Preview

The scenes of frontline healthcare workers taking the Pfizer vaccine this morning make me incredibly hopeful that this newsletter will quickly become obsolete. Getting the emergency use authorization on Friday and spending the weekend positioning the doses across the country turned out to be workable, and I’m slowly growing less concerned about the logistical heavy lift, even though there are bound to be glitches here and there. In fact, I think there are a lot of reasons for optimism with this rollout and one big reason for pessimism. Here they are:

Steady shipments: The expectation is that the Moderna vaccine will be approved this week and off to the states. At that point you will have two sets of vaccine doses moving across the country, at a fairly consistent rate. The Washington Post is tracking distribution based on state health official estimates; the site Tableau Public is doing the same in much more concentrated and visually pleasing fashion. In general, enough shipments for one shot of the two-shot sequence for about 4-7 percent of the adult population will be rolling out this month, which could (and should) ramp up in subsequent months, if for no other reason than this was half a month.

You don’t need 100 percent coverage of the adult population to actually reach herd immunity; the 16 million who have contracted the disease have antibodies, and that’s probably an undercount by at least a factor of three. Dr. Slaoui of Operation Warp Speed has said 70 percent of the population would be enough; it could be even lower. The numbers, with even a mild ramp-up, come out to enough doses to eradicate the virus within about 4-6 months. I’d love to see that sped up to 3-4.

A lot will go wrong. Incorrect refrigeration will cause some spoilage. If scheduling is mismanaged the Pfizer vaccine may be defrosted too early, therefore becoming unusable. There are the hurdles associated with making sure everyone comes back for the second shot. And vaccinating during a pandemic could lead to exposures and even outbreaks before the dosage takes effect. Mistakes will be made. But in general this looks achievable.

Enough doses: The U.S. purchased an additional 100 million shots from Moderna, on top of the 100 million they already pre-purchased. Add that to the 100 million guaranteed from Pfizer and you have enough to cover 150 million people without any other vaccine being approved. Given that both of these vaccines are around 95 percent effective in clinical trials, you’re not wasting many of them. Another even mildly effective shot like AstraZeneca (which the U.S. pre-paid enough for 300 million doses) should be enough to cover the necessary population. So the grumbling about the Trump administration not getting enough shots from Pfizer over the summer should subside.

No twindemic: Fears that flu season would cause a doubled-up rush to the hospital along with the coronavirus have not materialized. Flu activity is “atypically low,” according to experts, in all 50 states. Compared to some years, flu is seven times lower. That’s a rare assist to hospitals trying to deal with COVID patients and vaccinations at the same time.

A presidential-level effort: I think we will take what we can get from a White House that has checked out of reality. A $250 million public education campaign is rolling out, without the celebrity pitchmen once envisioned. Really any help at the margins to overcome confusion and deliberate misinformation ought to be welcomed. Surveys show that enough people want to take the vaccine to reach herd immunity, but having a cushion would help. And Trump actually did something right: after news that the White House staff would be quickly vaccinated (which is arguably not a bad thought, but contains elements of unfairness that would sap public confidence), the president shut that down, saying that staff would get vaccines “somewhat later” in the process.

A virus losing steam: Stay with me on this one. We are in the midst of a horrible cycle right now. But the wave has crested in some of the worst-hit areas. In fact, a review of data from the COVID Tracking Project shows that 24 states are at a plateau or on the downslope on the key metric of hospitalizations. Five states in the northern tier—Iowa, Nebraska, North Dakota, South Dakota, and Wisconsin—all saw hospitalizations peak before Thanksgiving, and they’ve gone steadily down since. The Midwest, Rocky Mountains, and the Ozarks are also down or flatlined, Texas has plateaued, and the Pacific Northwest is headed in that direction.

Right now we have a big problem in the Northeast (except Vermont), the Mid-Atlantic, the South, and the Southwest (California and Arizona specifically). But if the virus does tend to burn itself out, particularly after protective measures and personal distancing gets put in place, that could provide a mid-winter bubble concurrent with ramping up vaccinations.

So this is all good news except for…

The bipartisan COVID relief bill that’s been prepared for weeks will finally drop today, and it’s in two parts. One $748 billion piece includes unemployment, hospital, schools, broadband and other provisions, including a relatively meager $16 billion for vaccine distribution. The other $160 billion includes state and local government aid and a liability shield.

The second half was designed to be jettisoned. Mitch McConnell proposed this last week, to hold out the contentious parts and pass what’s able to be passed relatively non-controversially. That doesn’t mean anything will actually pass—it would only be the 29th bill passed by Congress all year—but it does mean that state and local aid is likely dead, at least for this Congress. And state and local governments are incurring significant costs to distribute the vaccine. Once the federal government allocates to the states, the rest is up to them: shipping to the direct vaccination point, storing the vaccine on site, hiring people to administer the doses, community outreach to maximize takeup, even the creation of pop-up clinics.

That’s not going to be covered by the $16 billion, which as I understand it is mainly for moving the vaccine into position and providing the needles and syringes and PPE to administer it. In other words, at a time when state and local budgets are suffering, this large and unanticipated cost (at least in budget terms) will be placed on them entirely. Only a couple hundred million dollars has been distributed across the entire country to cover vaccine costs. Previous CARES Act funding to states for COVID-related costs expires on December 30, meaning all that leftover money will be lost.

States have said they need $8.4 billion, with potential bidding between localities for workers and supplies driving that up higher. And of course, that’s under the current course of vaccination, which is unacceptably low. The government should be massively increasing production and distribution to finish the course of treatment well ahead of schedule. But without state funding, that’s impossible.

If you want to know what a failed state looks like, this is it. The entire world, governments and scientists and pharmaceutical companies, moved mountains to create a vaccine in record time. The federal government can’t pony up to get it into people’s arms. The result will be that states will cut other parts of their budgets to save lives: education and other forms of health care and public jobs will suffer. And we’ll stunt economic recovery for years, for no reason.

The Biogen conference in early 2020 spread the virus to as many as 300,000 people. (New York Times)
Germany going deep into lockdown to stop spread. (Financial Times)
A tick-tock on how Pfizer pulled off the vaccine in record time. (Wall Street Journal)
The two key CARES Act unemployment programs are already going to lapse; it’s just a question of whether it’ll be temporary or permanent. (Politico)
There will be plenty of need for other COVID vaccines to serve the entire world, I don’t buy that there’s room for only a few. (Bloomberg)
Deaths jumped in college towns. The fact that young “invincibles” got the virus doesn’t matter; they spread it to others who can’t handle it. (New York Times)
“Gargling Could Slow COVID-19 Spread, Mouthwash Makers Say”: sounds like an Onion headline but it’s real. (Wall Street Journal)