Preview

Back when this newsletter was called Unsanitized, I spent the first edition of 2021 lamenting the vaccine rollout, which at the time was plagued by a lack of presidential leadership, delayed funds to states, an over-reliance on hospitals busy fighting a pandemic, confusion over prioritization, and even reduced staff during the Christmas holiday. As of January 3, three weeks into the rollout, only 4.33 million doses had been distributed.

But in the past month, I have been far less concerned with the rollout, which has been among the best in the world. In the 49 days since January 3, the U.S. has delivered 58.8 million shots, with the seven-day average really moving in a straight line upward until Valentine’s Day, when that average topped out at 1.7 million shots per day. Early on, about 30 percent of vaccines shipped had been delivered; now the number is 84 percent. Only five countries on Earth have delivered a first dose to a higher percentage of the population than the U.S. (Israel, the Seychelles, the UAE, Bahrain, and the UK), and only one of them has a significant population.

Only the icy weather in much of the country stopped the momentum, due to a combination of people socked in their houses and unwilling to go get the vaccine, and a delay in shipping roughly 6 million doses. Those shipments should be made up this week, and we will get a test as to how much capacity has been built when states are more flush with vaccine supply, since they’ll have leftovers from last week and the current week’s shipment.

Even with the logistical hazards, the U.S. got 1.3 million shots out per day over the past week, about at the level of early February, and well above the original 1 million shots per day target of the Biden administration. The delays are unfortunate, and given the increasing variants could leave the country vulnerable to higher transmission and more mutations. But if it’s just a one-week blip caused by a nightmare in Texas and difficulties with shipping, and we get back on track this week, that danger could be muted.

Moreover, the bumper crop of supply this week (because of the make-up shipments from last week) could be a preview of the near future. Right now the U.S. is shipping about 10-15 million doses per week. That should increase to 20 million per week in March, 25 million in April, and 30 million by June. If distribution ramps up similarly, you could see 4.5 million shots delivered daily by summer. The one-dose Johnson & Johnson vaccine will get a vote this Friday from the FDA’s advisory committee, and although that could be a complex analysis given the variants, I’d expect approval and immediate shipping by the weekend. While initial shipments will be small, they add to the Moderna and Pfizer rollouts, and of course as a one-shot vaccine, each one is worth two of the others.

There’s some evidence for the idea that the Pfizer vaccine generates a strong response with just one dose, perhaps as good as J&J. The evidence is overwhelming that people who have contracted the virus only need one dose. I’d expect Pfizer to ask for changes on both, which would again stretch supply to a greater population. (Pfizer is already seeking permission to store the vaccine in normal refrigerators, after testing showed it can survive under those conditions for up to two weeks. This would allow the Pfizer vaccine to be shipped to areas without the capacity for ultra-cold storage.)

If you add this up, the U.S. is very well positioned to get the virus under control by early summer. The public even expects this now. The winter of our discontent could be made glorious summer. But there are a couple barriers still to cross.

First, we’re approaching a time where the binding constraint will be public willingness to take the vaccine. Without any public education campaign, a little more than half of the population will take it. But that’s just it, there’s been no public education campaign, explaining that the vaccines are safe and incredibly effective. They all stop hospitalization and they all stop death.

It’s incredible that the Biden administration is leaving this to a media given to hype negative stories to explain this to the public. A handful of public service announcements have rolled out, including an effective one from Boston Celtics legend Bill Russell. But private trade groups or particular executive branch agencies (like the military) have led the way. There’s been no real broadcast message from the White House, on a daily basis, hammering home that these vaccines are vital and should be taken. There’s no need for a public education vacuum.

The second barrier is getting a global rollout on par with the U.S. This is in our public health interest, because more virus circulating increases the potential for more mutations, including some that cannot be defeated through vaccination. To get the world inoculated, we have to produce more vaccine and we had to have done it months ago. The Biden administration pledged $4 billion to COVAX, the global campaign to vaccinate the world, but that’s not likely to go far.

There’s a very troubling genre of article that attempts to lecture Americans on why we just can’t ramp up production very much. This type of article has been written for the last three months in a row, which in itself proves the problem with it. Nobody doubts that it takes months to retool factories, secure ingredients, and hire staff. But we’re months from the point when this could have begun. And we’re going to need billions more vaccines for the world. We know it doesn’t take, you know, forever to build capacity; Pfizer started effectively from scratch and had factories ready to produce its vaccine within 6-8 months. The best day to replicate that process is four months ago, and the next-best day, absent a time machine, is today.

This requires two things: money from the industrialized nations of the world to ramp up production, and open-source intellectual property, so every country can produce vaccines. We have not come close to the limits of production, and we have not broken the patents of the vaccine makers fully during this global emergency. Half a million Americans have died, and millions more elsewhere. Each day without maximum vaccines in circulation puts millions more at grave risk. There needs to be a lot more urgency.

Susan Collins and Mitt Romney both announced opposition to Neera Tanden to run OMB, and with Joe Manchin opposed, it’s hard to see her getting confirmed. (Axios)
Chuck Schumer says he’s working to find votes for Tanden. It may be a long search. (Talking Points Memo)
In case you missed it from us, this likely means that Gene Sperling will get the nod to replace Tanden. See also Politico. (American Prospect)
Teacher vaccinations are “not a prerequisite” to opening schools. (Washington Post)
Merrick Garland’s confirmation hearing is today; he is pledging prosecutions for the Capitol Riot. (Bloomberg)
The U.S. is negotiating prisoner release with Iran. (CNBC)
Biden has vowed to not build more border wall but activists want it dismantled. (HuffPost)
Goodbye to Trump’s high-flow shower head rule. (NBC News)