U.S. seeks to boost vaccine supply and use. Why wasn’t this done already?

coronavirusvaxallocationfmgao-300x167As coronavirus vaccine supplies  keep far exceeding demand, and as the new administration races to acquire and distribute more doses, as well as to kick start  plodding vaccination campaigns across the country, it may be a challenge not to ask the people who oversaw battling the pandemic before: What the heck were you thinking?

More on that in a second.

As of Jan. 29, the federal Centers for Disease Control and Prevention reported that ~49 million vaccine doses had been shipped and ~28 million were administered, with ~23 million patients now having received at least one of two shots required.

That is a far stretch from what will be needed to get hundreds of millions of Americans vaccinated so the country achieves the long-sought herd immunity to allow normality to return.

The challenges to widespread vaccination also may be rising with potentially more infectious viral variants, on which vaccines — including a new, good, one-shot product from Johnson & Johnson — may be less effective.

What needs to be done

This is a deeply concerning matter, as Dr. Ashish Jha, dean of the Brown University School of Public Health, said in a recent interview in which he focused on B117, the variant first detected in the United Kingdom:

“We’re going to see this variant take off across the country. We’re going to see it cause large spikes in infections and hospitalizations and deaths. And we got to do everything we can to prevent it.  So what do we need to do? We absolutely need to be vaccinating many, many more people as quickly as possible. Probably our single most powerful tool in the short run. Probably all of us need to be upgrading our masks and the masks that we’re wearing. I think the standard cloth masks we’ve worn through 2020 — probably not good enough for this variant. We need better quality masks … A double mask can be pretty reasonable under certain high-risk circumstances. So, if you’re out for a walk with your dog, you probably don’t need a double mask. Even a simple cloth mask is maybe OK. But if you’re going to go into a room with a bunch of other people, I think double masks, certainly high-quality masks like KN95s or KF94s — these are all available on Amazon and other retail stores. Those are generally higher quality masks. A good surgical mask is also quite useful.”

Biden offered a useful boost to the much-demanded vaccination efforts. He said his administration, as the Washington Post reported, would be “securing an additional 200 million doses of the two coronavirus vaccines authorized for emergency use in the United States.” As the newspaper added:

“The purchases would increase available supply by 50%, bringing the total to 600 million doses by this summer. Because both products — one developed by Pfizer and German company BioNTech, and the other by Moderna — are two-dose regimens, that would be enough to fully vaccinate 300 million people.”

Even before then, Biden said the federal government had worked with makers, and would increase supplies to states in the next few weeks by 16%. Officials also would guarantee baseline supplies, so those in charge of scheduling and vaccinating patients could have greater certainty and not see see-sawing amounts and projections for them of just a few days.

The president said the more immediate steps would allow his administration to increase its aspirations to get out 150 million vaccinations in its first 100 days — up from 100 shots in that same time.

Reality checks

Any potential optimism — notably that the nation might vaccinate enough adults and tally so many coronavirus cases to see greater normality and herd immunity be achieved in the fall — was tempered by the reality of vaccination lags.

In the District of Columbia, Virginia, and Maryland the vaccination rollout continued to be choppy, at best, and officials cautioned that vaccine demand still outstripped supplies. At the same time, news media have reported that vaccine hesitancy in the region — just as it nationally — is running at distressing high levels in crucial groups, including nursing home staff, as well as health workers and first responders.

Distrust of the vaccine persists as a significant issue in black and Latino communities — even as they suffer staggering and disproportionate damage from the disease. People of color also are not getting vaccinated, when shots are available, at rates whites are, though too many programs are not keeping crucial data on this issue.

The nightmarish aspects of the pandemic response were avoidable, and folks who oversaw it got significant warnings. That is the understated but pointed criticism leveled by the U.S. Government Accountability Office, one of the nation’s top watchdogs. In a follow-up report on this issue, the experts (who work for the Congress) said this:

“As of January 2021, 27 of GAO’s 31 previous recommendations remained unimplemented. GAO remains deeply troubled that agencies have not acted on recommendations to more fully address critical gaps in the medical supply chain. While GAO recognizes federal agencies continue to take some steps, GAO underscores the importance of developing a well-formulated plan to address critical gaps for the remainder of the pandemic, especially in light of the recent surge in cases. In addition, implementation of GAO’s recommendation concerning the importance of clear and comprehensive vaccine distribution and communication plans remains a work in progress. Moreover, slow implementation of GAO’s recommendations relating to program integrity, in particular those made to the Small Business Administration (SBA) and Department of Labor (DOL), creates risk of considerable improper payments, including those related to fraud, and falls far short of transparency and accountability expectations.”

A graphic (shown above) from the watchdog summarizes the meager federal attention to the crucial issue of how vaccinations would occur: Less than 2% (~$377 million) of the $16 billion-plus allocated for the vaccine, developed in miraculous fashion in record time, was budgeted for getting shots in hundreds of millions of patients’ arms. Compare that with the $20 billion Biden is seeking in his $1.9 trillion pandemic response measure, pending before Congress. That sum would come atop $8 billion that lawmakers approved in December for vaccination efforts by states and local governments.

This also is worth noting: The past administration lobbied Congress during a crucial time in the fall to deny states funding for vaccination programs, reported Stat, the medical and science news site. An undersecretary at the Health and Human Services agency expresses pride (!) at the effort to block the aid, arguing that strapped states wanted it just to plump their depleted finances, not for a life changing and saving effort that now is slogging along.

Lax on the vaccine and jab plans

Anyone else saying, Huh? How did we get a year into the pandemic now, with such a shambolic response, with a calamitous rollout required to get decision makers in Washington to see giant shortfalls in federal inaction on the coronavirus?

Media reports, particularly from Europe, indicate that vaccine negotiations — many involving officials who once worked in Big Pharma dickering with former colleagues — gave makers major leeway on liability issues, as well as product timetables, including allowing for delivery delays. The Wall Street Journal reported how U.S. officials knew but didn’t sound alarms when makers roughly halved their planned deliveries in this country in December. Officials also kept insisting that ample supplies would be ready and at hand, though they understood — perhaps as they failed to clarify for the public — that, blur and spin, vaccine manufacture really was not concurrent with development and ran into obstacles. Makers, it is now clear, didn’t start rolling vaccines on the lines and out for use until near or after they secured emergency regulatory approval.

The previous administration had clear sight lines, perhaps in late October and certainly in November, that two drug makers were racking up good outcomes with vaccines. Why did it take until Christmas for officials, who had spurned offers earlier, to increase the national purchase from 100 million to 200 million — now with greater delay in delivery as other nations had leaped in and bought up supplies?

Sure, an option also was negotiated for yet more doses. But why did it take until the installation of a new administration to zip up a consequential decision — to get enough vaccine, in some timely fashion, to protect the needed number of Americans? The exiting incumbent obsessed in wild fashion that he would be in office, past Jan. 20. Did he and his crew not want to start fantasy term 2, not behind a giant mess with the coronavirus vaccinations?

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs. It has become a nightmare now, with the health system exhausted by dealing with the pandemic and the public subjected to almost a year of a flood of falsehoods and anti-science denialism about the pandemic.

Accountability for the carnage?

The disease’s terrible and unchecked toll (almost 440,000 deaths as of January’s end, in a likely underestimated count) is nearing the population equivalent of Virginia Beach (450,000) and soon may rumble in the forecast territory with as many Americans having died from the coronavirus as live in Baltimore (~600,000). The country already has racked up as many infections (26 million plus) as to exceed the populations of the New York (19 million) or Los Angeles (13 million) metropolitan areas.

The coronavirus is en route to becoming the leading cause of death in the country, killing more people than heart disease, cancer, stroke, Alzheimer’s or diabetes.

The infection has led to “enormous” declines in the forecast, fundamental measure of a nation’s well-being: its life expectancy rate. Experts find major reasons to discuss this metric in typical times if it moves incrementally — by a few points on the right of the decimal.

New research suggests Americans’ average life expectancy fell 1.3 years, due to the coronavirus — a huge shift on both sides of the decimal, and 10 times what has occurred during troublesome times in which scholars expressed huge concerns about the harms caused by drug overdoses, other external causes, and respiratory and cardiovascular diseases.

The same study also sees black and Latino life expectancy in this country plunging, at three- and four-times greater rates than the predicted average overall.

Biden, since taking office, has not taken pause to assail his predecessor’s clear failures, nor has he engaged in recriminations with the Republicans who controlled the House and Senate in recent times and sat on their haunches as the White House flailed at and ignored a health catastrophe. Now, with Democrats in slim control, GOP lawmakers — who were happy to lavish trillions of dollars in tax cuts on plutocrats and wealthy corporations — suddenly have become spending and deficit hawks.

The new president, correctly, insists he wants to work with his political opposition and has tried to bridge a partisan chasm, including by asking politicians to remove the vitriol and ad hominem attacks in policy discussions. History will tell. It also may look at the jaw-dropping deaths and damage that the nation has suffered in a few short months, including savage numbers for the aged and communities of color, and perhaps wonder if these might put recent U.S. leadership figures in ignominious compare with rotten tyrants of recent times and their unspeakable slaughters of their own people.

We have great work to do to battle the coronavirus, end the pandemic, and move the country to a far better place than it is now.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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