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January 25, 2021

Vaccine Rollout Moves Toward a Supply Snag

Plus, relief talks point to a checks and shots strategy

 

A long line of cars awaits vaccine distribution in Odessa, Texas. (Eli
Hartman/Odessa American via AP)

The Chief

You know you're having a good rollout to your presidency when the
biggest complaint is that you're not being ambitious enough. In the
case of Joe Biden, however, ambition is desperately needed, and heaven
and Earth moved to reach that lofty goal.

A couple months ago, the Biden transition set a target of 100 million
vaccinations in his first 100 days. It sounds like a big number and
subsequently a major achievement. But I know my times tables enough to
know that it comes down to 1 million shots a day. Well, in the first
week of the Biden presidency, we're tracking at about 1.2 million
shots

per day. That's even with the alleged non-existent federal
distribution plan
.
If Biden's "wartime
"
strategy for COVID moves well beyond the Trump ineptitude, why is the
target still behind the initial Trump pace?

In one sense, this is the classic political tactic of under-promising
and over-delivering. Indeed, Biden officials are now re-casting it

as more of a floor than a ceiling. ("That is our first goal, it's not
our final goal," White House chief of staff Ron Klain told Meet The
Press.) If they're seen as building on progress, they can control the
narrative of a successful rollout.

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But 100 million shots translates to about 67 million people. (some will
get two shots in that period, some just one). And 67 million people
every 100 days means herd immunity sometime around the end of the year
(depending on the level of natural immunity in the country, and of
course you would see results in terms of lower hospitalizations much
sooner). We can and need to do better than that; in fact lives are
depending on a faster rollout, especially with more transmissible
variants in the air.

The problem with reaching even Biden's more modest goal, of course, is
not setting up an efficient and equitable distribution system; it's
supply. The U.S. was only distributing 36 percent of the shots allocated
as of two weeks ago. Now we're at 54 percent. Distribution is far
outstripping supply, and we're approaching having not enough shots to
give within a month or so.  

Unbelievably, Biden's new head of the CDC told Fox News Sunday that
she doesn't know

how much vaccine is in the country, throwing the numbers we have into
question. And the supply challenge doesn't have an easy fix. We
thought that squeezing an extra dose out of every Pfizer vial

would instantly add 20 percent to supply. But it's going to take time
to make enough low dead-space syringes to be able to squeeze out that
extra dose, and Pfizer is counting every extra dose squeezed out toward
their contractual goal of 200 million shots
, meaning
that every dose added on the front end will come out on the back end.
States have been rumbling about trying to secure their own supply, which
would have been another headache, but the Biden administration shut that
down
.

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This gets at a growing sense that the dug manufacturers will not be able
to fulfill their promises on shots. Pfizer is hoping for the squeeze
play to save them. According to this Moderna production tracker
, the company
isn't producing enough vaccine in the U.S. to hit their 100 million
order. And AstraZeneca, whose vaccine was approved for use in Europe, is
already admitting a shortfall
,
by as much as 60 percent. Even if the U.S. approved it, presumably not
as much would be available as anticipated. (That the whole AstraZeneca
gambit, grabbing exclusive rights

to a vaccine developed at Oxford that was supposed to be free to donate
to any manufacturer, is now ending with a massive shortfall is
infuriating and tragic.)

There's very little that can be done at this point to massively raise
supply. Months and months ago, you could have retrofit pharmaceutical
plants, as Pfizer did. Now that wouldn't yield anything for a while.
The Defense Production Act is being leveraged to create more of the raw
materials used in production, hopefully reducing some supply
bottlenecks. (However, Trump had already done this
,
so it probably won't yield much.) A lot relies on Johnson &
Johnson's one-shot vaccine being approved for emergency use within the
next month. That would get you some supply all at once, though not as
much as expected. Of course, needing only one shot means that every J&J
dose is worth two from Pfizer or Moderna.

Maybe the Moderna numbers are wrong. Maybe J&J gets approved. Maybe you
can marry expanded supply to better distribution and double the 100
million challenge. Maybe, maybe not.

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How Do You Spell Relief?

Judging from yesterday's phone call with the White House, you don't
spell it "Gang of 16." Centrist Senators from both parties questioned
the American Rescue Plan

as being "too generous" to higher-income Americans. The Gang of 16
appeared more interested in funding for vaccine distribution, but
that's only a portion of the $1.9 trillion bill.

This sets up well for the "checks and shots
"
strategy. Vaccination money can clearly get a supermajority in the
Senate. The direct payments are incredibly popular in the country,
polling at around 80 percent. It's a different coalition of
Republicans who support checks, but I can't see Democrats who really
want that vaccine money denying cash payments for the American people.
It seems to me that checks and shots gets you to 60 votes. You might
need to target the checks a little more (Read: give them out to fewer
people) but you could also just dare anyone to vote against

an 80/20 proposition.

Then, you get the rest of the bill through budget reconciliation, which
Senate Budget Committee chair Bernie Sanders has already vowed to do
.
There's a short window between now and the week of February 8, when
the Senate impeachment trial begins
.
Democrats should take it, and put checks and shots on the floor.

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Well Will You Look At Me

It was a real pleasure being part of Left, Right, and Center on KCRW
last Friday, part of a residency that I believe will last a few weeks.
Listen to last week's episode here
.

I was on the Bradcast with Brad Friedman on Friday talking about
Biden's first week. Listen here .

Alexander Heffner had me on the Open Mind podcast. Listen here
.

I was also on The Young Turks last Friday but it's unclear to me how
that gets archived.

What Day of Biden's Presidency Is It?

Day 6. Among the highlights today is a Buy American plan

for federal procurement that strengthens what Trump put in place.

We Can't Do This Without You

Today I Learned

* Lina Khan to the Federal Trade Commission

looks real and would be a signature achievement. (Recode)

* It's lower profile but Sam Bagenstos

as a chief counsel at the Office of Management and Budget is pretty darn
good too. (Detroit News)

* Yes, we absolutely should make the child tax credit

a monthly payment. (Washington Post)

* Shifts in public lifestyle patterns will frustrate policy aims for the
next four years. Exhibit A: urban transit
.
(Politico)

* We've built a debt overhang

for many borrowers that looms once foreclosure and eviction moratoria
end. (Wall Street Journal)

* No vaccine for poorer countries will hurt richer ones
due to
less trade. It's urgent to open-source the vaccine. (Financial Times)

* It took Obama eight years to dump the top accrediting agency for
for-profit colleges. After Trump brought it back, it took Biden three
days
.
(New York Times)

* Every Cabinet job is a climate change job
.
(Washington Post)

* I can't think of anything more misguided and politically motivated
than Gavin Newsom lifting the stay at home order

in California just as it's beginning to work. (NBC Los Angeles)

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