Biden’s COVID-19 plan creates more vaccination sites, speeds through priority groups
President Joe Biden’s national distribution plan for COVID-19 vaccines calls for increased access and ramping up production for a pandemic that he warned on Thursday will get worse before it gets better.
“More people, more places, more supply,” Bechara Choucair, the Biden administration’s vaccine coordinator, told reporters. “That’s what this boils down to.”
Biden wants to expand the number of people with access to vaccines as quickly as possible. His plan seeks to create hundreds of mass vaccination centers around the country. And he wants to compel the manufacturers of vaccines, and of the medical equipment required to administer them, to ramp up production.
But to achieve those goals, and to properly sequence them, the new Biden administration faces a slew of challenges that similarly hampered the Trump administration when vaccines were first introduced in December.
The administration wants to ensure equitable, fair allocation of the vaccines, while speeding through the groups who are prioritized to receive them first – a delicate balance that will be difficult for states either to monitor or to enforce.
Biden’s plan calls for setting up hundreds of mass vaccination sites, but experts warn that such facilities could risk wasting time and resources unless the amount of vaccine supply drastically increases.
And whether vaccine manufacturers will be able to dramatically ramp up the production of sensitive biochemical products remains a concern among federal public health officials.
“The issue is going to come down to supply of vaccine,” said one senior official at the Centers for Disease Control and Prevention, speaking on the condition of anonymity to speak candidly on the matter. “That’s going to be the issue – where is the supply and whether we can get states, week to week to week, the information they need to prepare.”
The Biden team is emphasizing speed in its strategy, warning the nation faces a deepening crisis as highly contagious variants of COVID-19 spread unchecked, and as the pandemic reaches its deadliest phase. The president acknowledged that success will take time.
“Things are going to continue to get worse before they get better,” Biden said, unveiling his national pandemic response plan from the White House. “The cases will continue to mount. We didn’t get into this mess overnight and it’ll take months for us to turn things around. But let me be equally clear, we will get through this.”
Experts who have reviewed the plan agree that the new president’s goals are aspirational and will take time.
“All the items that I’ve seen in the president’s plan are important and lofty goals, but all of them are going to take a while to be implemented, so it’s going to take us a while to assess their effectiveness,” said Dr. Eric Toner, senior scholar at the Johns Hopkins Center for Health Security. “This is step one of having an effective national strategy. There are many more steps to come.”
SPEEDING THROUGH PRIORITY GROUPS
Biden has set a goal of vaccinating 100 million Americans in his administration’s first 100 days – a goal that will require speeding through tiers of individuals who are prioritized to get doses.
“We are calling on states to mount vaccination programs that move as rapidly and as equitably as possible, which means not waiting for earlier phases to fully wind down before opening up eligibility to additional critical priority populations,” Choucair said.
“We do know that doesn’t mean that everyone will be able to get vaccinated right away. It just means that the more vaccines are available to states, the faster those vaccines are loaded into people’s arms,” he said.
Enforcing eligibility requirements will become increasingly challenging for state officials as access begins to broaden, especially at mass vaccination sites.
Certain populations are simply easier for state and local governments to track than others. While public health departments have no problem identifying what percentage of a certain age group, for example, has been vaccinated, that becomes more difficult when vaccine eligibility expands to groups such as teachers or individuals with underlying medical conditions.
And unless individuals are getting vaccinated through their employer, it will become increasingly difficult for large vaccination facilities to verify eligibility.
Former President Donald Trump and his aides generally deferred to the states to decide who received vaccines, at what locations and at what times. But the Biden team is telling state and local officials that it will provide more detailed national guidance on how they should begin expanding eligibility to the vaccines.
“It is a double-edged sword – if we don’t set a goal, people get angry we don’t set a goal. If we do set a goal, people are angry that it’s not the right goal,” said the CDC official. “We tell states how they should be moving, they say it’s too restrictive. We don’t give them enough information, they say they want more guidance.”
The Biden administration entered office not knowing precisely how many vaccine doses had been released to the public. But in broad terms, they know that the manufacturers have not produced as much as the Trump administration had expected, and only a fraction of the priority groups identified to get the vaccines first have been able to do so.
Because states are expected to struggle to keep track of how many people in each priority group have been vaccinated, experts say it will be difficult for the Biden team to establish benchmarks for success, or thresholds for them to know when to move on to the next group.
“Like so many things in this pandemic and in the president’s plan, the devil’s in the details – at what threshold do you move on, and how you decide that, will be interesting to see,” Toner said. “It really is up to each state, although the feds can provide guidance and leadership, which is incredibly important.”
BUILDING SUPPLY FOR MASS VACCINATIONS
Biden’s team plans to mobilize clinicians and first responders to run “as many venues for vaccination as needed,” according to the White House.
The facilities will be set up by the federal government with state and local input, repurposing large facilities such as gymnasiums, stadiums and conference centers.
Unveiling his plan, Biden said that the Federal Emergency Management Agency, or FEMA, would immediately begin setting up federal vaccination sites around the country, with the goal of establishing 100 facilities within the next month.
The plan might also expand military involvement in the distribution process, officials say.
Last March, the Army Corps of Engineers was tapped to quickly erect field hospitals or alternate care sites, such as converting empty hotels into medical sites, across the country. But in many cases, the extra beds weren’t needed, and the field sites were dismantled.
Pentagon spokesperson John Kirby said that Biden had not yet directed the military to take on a new role in vaccination distribution. “We haven’t made any changes to the military’s role in the COVID vaccine,” he said.
But the new White House said it is willing to turn to the Army Corps for help constructing the sites. “Our goal is to use whatever capability we need to bring to bear for the problem at hand, and if the Army Corp of Engineers building a facility is the right solution, it is certainly on the table,” a White House official told McClatchy.
Setting up mass vaccination sites poses risks for the administration if the supply of vaccine doses isn’t there, experts warn.
“Mass vaccination sites are efficient, but we need more supply to make that worthwhile, and right now the amount of supply isn’t even barely enough to cover the groups that have been identified,” said Dr. Julie Swann, head of the Department of Industrial and Systems Engineering at North Carolina State University and an adviser to the CDC during its response to the H1N1 pandemic in 2009.
Biden’s decision to invoke the Defense Production Act — which empowers the president to compel manufacturing in the United States, and has historically been used in wartime — will help increase that supply.
“Our national plan launches a full-scale, wartime effort to address the supply shortages by ramping up production of protective equipment, syringes, needles you name it,” Biden said. “Four hundred thousand Americans have died – that’s more than died in all of World War II – 400,000. This is a wartime undertaking.”
But the White House is also cautioning that, even under federal order, vaccine manufacturers might not be able to accelerate production as rapidly as the public would like.
“A lot of fairly complicated chemistry goes into the manufacturer of the vaccine,” Tim Manning, the president’s COVID-19 supply coordinator, told reporters. “There are many other tools at our disposal, and we’ll be watching carefully, using whatever we need to do to ensure that we have an adequate supply of vaccine.”
Tara Copp contributed reporting.
This story was originally published January 21, 2021 at 4:07 PM.
