In addition to hospitals, states sent the vaccine to county health departments because, the thinking was, health departments could get doses into arms quickly. Health departments “know how to do mass-vaccination clinics,” Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials, says. They know how to set up a big tent with metal chairs and vaccinate hundreds of people within a few hours. Getting the vaccine to other types of doctors and pharmacies, as I heard over and over in recent days, is impossible until there’s more of it.
This shortage of doses is why, in Palm Beach County, Florida, 100,000 seniors were on a waiting list recently for only 4,000 doses of vaccine. In Louisville, Kentucky, 40,000 people have signed up to wait for their dose. Walton County, Florida, opted against even maintaining a waiting list, because it was taking too long to call everyone back to schedule an appointment.
These waiting lists might seem strange, given that states supposedly haven’t administered all of the vaccine they’ve been allocated. As of this writing, for example, North Dakota is performing the best, having used 74 percent of the doses it’s received. If states have extra vaccine sitting around, why not give it to Siedlecki or Wong or another doctor to give to some of those patiently waiting seniors?
Because those doses, which exist but haven’t been used yet, “are spoken for—they’re gone,” Claire Hannan, executive director of the Association of Immunization Managers, told me. Some are in hospitals, and some are reserved for long-term-care facilities, where CVS and Walgreens are vaccinating residents as part of a federal program. It’s taking the pharmacy chains some time to get through these facilities, making it appear as though there’s a big pile of vaccines sitting there, just waiting to be injected. (Plescia thinks the distribution numbers aren’t accurate, and that state data systems might not be showing the latest immunization figures.) Those numbers look bad for states, which makes health directors less eager to send precious vaccines to a bunch of small-practice doctors, only to risk having more doses of vaccine sit around unused.
When the Trump administration earlier this month urged states to begin vaccinating people older than 65 and those with underlying conditions, the public-health world erupted in quiet panic. The federal government hasn’t sent them enough vaccine to cover everyone over 65, and some states haven’t yet finished vaccinating health-care workers—the first-priority group. Health directors are saying that deliveries of the vaccine have been small and unreliable. The problem, they say again, is the supply.
Both Moderna and Pfizer are trying to increase vaccine production, according to a White House coronavirus adviser who would only speak to me on the condition of anonymity. But because the technology to make the vaccine is so specific, it doesn’t make sense for the government to build a new factory for manufacturing it, the adviser said. In the time it would take to build a new facility to make the vaccine, the companies could expand their own production lines—something they’re already doing. The best hope for quickly expanding vaccine supply lies with Johnson & Johnson’s vaccine, which should be ready soon.