Don’t drop the baton — Speed access to COVID vaccines
By Dr. Rob Breiman
The development and production of large numbers of new, safe, and effective vaccines to prevent COVID within a year since the causative virus was identified is an extraordinary accomplishment. In the first month of vaccine availability, while COVID is raging at the highest rates since the start of the pandemic, our rate of utilizing the new vaccines is also remarkable, but not in a good way. There are 20-30 million doses of vaccine available as we approach the end of the year. However, at the current rate of immunizations, we will use only a fraction of available doses.
The reason for this underutilization is not “vaccine hesitancy”—in other words, it is not because a vast portion of the population is not willing to be immunized . It is quite the reverse—enthusiasm for getting immunized is growing, but an immense number of people at risk for COVID illness and complications cannot get their hands on the vaccine; that is, they can’t get the needle into their arms. This is not to say that vaccine hesitancy will not become a problem in the future as the program expands; studies show that some populations at highest risk for severe COVID outcomes are more likely to not trust and accept SARS-CoV2 vaccination. Providing context-specific and culturally relevant scientific information about available vaccines is a critical part of the process of equitable and optimal vaccine access and use—this is another subject that needs urgent attention.
At a time when a variant strain of SARS-CoV2 appears to have acquired increased transmissibility, we need to be maximizing our use of vaccine to prevent spread of these strains and the incidence of severe illness. So far, it appears that viral mutations have not resulted in strains that would evade vaccine-induced immunity. That could change in the future, so it is imperative that we reverse the trends quickly and diminish the force of the pandemic.
How can we justify underutilizing the available quantities of vaccine, and what do we need to do to change this?
There are two fundamental reasons for this suboptimal use: 1) many immunization centers have not fully ramped up to maximize immunization capacity; 2) and, more importantly, ACIP guidelines only list two categories at the moment—people working in direct health care and people living and working in long term care facilities. Regarding the first reason, there is clearly a learning curve — immunization centers are gaining the experience with unique, complicated logistics to be able to operate more efficiently. With regard to the second reason, as we enter the third week of vaccine availability, it’s time to move to inclusion of other risk groups and quicken the pace.
Right now, even if there is extra vaccine available, people at substantial risk for COVID, like the elderly and people with underlying condition, cannot get immunized. Other essential workers, like fire fighters and police cannot get vaccine either. The doors are closed for all of these people—and at the current rate, they may have to wait until mid-to-late February or beyond. Many are clamoring to get immunized, like people waiting overnight in the cold to buy concert tickets (in bygone days). Yet, even though there may be boxes of vaccine vials jamming freezers, they have to wait until it is decided that health care workers have had sufficient time to get immunized, to make it possible to add other categories (or subcategories). Like when boarding airplanes, for which high mileage passengers can board first and then at any time, health care workers should always be able to get in line (with other priority passengers) to get vaccine, but don’t hold vaccine administration until all of them decide to get dosed.
The rate-limiting step to providing immunity should be only the amount of vaccine available. We know that more vaccine is coming—there is reasonable confidence in the manufacturing and distribution plan for timely delivery of future doses– so, don’t hold back. Get as many people at risk (especially for severe disease and mortality) their first dose as quickly as possible. State and local health authorities could open the doors to critical priorities to begin a systematic process for getting people in those categories immunized. States and counties should maximize capacity within their jurisdictions to immunize without delay. We cannot drag our feet at this pivotal moment. Vaccines left in the vial will not prevent spread and won’t save lives. Immunizers should not be sitting idly at their stations (or at home without being given the opportunity to assist with expanded capacity), and there should not be a single vaccine dose remaining in the freezer as the next tranche arrives.
This is like a relay race. Our first two runners—vaccine development and production — have given us an impressive edge. The baton has now passed to vaccine distribution and administration, which must keep up the pace and bring us across the finish line. Supporting state efforts to address these challenges will improve the nation’s chances of crossing the finish line as timely as possible to protect and save the lives of those in the cheering crowd.
Dr. Robert Breiman is professor of Global Health and Infectious Diseases at Emory University and Chief Scientific Officer for the Global Health Crisis Coordination Center. He is a member of the National Academy of Medicine.