When he assumes the presidency, Joe Biden will inherit what is perhaps the greatest twin crises ever to face an incoming president: a pandemic raging out of control and an economy sitting on shaky foundations.
And the greatest weapons in his arsenal to combat both — the Pfizer/BioNTech and Moderna vaccines — are scarce.
Things were not supposed to be like this.
The Trump administration's Operation Warp Speed was supposed to not only help speed development of an effective vaccine, but to ensure its production and swift delivery across the country. State and local governments were supposed to have plans in place to put shots in arms; hospitals and other vaccine distributors were supposed to be ready to handle the demand.
Sadly, none of this has happened.
A study in Israel found that, two weeks after the first dose, infections among vaccinated people were 50 percent less than those who were not.
The Trump administration promised 20 million people would be vaccinated by the end of 2020; approximately 4 million were. By the end of his time in office, only about 15 million shots have been administered in all and less than 2 million people have been fully vaccinated. The CDC only publicly released its tiered vaccination plans on Dec. 20; prior to that, no two states had even remotely similar tiers or timing for vaccine distribution because of the lack of any federal guidance. But because the CDC's plans were just a guideline with no force of law or backing from the broader federal government, states' plans for vaccine distribution remain a complete patchwork of different rules and timings.
And, all in all, the federal government only initially contracted with Pfizer and Moderna to sell 100 million doses each — or enough for 50 million people in the U.S. to get fully vaccinated by a Pfizer or a Moderna shot — by the end of March. (They've since each agreed to provide 100 million more doses by the summer.)
Last week, outgoing Health and Human Services Secretary Alex Azar announced that he was releasing the rest of the second-shot doses of the vaccine in the national reserve stockpile to enable more Americans to receive their first shots while their second shots were being manufactured, rather than holding on to those. Health experts were ecstatic, in part because a study in Israel found that, two weeks after the first dose, infections among vaccinated people were 50 percent less than those who were not, and testing done by the manufacturers has found high rates of efficacy after the first shot of either. State officials, who are the only authorized nonfederal distributors of the vaccine, began planning accordingly, mostly by adjusting their tiers to include people 65 years and up or other essential workers who had been anticipating longer waits for vaccines and scheduling their appointments.
Unfortunately, it turned out that this exciting news was a charade; by the end of the week, states discovered that there were no doses in the strategic reserve being sent, as all the doses sent by the manufacturers had been distributed. There would be no windfall of vaccine doses to meet the already pent-up demand — or to fulfill the appointments offered to those waiting.
Another major challenge to vaccinating more Americans, of course, lies with the companies that manufacture the vaccine themselves.
It added more chaos to an already-chaotic system: According to ProPublica, though the manufacturers have consistently shipped 4.3 million doses each of the last three weeks (2 million for first shots and 2.3 million for second shots), the federal government only tells the states what their allocations for the following week will be on Tuesdays, after it subtracts the doses given to the corporations handling long-term care facility vaccinations and adds in any potential unused doses from those corporations. States have until Thursday to place orders, for which they have to have plans to distribute each dose.
Some weeks, some states will have more than they expected, forcing them to scramble to find more people to vaccinate; other weeks, they'll have less than expected, forcing them to scramble to find more doses or cancel appointments.
New York is a case in point: last week, it received 300,000 doses, but for the week of Jan. 18, it was only allocated 250,000 — even though, last Monday, Azar had said that more vaccines were being released from the supposed reserve, and the state opened up eligibility accordingly.
The new, federally enforced shortage hit New York City, once the epicenter of the epidemic, particularly hard. Mayor Bill de Blasio warned that the city could run out of vaccines to give as of Thursday (it had, as of midday Tuesday, distributed 75 percent of all the doses it had received).
The Mount Sinai hospital system, one of the largest in the state, was forced to abruptly cancel all vaccination appointments from Friday through at least Tuesday, and could not make any others for the foreseeable future — even, according to several people whose appointments were canceled, to reschedule those who had been expected to be vaccinated during that period of time. Further, the sudden cancellations and the way Mount Sinai dealt (or did not deal) with the fallout for its patients left many deflated and worried that they would not be able to get vaccinated at all for quite some time to come, given the dearth of availability elsewhere. (A spokesperson for Mount Sinai did not return a request by NBC News Think for comment; an updated message on their website Tuesday said they would reschedule those appointments as supply allowed.)
Sadly, none of this has happened.
Meanwhile, the state began largely consolidating vaccine distribution, pushing people to make appointments at mass vaccination sites administered by the state. But getting appointments there is also proving impossible for New Yorkers — even hours outside of New York City, wait times for vaccine appointments for those 65 and older and eligible essential workers now stretch well into April and beyond.
These difficulties are being repeated across the nation.
In Oregon, the dwindling supply of doses caused Gov. Kate Brown to delay allowing Oregonians 65 and older to receive the vaccine. Arizona, as well as other states, is facing a similar shortage and will likely be forced to confront a similar reality soon. More than 40,000 Floridians are overdue for their second shot, in part because of wait times, while thousands of other people there can't get appointments for the first shot — which officials directly attribute to the extremely short planning window the federal government offers states, as well as the rapidly fluctuating supply that makes it impossible to plan.
And, when New York Gov. Andrew Cuomo, who has been accused of micromanaging vaccine distribution and thus causing delays in inoculating New Yorkers, and Michigan Gov. Gretchen Whitmer, who has not, proposed buying more doses directly from Pfizer, they were told that the company needed special permission from the federal government to sell to them. (No such permission is expected to be forthcoming.)
Last spring, Cuomo rightly decried how the federal government had instituted a system in which states competed against one another on the market for personal protective equipment for health care workers; Illinois Gov. J.B. Pritzker called it the “Wild West,” where states undercut one another, drove up prices and caused chaos. Yet, the federal government, through its incredibly inefficient distribution system and poor communication, has incentivized governors to attempt the same behavior that served us all so poorly a year ago.
Last week, Joe Biden called the vaccine rollout what it is: a “dismal failure.”
Another major challenge to vaccinating more Americans, of course, lies with the companies that manufacture the vaccine themselves. With global demand for the vaccine at an unprecedented high — and after the Trump administration turned down an opportunity to secure more of Pfizer's vaccine — Moderna, Pfizer, Johnson & Johnson as well as other companies do not have enough workers to help in the manufacturing and logistics needed to meet the current demand.
And the delay is causing serious economic consequences too: President Donald Trump’s own Council of Economic Advisors found that each day that the distribution of the vaccine is accelerated will add $10 billion worth of daily benefit to the United States.
Last week, Biden called the vaccine rollout what it is: a “dismal failure.” He's announced that he wants to vaccinate 100 million Americans in the first 100 days of his presidency. However, to do that, he'll need to both fix the problems with the federal distribution and help the states shore up their implementation strategies — fast.
Without fixing the vaccine distribution system at all levels — and holding leaders who make illogical decisions about their vaccination plans accountable — we can all expect there to be more Americans wondering how to even get vaccinated, rather than 100 million of us showing off our vaccine cards come the end of April.