Millions of doses of COVID-19 vaccine are likely lost in the complex system to distribute the shots, U.S. officials believe. And no one working on the federal response to the coronavirus is quite sure why.
Members of President Joe Biden’s coronavirus task force have spent their first days in office working overtime to find an answer to this puzzle. So far, one hasn’t emerged.
According to data from the Centers for Disease Control (CDC), 41.4 million doses have been handed out to the states. Only 21.8 million have been administered. Officials say they think there is a vaccine surplus, although how large of one is unclear. Bottom line: Doses should be flowing, they said But instead, states are complaining of vaccine shortages.
Task force members rechecked the numbers—local and federal data— this week to try to discover the cause. They looked at whether there was enough being manufactured to fill demand; where that vaccine had been shipped and who had received it; how much was still sitting waiting to be administered; and how many doses were still sitting in warehouses. They’ve still come up short, officials tell The Daily Beast, in part because the data sets they are working with are incomplete.
“What we are seeing now is incredible inefficiencies. You have cities canceling vaccination appointments while the data says they still haven’t administered a large portion of the vaccine that’s been shipped to them. That is the biggest problem,” said Dr. Craig Spencer, an emergency doctor at New York Presbyterian Hospital.
In the weeks leading up to the inauguration, officials working with Biden’s coronavirus transition task force assumed that the low vaccination rates were due in part to a lag in states reporting to the CDC. The actual vaccination rates were far higher than those reflected on the federal government’s dashboard, the officials believed. They also calculated that some states were struggling to administer the vaccine efficiently because of staff shortages and, in some regions, because of a hesitancy among residents to sign up for the shot. The idea was that as states began to work out the kinks in reporting and distribution, rates would rise and supply would eventually meet demand.
Officials say they still believe all of that to be true. But the picture is even more muddled, and more complex, than they thought.
According to two officials working on the administration’s vaccine effort, some state officials, including in those states reporting vaccine shortages, have determined there might be additional doses in their jurisdiction—outside of their second-dose reserves— that are unaccounted for. But those state officials do not know whether those doses are sitting in warehouses, freezers or in other distribution hubs, or whether they have been used but unreported. In other words, there could be perhaps millions of doses across the country missing in the distribution system, officials said. There could be a number of explanations to explain the discrepancies; some doses could have expired or been contaminated or otherwise destroyed, though those scenarios are rare.
In response to a question about the discrepancy between states reporting shortages and the CDC alluding to the fact that there is a glut in vaccine doses across the country, Dr. Anthony Fauci, Biden’s chief medical adviser, said in a press conference that it would be “disturbing” if doses were found “laying around.”
The underlying issue seems even more daunting and perhaps more difficult to remedy, according to those same two Biden officials and two other individuals who worked with the Biden transition. There are massive inefficiencies on the city, county, state, and federal levels. There isn’t just one—or two or three or four—problems with the vaccine distribution process, officials said; there are dozens. And finding solutions to those problems will require a level of communication and coordination between the federal government and states that hasn’t existed since the pandemic hit.
Some cities lack comprehensive reporting systems to track where vaccines are located, whether there is adequate freezer storage, and whether doses are expiring on the shelf. And some states are having difficulty ensuring each distribution hub has enough vaccine supply for the appointments scheduled, in part because major cities in that state have their own separate distribution plan and tracking processes. Finally, some doses are getting held up as shipping companies are confused about which packages go where.
Streamlining the distribution will take time, officials said. But the clock is ticking. Not only is there a political imperative—President Biden repeatedly laid out a goal of 100 million shots in the first 100 days—but the CDC has said that it expects a more contagious variant of COVID-19 to spread throughout the U.S. in the next several months. While health experts say the vaccine should work against that variant, the Biden administration wants to get as many Americans vaccinated as possible as a way to prevent another spike in COVID-related deaths this spring.
“There are real implications of this delay which is why we need to do this as quickly as possible. What I want to hear is that you’re willing to get every dose out and in someone’s arms. We can’t increase Pfizer or Moderna supply right now,” Spencer told The Daily Beast. “It’s going to take months.”
After more than a week of calling on the federal government to send additional vaccine doses, hospitals, doctors’ offices, and pharmacies across the country late last week sent out notifications alerting thousands of Americans that they would have to cancel first-dose COVID-19 vaccinations due to a lack of supply.
The U.S. vaccine rate is beginning to improve, but the mass cancellations prompted state leaders in states such as New York, New Jersey, Pennsylvania, Kentucky and California to speak out publicly about their shortages and the need for the federal government to do more to help. It was a familiar tone—one put to the Trump administration by governors who said they lacked testing and medical supplies and personal protective equipment needed to contain the spread of the virus.
“The supply that we’re going to get next week is already 30,000 doses underneath our ability of what we can put in someone’s arm in just a seven-day span,” Kentucky Gov. Andy Beshear said in a press conference Jan. 20. Kentucky has begun canceling some vaccine appointments due to the shortage. According to the CDC’s vaccine tracker, the state has received 471,000 vaccine doses but has only administered 299,493. According to data gathered by The Washington Post, the doses that Kentucky has administered has covered just 24.8 percent of the prioritized population.
Although governors across the country are dealing with increasingly frustrated and disheartened constituents, some of whom have had their vaccine appointments canceled over the last two weeks because of shortages, officials with the Biden COVID-19 task force say they’re not too concerned about the supply issue. At least not yet.
“It’s better to have the demand… to have vaccine sitting on shelves even if there are lines and queues, than to have people not wanting to sign up and take it,” one individual working on the administration’s vaccine effort said, adding that the Biden team expects supply and demand to swing back and forth over the coming months as the country recalibrates the distribution process.
Officials point to the decision made earlier this month to widen the pool of those who could receive the vaccine as a reason for the increase in demand for the shot. The Biden team and the outgoing Trump administration made the decision that they would recommend states allow individuals 65 and older and outside of the first wave of vaccine eligibility—people other than health-care, frontline workers and nursing home residents—receive the shot if they wanted. But officials say there was never a reserve of doses, even those the Trump administration said it had set aside as second-dose shots, to help states handle the increasing number of people signing up for vaccine appointments. In an interview with NBC’s Lester Holt Jan. 15 that the U.S. did not have a reserve stockpile.
States weren’t made aware of the reserve issue until it was too late—until they had scheduled hundreds of thousands of additional vaccine appointments.
Meanwhile, distribution hubs across the country were creating rules about who should and could get the vaccination and when on the fly. According to an individual who worked in one of New York City’s distribution hubs, volunteers did not ask for identification and sometimes forgot to ask for appointment confirmation. Volunteers at this particular hub rotated on a daily basis, this person said, and often received little instruction about how to run the distribution process. “We were just reinventing the wheel every day.”
Two individuals who spoke to The Daily Beast said they found a primary care health-care office in Jersey City, New Jersey where they could receive their first dose even though they were residents of New York.
In Fairfax, Virginia, a vaccine volunteer said his staff last week made the decision to hand out the shot to not only those who had made appointments but also anyone who accompanied those individuals to the distribution site.
It’s that lack of communication, and each state approaching the decision to vaccinate a wider pool of people differently, that has federal officials on edge. One senior health official said there was discussion in the Trump administration about the piecemeal vaccination distribution approach causing problems during the rollout. Those concerns were largely shot down, the official said, adding that states were rushed to submit their vaccination distribution reports and “barely had time to speak to the federal government about those plans before the vaccine shipped.”
“We knew this was coming,” the official said. “To some extent there was always going to be problems with a distribution campaign of this size and complexity. Things are bound to improve. But I’m not sure things had to get this bad.”
White House officials say they plan to hold a virtual meeting with the nation’s governors Tuesday to discuss vaccine distribution. But the federal government has no plans to increase vaccine supply at this time, officials said.
Over the next several weeks the Biden team plans to work closely with states to assess how many doses are already distributed that need to be accounted for, how many appointments have already been booked for first- and second-dose shots, and how many vaccine doses have been requested by states that have yet to be allocated. “Right now there’s no holistic way of accounting for all that,” one Biden official said.
Another official said there are discussions underway about the possibility of changing the way local health departments report their vaccination numbers to the federal government as a way to improve the administration’s understanding of the distribution effort.
In addition, the Federal Emergency Management Agency has established a new interagency vaccination task force in the agency’s National Response Coordination Center and is set to deploy staff to support dozens of vaccination sites across the country to help with distribution, according to a spokesperson for the agency.
In the meantime, Biden will tap the Defense Production Act to compel manufacturers to produce more personal protective equipment and to continue to scale testing across the country. Officials say Biden will also use the act and to develop more raw materials and syringes needed to increase vaccine production. Biden signed an executive order last week that allows federal agencies to “to fill those shortfalls as soon as practicable by acquiring additional stockpiles, improving distribution systems, building market capacity, or expanding the industrial base.”