WASHINGTON — Before an uptick in available vaccines in the next month, the Biden administration has been taking control of an increasing number of doses, bypassing state programs in an effort to get shots to Black, Latino and low-income communities.
But after less than five weeks to retool the system they inherited from the Trump administration, the Biden plan to use pharmacies and federally run mass vaccination sites could be tested by a new wave of doses.
"There is a lot of untapped capacity out there, " said Celine Gounder, an infectious disease specialist at New York University, who advised the Biden transition. "I think there is huge potential to scale up through the retail pharmacies. It has been much more focused until now, but once supply opens up they will be targeting those most-at-risk populations, but also scaling up more broadly."
On Thursday, President Joe Biden marked the 50 millionth vaccine with a White House event that included a made-for-television administration of vaccines to four people — a teacher, a grocery store manager, an EMT and a firefighter.
"What I will say to the American people is this: if — if — the FDA approves the use of this new vaccine, we have a plan to roll it out as quickly as Johnson & Johnson can make it," Biden said. "We’ll use every conceivable way to expand manufacturing of the vaccine and we’ll make even more rapid progress on overall vaccines in March. "
Pfizer and Moderna have scaled up production and Johnson & Johnson is on track to win FDA emergency use authorization for their single dose vaccine over the weekend — after which the drug maker has said it will send 20 million doses into the U.S. market in a few weeks.
If the manufacturers meet their projections, the U.S. will have enough doses to vaccinate 4 million people per day by the end of March, up from the current pace of around 1.5 million shots a day.
The coming test for the Biden administration is whether it can successfully ensure that those doses get from the manufacturers into the arms of people at the increased rate, and meet its goal of ensuring the hardest-hit communities don't get left behind.
The U.S. will also want to avoid problems like those emerging in other countries, such as Germany, which acknowledged Wednesday that is has 1 million doses in storage because people are reluctant to be vaccinated.
Unlike the Trump administration, which allocated vaccine doses to states based on their population size and left it up to local officials to decide how to dole out the shots, the new administration has been routing more doses to community health centers, federally run mass vaccination sites and retail pharmacies specifically targeting minority and low-income communities, administration officials said.
So far, just 9 percent of those receiving the vaccine have been Hispanic and 6 percent have been Black, according to CDC data. Hispanics make up 19 percent of the total U.S. population, and Blacks 13 percent.
Even among health care workers, the first group to get the vaccine, whites were disproportionately vaccinated more than Blacks and Hispanics, according to data from the Kaiser Family Foundation.
To try to reverse that trend, the federal government began this month to ship vaccine doses directly to retail pharmacies with the initial locations selected for their ability to reach “socially vulnerable communities,”said Jeffrey Zients, the administration’s Covid-19 coordinator. Last week, 2 million doses went directly to pharmacies while 13.5 million went to the states.
Walgreens said it will start getting a weekly allocation of about 500,000 vaccine doses a week with about half of them going to stores in what the federal government has identified as “medically underserved areas” and areas with social vulnerable populations, said a Walgreens spokesperson.
After using pharmacies to target low-income areas, delivery through retailers is expected to be scaled up nationally once more shots are available. Albertsons grocery store, for instance, said it has the ability to administer 150,000 doses a day and handle about 90 percent more supply than it has received. CVS said its 10,000 stores will have the capacity to give 5 million to 6 million shots per week, but they are receiving just 500,000 doses a week now.
Part of the challenge as more doses roll out will be helping people figure out which pharmacy has doses and how people can get appointments. The CDC is partnering with other health providers on Vaccinefinder.org, a website where people can enter their zip code and see where shots are available.
The website was created by Boston Children's Hospital to help families find flu shots, but was converted into a Covid-19 vaccine site that pulls data directly from the pharmacies. It currently offers information in only four states.
Administration officials said this month that they will be shipping 1 million vaccine doses directly to 250 federally funded community health centers, which serve hard-to-reach groups such as homeless people, migrant workers and public housing residents.
The administration has also set up vaccination centers in largely minority neighborhoods in Oakland, California, and Los Angeles that are each administering more than 4,000 shots a day that come directly from the federal supply of the vaccine. It plans to open four additional federal vaccination sites in the next two weeks in Florida — near Miami, Tampa, Orlando and Jacksonville — with large populations of Black and Latino residents.
“Selection of all of these sites is based on a CDC, FEMA framework that has been developed to target vaccinations to those who are most vulnerable,” said Andy Slavitt, the White House senior adviser on the pandemic response, in announcing the locations. “The goal is to launch vaccination sites that use processes and are in locations that promote equity.”
And he acknowledged that in some instances, people from outside the communities have been scheduling appointments, Slavitt said.
“People from outside of these communities — outside of the hard-hit communities — come in, make appointments and often take some of those doses, which we shouldn't be surprised about — it happens in a shortage,” said Slavitt during a press briefing last week. “But we have to act on it because we are purposely setting up both sites that are located conveniently in these communities.”
At a vaccine site opening this week at the Dallas’ Fair Park staffed by military and federal officials and targeted at minority neighborhoods, only about 18,000 residents in the eligible zip codes had registered for the vaccine as of Monday — 3,000 fewer than the total number FEMA can inoculate in a week, The Dallas Morning News reported.
Slavitt said the federal government is working on ways to improve the appointment reservation system and other issues that can become obstacles for people who live in those communities, like transportation and limited hours for appointments.
States have also complained about a lack of coordination as the federal government takes a stronger role, according to a bipartisan group of governors who sent a letter to the administration this month.
The governors said that, because of a lack of communication, some pharmacies have received doses from both the state and federal government.
“If the federal government distributes independently of the states to these same entities without state coordination and consultation, redundancy and inefficiency may very well follow,” the letter said.