On Thursday, Dr. Anthony Fauci, the nation’s top infectious disease expert, made a prediction that was like music to the ears of millions of Americans who aren’t eligible for COVID-19 vaccination yet.
“If you look at the projection, I would imagine by the time we get to April, that will be what I would call, for [lack] of better wording, ‘open season,’” Fauci told NBC’s “Today” show. “Namely, virtually anybody and everybody in any category could start to get vaccinated.”
April? That’s less than 50 days away. The U.S. vaccination campaign started 60 days ago, on Dec. 14. Since then, just 11.3 million Americans — mostly health workers, with a few seniors sprinkled in — have received both doses of either the Pfizer or Moderna vaccine. Another 24 million Americans have gotten their first shot and are awaiting their second.
The news has been filled with headlines about crashing appointment websites, struggling seniors and governors complaining about supply shortages. Meanwhile, we’ve only just started vaccinating Americans 65 or older; most essential workers aren’t even eligible yet.
So is Fauci offering false hope when he says that “anybody and everybody in any category” will be able to sign up for vaccination starting in April? Or is his projection realistic?
The answer, if you actually examine the numbers, is surprising — and encouraging. It turns out April isn’t out of the question at all.
The first thing to consider is the current pace of vaccination, which is faster than you might think. “If you compare now to what we were doing just literally a month ago,” Fauci said Thursday, “the escalation has really been considerable.”
He’s right. On Jan. 11, the U.S. was administering an average of 632,000 doses per day. Now we’re averaging 1.6 million. That’s not just a two-and-a-half-fold increase. It’s also more, already, than the revised goal of 1.5 million doses per day President Biden set two short weeks ago after critics said his previous target of 1 million doses per day was too low.
The next thing to consider is where supply is heading next. (Hint: it’s heading upward.) “As we get into March and April, the number of available doses will allow for much more of a mass vaccination approach, which is really much more accelerated than what you’re seeing now,” Fauci said Thursday.
Initially, logistical bottlenecks were slowing vaccination; many states were administering less than half the doses they’d received. But now that some of those knots have been untangled, the national share of available doses administered has climbed to 68 percent, with several states clearing 80 or even 90 percent.
Supply, in contrast, is what’s holding us back today; at the moment, doses administered are consistently outpacing doses distributed for the first time since the rollout began. But as Fauci said, this should change soon. Since Biden took office, the number of doses being sent to states has increased by 28 percent to 11 million doses a week, according to White House COVID-19 coordinator Jeffrey Zients. Starting Thursday, the administration will boost that number by another 5 percent, with 1 million doses going directly to 6,500 retail pharmacies and another 1 million going directly to 250 community health centers serving hard-to-reach groups such as homeless people, migrant workers and public housing residents.
Production is picking up too. At first, Pfizer and Moderna promised to deliver 100 million doses each by the end of March. But Pfizer recently added 20 million doses to that pledge — then announced it could ship all 200 million doses purchased by the U.S. before the end of May, or two months earlier than expected, because vaccinators can squeeze six or even seven doses out of vials that were supposed to contain just five.
At the same time, Moderna is “asking U.S. regulators to approve what it says could be a remarkably simple proposal to speed up the immunization of Americans against the coronavirus: Fill empty space in its vials with as many as 50 percent more doses,” according to the New York Times. If the change is approved, which could happen this month, it would theoretically allow Moderna to ship tens of millions of additional doses by the end of March and another 150 million by June.
To put that in perspective, about 68 million doses have been distributed over the last 60 days. Over the next 50 days — that is, by April — the U.S. could be getting 175 million more.
And that’s not even counting the single-dose Johnson & Johnson vaccine, which the U.S. Food and Drug Administration is expected to approve this month, with 100 million doses to follow before July. Or the Novavax and Astra Zeneca vaccines, which could also be available by April. Or the fact that on Thursday, the Biden administration announced that it had secured another 200 million doses from Pfizer and Moderna to be delivered in "regular increments" by the end of July — bringing the grand total from just those two manufacturers to 600 million doses, or enough to fully vaccinate every adult in America (and then some).
Administering so many additional millions of doses will be a challenge, but Fauci sounded confident Thursday. “I would imagine, and in fact, I’m fairly certain, that as we get into and toward the end of April, you’ll see … pharmacies, community vaccine centers, mobile units really stepping up the pace of vaccination,” he said. “Hopefully as we get into the early spring we’ll have a much greater acceleration of dosage.”
It’s worth noting here that the U.S. has already shown it can administer three million flu shots per day — double the current daily average for COVID-19 shots.
But even if the pace of actual vaccination doesn’t accelerate that much, we should still be on track for “open season” in April. The numbers add up. There are about 54 million seniors in the U.S., and the Centers for Disease Control and Prevention classifies about 30 million Americans as essential workers. All told, the combined number of people who are likely to be eligible for vaccination before “open season” — a group that may also include non-seniors with “high-risk medical conditions” — is about 182 million, according to the CDC.
But here’s the thing: not all eligible Americans will actually go through with vaccination — especially as more and more younger workers become eligible. Based on the latest Kaiser Family Foundation tracking survey, a majority of Americans say they don’t want to get vaccinated as soon as they can, and a full 31 percent of nonmedical essential workers say they plan to wait and see how the vaccine is working on other people before rolling up their own sleeves. Among Americans aged 18-29 — and among Black Americans, who have long suffered from medical discrimination — that number rises to 43 percent. It’s 37 percent among Latinos.
According to one respected forecast, the current U.S. trajectory suggests that at least 100 million Americans will have initiated vaccination by April 1 — more than enough to cover all of the seniors, frontline workers and high-risk individuals who say they plan to get vaccinated as soon as they can. And that’s assuming the pace of vaccination never exceeds 2 million doses per day.
The bottom line, as former FDA Commissioner Scott Gottlieb recently explained, is that soon, “perhaps in April, supply will start exceeding demand” — and then “the challenge won’t be how to ration a scarce resource, but how to reach patients reluctant to get vaccinated.”
At that point, it wouldn’t be a surprise if state and federal leaders decide that the time has come to keep the ball rolling by opening up vaccination “to virtually anybody and everybody in any category.” That’s especially true if, as Gottlieb predicts, the monthly vaccine supply hits 100 million doses by the end of March.
Not that vaccination itself would be immediate for anybody and everybody who wants it, as Fauci noted Thursday. “From then on,” he said, “it would likely take several more months, just logistically, to get vaccines into people’s arms.” Hesitancy, meanwhile, would continue to pose a challenge, particularly if cases continue to decline, seniors are shielded from serious illness and more reluctant Americans start to wonder, “Why bother?”
Still, Fauci remains optimistic. “Hopefully, as we get into the middle and end of the summer,” he said Thursday, “we [will] have accomplished the goal we’re talking about — namely, the overwhelming majority of people in this country having gotten vaccinated.”
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