- Experts say it’s important to speed up the COVID-19 vaccination process as soon as possible.
- They say the United States needs to solve distribution and access issues as well as persuade reluctant people to get the vaccine.
- Experts say President-elect Joe Biden’s goal of delivering 100 million doses in his first 100 days in office is an important target to hit.
- Achieving this goal would, in the short term, lower hospitalizations and deaths, they say.
She’s been treating people since February, before COVID-19 commonly rolled off the tongue.
Nearly a year later, Dr. Elissa Schechter–Perkins, director of emergency medicine infectious disease management at Boston Medical Center/Boston University School of Medicine, is uplifted by the fact that vaccines are going into arms.
“I have taken care of probably hundreds of patients with COVID at this point, many of whom have gone home, many of whom have been admitted to the hospital, a few of whom have died,” Schechter-Perkins told Healthline.
“I do feel like we can see the light at the end of the tunnel. It’s not bright yet but, it’s getting there,” she said. “It’s kind of starting to come more and more into focus that we can end this. I’m starting to tear up just talking about it. It’s been such a long year.”
With a record number of COVID-19-related deaths registered this month, the vaccines can’t get into those arms fast enough.
The rollout has been slow. In an interview last week,
“I think it would be fair to just observe what happens in the next couple of weeks. If we don’t catch up on what the original goal was, then we really need to make some changes about what we’re doing,” Fauci told NPR’s “Morning Edition.”
What can be done to pick up the pace?
Some experts told Healthline that it’s good to set ambitious goals such as the one announced by President-elect Joe Biden’s administration: 100 million doses administered in his first 100 days in office.
Experts also shared with Healthline what can be done to get this initiative moving, what difficulties Biden faces, and what impact it will have if the United States can hit that mark.
More than 10 million first doses of the COVID-19 vaccines have been given as of Jan. 14. This is far less than the 20 million Trump administration officials had hoped would be done by the end of December.
Funding is a key element here, according to Dr. William Schaffner, the medical director of the National Foundation for Infectious Diseases and a professor in the division of infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee.
“How can we play catch-up? There are a number of things we have to do,” Schaffner told Healthline. “One of which the Congress has already begun, which is absolutely critical, which is appropriate some money to the state and local health department. We the taxpayers have put a fair amount of money in, a lot of money into first of all developing the vaccine, hugely successful, and then doing the clinical trials for the vaccine, hugely successful.”
“Our bet paid off. We got these two — up until now and maybe more to come — extraordinarily successful and very safe vaccines,” he said.
Two COVID-19 vaccines were approved in December for emergency use by the Food and Drug Administration (FDA). They are the Moderna-NIAID and Pfizer-BioNTech vaccines. Both require 2 doses given several weeks apart for full protection.
Schaffner believes Washington, D.C., officials perhaps didn’t appreciate that the United States is now entering the most difficult distribution phase.
“This is the third stage, where we actually have to deliver the vaccine into the arms of people, essentially the entire, or close to, the entire United States population, and we’ve never done that before,” he said.
“That’s going to take much longer. It’s much more difficult. It’s easily as complex as stage one and stage two, if not more so, because you have to involve the behavior of human beings, all of the human beings in the country, and that’s very difficult,” Schaffner said.
State and local health departments have had their budgets shrink over the past 20 years, he said, so getting money into their hands to pull off this effort will go a long way.
“I wish the money had been appropriated 6 months ago so that everybody could have ramped up already and we’re better prepared. So money is important,” he said.
Schaffner thinks it’s also critically important to clarify the delivery of the vaccine, something that hasn’t been happening thus far.
“I know in my own state there are health departments and hospitals and other places that are having difficulty planning because they don’t know how much vaccine they will get and when,” he said.
“How’d you like to run a clinic and not know [how much vaccine you’ll get]. If you’re going to sell cars you’ve got to know how many cars you have,” Schaffner said. “We need to clarify the delivery of vaccine and really get it on schedule, so it moves nicely and smoothly, in a predictable fashion.”
Dr. Georges C. Benjamin, executive director of the American Public Health Association, said we need to better engage people in this process.
“Right now, it’s pretty hospital-centric and they need to move beyond hospitals, so if you are a physician that is linked to a hospital or healthcare provider, or nurse, or even a food service worker in a hospital, you can get vaccinated,” Benjamin told Healthline.
“But if you’re a private office in a community and you’re not necessarily linked to the hospital, those folks are having a much more difficult time getting vaccinated or figuring out how they are going to,” he said.
It’s important to think creatively about how we’re going to do this, said Dr. Westyn Branch-Elliman, an assistant professor of medicine in the infectious disease section at Harvard Medical School as well as an infectious disease consultant at Beth Israel Deaconess Medical Center in Boston.
“We’re going to need to get creative about how we leverage our local, state, and national resources in order to move forward with this plan,” she told Healthline. “Can we leverage already existing infrastructure and convert it into vaccination sites? Can we activate the National Guard to assist with building vaccination sites? Can we do things like activate the Veterans Affairs’ Fourth Mission to help vaccinate?”
“It’s going to require some creative thinking about how we leverage the resources that we have and use those resources to help vaccinate people,” Branch-Elliman said.
Schechter-Perkins agreed that as a country we need to think more broadly about how to reach the population.
“It’s not going to work if it’s only the healthcare systems, the big hospital systems, because right now we are facing major capacity issues, just on the personnel side because of the second surge of the pandemic that we’re in,” she said.
“The system cannot rely on medical centers and healthcare systems to do all of the vaccination and to coordinate the logistics, there has to be more help,” Schechter-Perkins said.
She pointed to countries in Europe that have pulled resources together to help with their mass vaccination plans.
“They’ve set up stadiums, they’re really thinking very broadly about how they can do mass distribution,” she said. “And we need to think that way as a country. This is a pandemic, this is a crisis, this is the time to call in every resource. The same way we had field hospitals being set up by the Army Corps, we need to take really extreme measures to get these vaccines into patients.”
While the rollout has been slow, Branch-Elliman is still hopeful things will pick up.
“As we move forward, we’re going to gather more information about systems that work and systems that don’t work,” she said. “We can use that information and translate that into a mass vaccination campaign in order to hopefully improve the situation from where we are now.”
On Thursday evening, President-elect Joe Biden released details of his $1.9 trillion plan to combat the COVID-19 pandemic and restore the economy.
About $400 billion of the plan will go toward vaccinations and other COVID-19 program. Included in that is $130 billion to safely reopen schools.
Biden also plans to use the Defense Production Act to increase the supply of available vaccines.
“I think it will be challenging, but I think it’s important to have aggressive goals,” Branch-Elliman said. “Our country has spent a lot of resources on vaccination and vaccination as a strategy to help bring the pandemic under control. I think it’s a very, very challenging and certainly ambitious goal, but it is also a very important goal.”
In a recent reversal, the Trump administration released nearly all available doses of the vaccine from reserve, rather than holding back supply for second doses — something Biden plans to do when he takes office this week.
The Centers for Disease Control and Prevention (CDC) has also expanded COVID-19 vaccination guidelines to everyone 65 and older as well as those under 65 with serious underlying medical conditions.
While more vaccines getting out to people is helpful, those vials are headed for a bottleneck in some places.
“At the moment the vaccination sites are struggling to deal with that they’ve got already. Now, the federal money that’s been fairly recently appropriated is going to come into the state health departments and then will go to locals, but that will take a while to have an effect,” Schaffner said.
“So I think we may still be in a logjam for a while, but everybody’s working to get people vaccinated as quickly as possible,” he said.
There’s a lot of variation from site to site right now, he said, and some vaccine reservation systems are clogged up while other sites need to extend hours of operation to meet the needs in their areas.
The other roadblocks Biden’s plan could face along the way are multifaceted.
“There is, of course, fatigue at every level. Stress at every level,” Schaffner said. “But assuming the companies can make the vaccine and we can get it delivered, if we can assume that, I think the big roadblock is skepticism. That looms very large.”
Just as mask wearing has become politicized, so too has getting vaccinated.
“In my state the wearing of masks has become very politicized. The same people who don’t want to wear masks — I don’t want to wear a mask, why should I get vaccinated? Those two things are linked,” Schaffner said.
It’s important to make sure all populations have access to the vaccine as the rollout continues.
“Making sure that people are clear and transparent about who’s getting it and when, I think will be very important,” Benjamin said. “And there’s risk of issues around inequalities, and we just have to be very careful that people get equitable access to the vaccine when it becomes more widely available.”
Making this initiative more about public health than politics will go a long way, Schaffner said.
“I would put the public health people and the infectious disease doctors up front and I would pull the politicians back and say we’re supporting public health, and then let public health do what they do,” Schaffner said.
“Remove this phenomenon, remove the political veneer. We’ve had too much of that. If the politicians get too much involved, any politician, half the population gets antsy,” he said.
Branch-Elliman noted the challenges of vaccine documentation, the manufacturing pipeline, distribution, “and thinking through locally how we’re going to set up vaccination sites.”
Benjamin said the use of the Defense Production Act is necessary to help companies get raw materials.
“They should use the Defense Protection Act to help produce the materials — and that includes supplies like stoppers, vials and anything needed for the vaccination process,” he said. “We need to do the same kind of thing on a national scale, so the companies know they can produce and promise us that they are going to have x number of vaccines and get them out the door.”
Combating the existing skepticism is and will continue to be a huge challenge going forward, Schaffner said.
“I don’t think we’ve come close to communicating sufficiently to the people who are going to receive the vaccine. There are 897+ questions out there. We get the same questions every day. Today, I got a new one,” he said.
“There are all kinds of questions that people have to ask and that’s because they’re being thoughtful, they’re being careful, they’re being a little hesitant,” Schaffner said.
Communication to the public about vaccine safety and efficacy will help move things along.
“They need not only facts, they need reassurance, they need comfort, they need a sense that everybody else is doing it so I’m going to be doing it, too. That it’s the social norm,” Schaffner said.
It’s important to note that the vaccine rollout as it is now will not change the moment a new administration takes over.
“I think it will change, but I’m not going to link it specifically to the new administration. I think it will change over time,” Schaffner said. “I know, having just come off the phone with the Food and Drug Administration, they’re doing their best to facilitate it, this will take some time.”
“I think the companies will get better at it. I think Operation Warp Speed will get better at it. It’s a big enterprise,” he said. “Do we expect some bumps in the road? Sure, but let’s get past them now, let’s learn our lessons and get this train on track.”
The impact of vaccinating 100 million people during the first 100 days may not be visible right away.
“I would say that certainly we will see an improvement in healthcare capacity,” said Schechter-Perkins, who is also associate professor of emergency medicine at Boston University School of Medicine.
“I think as we start to vaccinate more and more people, we will see that incredible strain that hospital systems have been under over the last year start to dissipate because people won’t be getting as sick and so that will really free up healthcare resources,” she said.
Even with a shot in your arm, life will not immediately return to normal.
“The changes that it will make in our everyday life are a little bit harder to know at this point because it’s still not clear whether the vaccine actually prevents transmission,” Schechter-Perkins noted.
“So, as we have some but not all of the population vaccinated, and that’s gonna be our status for the next several months, life can’t go back to normal yet,” she said.
She stressed that even when a person has been vaccinated, they will still need to wear a mask, maintain physical distance, and quarantine if they have been exposed.
Schaffner reiterated that we’ll have to vaccinate up to 75 to 80 percent of the population to achieve herd immunity.
“That’s going to take some time,” he said. “But even if we’re only halfway there I think it will help stimulate the economy, give everybody a more optimistic feel, it will reduce the strain on the healthcare system.”
The struggle of having few intensive care beds is real for many hospitals across the country during this current surge, not to mention a staff spread so thin there simply aren’t enough hands.
“We’ve doubled up rooms. We’ve opened up a new floor that we had plans to open up several years from now, but we opened it up. We put the beds in there — it’s the people,” Schaffner said.
“Where do you get the nurses? Where do you get the technicians? Where do you get the radiologists who have to do all those X-rays and read them? It goes throughout the system and particularly those individuals who are giving direct bedside care, I mean you can’t shake them out of your sleeve,” he said.
Reaching Biden’s goal would not solve our healthcare situation, but it “would profoundly reduce the strain that currently exists all over the country in the healthcare system,” Schaffner added.
Branch-Elliman noted that it will be difficult to pin down what had an impact and what didn’t in those first 100 days, but she believes we’ll see an effect on mortality because of the way we have prioritized vaccinations.
“Because we’re vaccinating the people who are at highest risk of death from COVID, I think you may continue to see COVID infections, but deaths will decrease dramatically because the people at highest risk of death will be protected,” she said.
“Because we are now vaccinating our healthcare staff we should see fewer staffing problems in the hospitals,” Branch-Elliman added. “That doesn’t mean that we’re going to be seeing hospitals that aren’t full and hospitals that aren’t overwhelmed, but at least some of the staffing issues will hopefully be alleviated.”
Schechter-Perkins said that with vaccines going into arms, there’s hope for the future.
“It’s really uplifting to be thinking this way. Six months ago we were not thinking this way,” she said. “There’s definitely optimism where there maybe was a little less optimism a few months ago.”