderna. The  fear has been that, without sufficient doses in reserve, there would be mayhem, with some sites keeping doses in reserve themselves and recipients becoming upset if their second dose was not available. But the policy has also meant that only half as many people get shots in their arm at a time when the U.S. breaks its record number of Covid-19 deaths daily and two new, apparently faster-spreading, variants of the SARS-CoV-2 virus have been let loose on the world.

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Governors have called for Operation Warp Speed, the government’s effort to fast-track the development and distribution of vaccine, not to hold back doses.  

On Friday, Scott Gottlieb, a former FDA commissioner, called the move “a prudent move that will help expand Covid vaccine access to more high-risk patients at a time when the epidemic is worsening.” Gottlieb, who is also a member of Pfizer’s board of directors, has been pushing the idea of distributing doses as they are manufactured since vaccine distribution began.

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Over time, holding the doses in reserve made less and less sense. A recent analysis published by researchers in Ottawa argued that even holding half the doses in reserve would mean more people would get Covid. Holding them all in reserve only makes sense if a massive shortfall in manufacturing is expected.

Some researchers go a step further. Estimates based on a small amount of data in pivotal clinical trials indicate that the first dose of the vaccines may reduce symptomatic Covid by as much as 85%. This contrasts with data from the early studies that showed the second dose was needed to ramp up the body’s immune response. But Britain has already decided to wait as long as three months, not one, between doses, and some researchers are arguing for gambling by skipping second doses entirely. The Food and Drug Administration has said it would not change its dosing schedule without further evidence that it made sense to do so.

While the transition’s announcement Friday makes sense, it also may be mostly symbolic, as it’s not clear that the practice of keeping doses in reserve was going to be permanent. Last week, Nancy Messonnier, an expert at the Centers for Disease Control and Prevention, indicated during a STAT virtual event that the policy was a moving target.

“In the short term, the holding back of the second dose is to ensure that individuals get the full benefit of the vaccination series by getting a second dose,” she said. “I hope that, in short time, the supply will be more dependable, we’ll have more confidence in it, and we will be able to, as you say, have less vaccine held back.”

The bigger problems with the vaccine rollout have less to do with supply or distribution and more to do with disorganization, which has prevented getting shots into arms. In the past week, for example, the mayor of New York City and New York’s governor have sparred in public over which first responders, including police officers, are up for vaccination right now. The American Hospital Association has complained to the health and human services secretary that it is not even clear who is responsible for answering hospitals’ questions about vaccine distribution.

The Biden administration is going to have to figure out how to reshape the effort without shaking public confidence in the vaccines. And, like so many tasks involved in the Covid-19 rollout, the devil will be in the details.

Correction: a previous version of this story incorrectly referred to disease reduction as transmission reduction.

  • Well so much for follow science and all that. The trials of Pfizer and Moderna were two doses 21 or 28 days apart. We have no significant data about what happens if the second dose is delayed or absent. For a year we were lectured about “gold standard clinical trials” but suddenly now, out the window with that.

  • I do not have any strong opinion on releasing the second dose to another person or keeping it in reserve -but I DO have a strong opinion about why I do not have a strong opinion – the media has not told me how many doses can be delivered and when. If we are going to get plenty more vaccine in 3 weeks, of course give everyone a dose – if no more is coming, then it’s a complex epidemiology problem to figure out what is best, and based on data many people consider inadequate, way over my head.
    Why are we – and i do not mean just the worried public, but, seemingly, the state officials and others who are part of getting the vaccines into arms – why are we not being told precisely how much we will get, and when? Even if Trump/FDA/CDC have screwed up, can’t Pfizer and Moderna tell the media their projected production, so the state officials can know how much, if any, needs to be held in reserve?

  • i am 80yrs old and was concerned about the vaccine fo covid 19 vaccine. yrs ago iwas was allergic to sulphur but i have always taken all flu shots for yrs and all vaccine reccommended by drs and up to date on my shot so please let me know if taking this one is safe for me

  • I get the benefit of releasing the reserved second doses if supply is assured, but how does this help if the constraint is in delivery? Aren’t you just increasing the backlog?

  • Availability of more vaccine does not address the current problem which is lack of capacity to vaccinate large numbers of people quickly. Nearly 2 million vaccinations a day need to be completed between now and the end of June to vaccinate the US adult population. A federal program is need to get this done. Use of military personnel should be considered.

  • This about Joe Biden promise to get out
    100 million doses in his first 100 days. Nothing more or less. You don’t think he
    cares about your second shot. He’s a politician, it’s making good on promises that’s driving the decision.

  • Here we go again with the unbridled and selfish American psyche. And we (the first vaccine dose recipients) are better and more deserving than the Brits, some may have to wait as long as three months before the second dose.

    I want to be fully protected ASAP and screw everyone else. Why should I wait. What’s in it for me to let others share my second dose?

    Pathetic and deplorable!

  • I keep remembering that the Trump operation is the one that repeatedly left rally attendees out in freezing weather because no one thought to organize how the bus pick up after the rally would work. And in hot Florida weather, older attendees were fainting — and when a fire truck was dispatched to spray the crowd with water to cool them down, Trump instructed the crowd to make sure the fire fighters were “our people” and if not . . . . . he made some threat.
    Or read the book by the woman who was essentially his chief operating officer, about how his “empire” was actually “managed.”
    We saw testing bungled. How on earth did anyone think his “team” could manage anything as complex as a national vaccine effort?

    • You need to be careful on how you are grouping these “teams” – one is a local campaign group and the other is the management of the vaccines consisting of some of the most qualified group of specialists trying to make the best out of a trying situation.

      This “team” is made of not just Trump supporters but also democrats and independents which are all attempting to come together and make sure the CDC and FDA guidelines are met.
      I myself am a frontline medical provider and work with COVID and immunocompromised patients daily. It’s exhausting but have seen a seen a tireless flow of vaccines going into the arms of our staff – myself included. So tread lightly that you are not discounting their efforts by comparing this to mistakes made by campaign groups.

  • Problems with efficient administration seems to be the problem not supply. If 2 doses weren’t necessary then why was it recommended? Lets improve the process, not start cutting corners.

  • During this pandemic there has been a lot of rhetoric about “following the science.” But if the science changes ever day or politics takes over you can understand why some people lose confidence in our scientific experts. Is one dose enough for the elderly and others who have weaker immune systems? How many shots will 78 year old Joe Biden get?

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