Ride or die.
Support The Bulwark.
  Join Now

Quadrupling the U.S. Daily Vaccination Rate

Ramping up will require a greater sense of urgency and a national call to action.
January 5, 2021
Featured Image
Pharmacist Colleen Teevan reconstitutes the Pfizer/BioNTech before having it administered to people at the Hartford Convention Center in Hartford, Connecticut on January 4, 2021. - The vaccine is being given to First Responders currently and front line workers at the Hartford Convention Center, where a vaccine distribution clinic has been set up. Hartford Health Care is currently running ten vaccinations centers with an eleventh planning to open next week and a total capacity to vaccinate 2000 people a day. (Photo by Joseph Prezioso / AFP) (Photo by JOSEPH PREZIOSO/AFP via Getty Images)

The rollout of the COVID-19 vaccination campaign is frustratingly slow, that is obvious. But what would constitute success? Both the current administration and the incoming Biden team are setting goals that are below what the moment requires. If vaccination is the route out of this national crisis—and it is—the federal government and the states need to start acting like it.

Over the weekend, Anthony Fauci and Moncef Slaoui—two of the leaders of Operation Warp Speed—touted the recent rate of 500,000 vaccinations per day, and promised further acceleration is forthcoming. The incoming Biden team is pledging a jump to an average of 1 million per day during the first 100 days of the presidential term. Neither pace is sufficient. To use all available supply, the daily throughput should be double what Biden is targeting, and quadruple the pace of recent days.

Operation Warp Speed’s great initial achievement was to incentivize the development and testing of two safe and highly effective vaccines, and to secure an initial supply of 200 million doses, delivered by no later than the end of March 2021. The Pfizer-BioNTech tandem has committed to produce 100 million doses for the United States in that timeframe, and Moderna has done likewise.

Every moment of unchecked viral spread is costly, in terms of additional mortality and further damage to the national economy. The goal, then, for the vaccination campaign must be to hasten the pandemic’s end by using all supply as soon as it becomes available.

As of January 4, the manufacturers had delivered 15.4 million doses to the states, out of an available stock of 40 million manufactured and stored doses. The states had successfully administered about 4.6 million of those vaccines. Operation Warp Speed has held back 22 million of the 40 million available vaccines, to deliver as second doses for the initial vaccinees (three to four weeks after their first shots), and to build a small emergency reserve.

Having delivered 40 million doses already, Pfizer-BioNTech and Moderna have a remaining commitment to produce 160 million doses over the next three months (and to produce an additional 100 million doses each in the following months, mostly in the second quarter). There is no reason at the moment to doubt they can meet this production schedule.

During the 86 days between January 4 and March 31, there is expected to be a total inventory of 195.4 million vaccines (with 4.6 million vaccines having been administered). If the United States continues to set aside an emergency reserve of 2 million doses, and reserves another 25 million for the second shots of the vaccinees getting their first doses in late March, that means there will be 168 million doses available for administration before March 31. Putting all of that supply into the arms of patients before the end of March would require maintaining a consistent pace of 2.0 million vaccinations per day, starting immediately.

Ramping up vaccination throughput will take time; a slower initial pace should be offset with more rapid take-up later, which further underscores the inadequacy of a 1-million-per-day target. If the country maintains a pace of 0.5 million vaccinations per day through January 20, and then moves to 1 million per day through March 31 (day 70 of the Biden administration), the U.S. stock of available but unused vaccines would grow to 86 million, which is unacceptable when so many Americans are desperate to get protection.

Administering 2 million vaccines per day is not an unrealistic goal. In the 2019-2020 flu season, the U.S. administered 175 million vaccines. The bulk of those vaccinations took place over a four-month period (September to December), which translates into a daily rate of roughly 1.0 to 1.5 million vaccinations.

And flu vaccinations occur in an environment of much less urgency. In the current pandemic, hospitals have become distribution centers, and pharmacies are expected to become central to the campaign in coming weeks. Further, state public health departments are building special COVID-19 vaccine sites, which should further speed up the process.

What will it take to hit 2 million inoculations per day? Many things. Better organization. More clarity and transparency on vaccine delivery timetables and thus availability of supply. Opening up commercial pharmacies and physician offices more rapidly as critical distribution centers. And moving more quickly toward open scheduling of vaccination times for populations outside of the health sector and nursing homes, based on whatever prioritization criteria the states choose but certainly focused on the elderly.

Most importantly there needs to be a sense of urgency and a national call to action. President-elect Biden has made it clear that getting the pandemic under control is his number one priority, which is why it is puzzling that his vaccination pledge lacks ambition. His team may have settled on the 1-million-per-day target because it is an achievable goal based on current trend lines. But reaching that milestone won’t set in motion the major course correction that was promised during the campaign (Trump himself might reach that goal before January 20).

Setting 2 million vaccinations per day as the goal would be difficult to achieve, and might set the administration up for falling short, but it would push the federal bureaucracy and state governments to revisit every aspect of the current process to see how it might be sped up. And that is exactly what should be happening when a new administration takes over with a pledge to shake things up and set the nation on a better course.