America’s Vaccine Rollout Is Already a Disaster

Boxes containing the Moderna Covid-19 vaccine are prepared to be shipped at the McKesson distribution center in Olive Branch, Mississippi, on December 20, 2020. Photo: PAUL SANCYA/Getty/POOL/AFP via Getty Images

It’s happening all over again. For months, Americans who despaired about the country’s coronavirus-suppression efforts looked desperately to the arrival of a vaccine for a kind of pandemic deliverance. Now that it has arrived, miraculously fast, we are failing utterly to administer it with anything like the urgency the pace of dying requires — and, perhaps most maddeningly, failing in precisely the same way as we did earlier in the year. That is, out of apparent, near-total indifference.

Almost as soon as the coronavirus arrived in the United States, public-health officials understood quite precisely the basic building blocks of a proper response: test, trace, isolate — in the three-beat mantra of those early months. There were, along the way, misunderstandings and miscalculations — about surface versus aerosol transmission, about mask-wearing, about the relative safety of outdoor socializing, among others. But the basic path was abundantly clear, as nearly every epidemiologist kept screaming, and yet the country failed spectacularly to walk down it. Within hours of receiving WHO guidance on January 13, scientists in Thailand began deploying a COVID-19 test, as the Washington Post recently recounted; it took the CDC 46 days to produce one that worked. By March 1, South Korea was administering 11,000 tests per day, a rapidly growing figure; in the U.S., a country about seven times larger, the number was 183. Early, low-end estimates suggested 500,000 to 700,000 tests each day were necessary to slow the spread of the disease, and high-end estimates ran to 3 million per day; the U.S. didn’t reach 700,000 daily tests until mid-June, and still hasn’t reached that threshold of 3 million per day. As recently as August, lab delays caused by pent-up demand meant it was taking so long to deliver results that the tests themselves were effectively meaningless.

That is just the story of testing, but contact tracing and isolation were bungled just as badly. Early estimates for the number of contact tracers needed ran between 100,000 and 300,000 people working, nationwide, to alert the contacts of positive cases to encourage them to isolate. As of May, the number was under 8,000. Today, it is still just 70,000, and those who are reached by those tracers are overwhelmingly not responding. There has also been hopelessly inadequate support for those hoping to isolate, or quarantine, during periods of risk — not to mention insufficient protections for those who had to miss work to do so.

And now here we are, nearly a year into the pandemic, making precisely the same mistake with the vaccine. That is to say, despite the horrible continuing brutality of this pandemic and the incredible efforts and good intentions of health-care workers, we are, practically speaking, at a social level, not even bothering to try to end it.

How badly are we doing? In September, President Trump promised 100 million vaccinations by the end of the year. As a country, we have only 40 million doses, and had aimed, according to Secretary of Health and Human Services Alex Azar, to vaccinate 20 million by year-end. That’s bad enough. But we have administered only 2 million of those — barely 10 percent of the goal. At this rate, achieving sufficient vaccination to reach herd immunity and bring the pandemic to a close in the U.S. will take about seven years. In Israel, they are vaccinating about one percent of the population each day, meaning the full program of population-wide vaccination will be done by this March.

Of course, at that speed the effects will show up much sooner, as well. Because of the dramatic age-skew of disease, vaccinating the small number of very old people has an astonishing impact on mortality risk. According to one assessment of the Israeli approach, which focuses on protecting the elderly first, vaccinating just the 0.5 percent of people over 90 drops the total fatality risk by 19 percent; vaccinating the 2.5 percent over 80 cuts it fully in half; vaccinating the 7.5 percent over 70, drops it by three-quarters. Ultimately, Israel chose to bulk-vaccinate all those over 60, so the improvements are less dramatic than they might have been. But by late January, the country will probably have reduced its fatality risk from the disease about tenfold.

The U.S. is not Israel — it is a large country, much more rural, with a much more complicated (indeed, tattered) health-care system. There are probably some understandable, if maddening, reasons that we are not moving as swiftly as others to administer the vaccine. But it is an awful show of hot-potato responsibility that no entity or authority with the wherewithal to accelerate rollout is actually functioning properly. This is precisely as we were warned throughout the fall, as close observers noted that the federal government was dumping the responsibility onto states, most of which lacked the capacity to truly administer the rollout, and many of whom would push the job to local groups, hospitals, and even pharmacies. Keep in mind that, in 1947, New York City vaccinated 5 million people against smallpox in two weeks. Now just look at this chart from Bloomberg’s vaccine tracker:

As a whole, the country has administered barely 10 percent of even the first doses allotted — and 20 million (identical) doses are being reserved for a second shot. A group modeling the Canadian rollout suggested that rushing to get as many first doses as possible out, and waiting for new supply to deliver second doses, could avert as many as 34 to 42 percent of new infections, which is why Canada has now embraced that approach — as has the U.K. Here in the U.S., we are continuing to hold back half of the vaccine doses we have, and hardly any state in the country is significantly above 10 percent of that initial allotment — which is to say, 5 percent of available doses. Though refrigeration capacity varies from location to location, vaccines are only cleared for 30 days of storage in the most common units (including those in which they have been shipped). States have been rushing to build out their storage capacity, but have been warned of monthslong waits for ultracold freezers that could extend shelf life to about six months. That means that, in many places, this first batch of vaccine is set to expire in late January, around the time Joe Biden, who has been criticizing the rollout and promising to accelerate it, is set to take office. Presumably, the American pace will accelerate somewhat even before then. But on the current pace, by that point about 6 million Americans — perhaps 10 million — would have been vaccinated. And, depending on local bureaucracy and storage capacity, perhaps many million doses will be set to expire.