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U.S. vaccination campaign struggles to keep pace with infections

The death toll from COVID-19 has passed 365,000 in the U.S. with 130,000 people hospitalized with it now. But the best hope for moving past the pandemic -- mass vaccinations -- is going slower than had been expected. Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, joins Stephanie Sy to discuss.

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  • Judy Woodruff:

    With the events of the past few days, the impact of COVID around the country has been pushed off the very top of the news, but the virus is not letting up.

    The death toll has now passed 365,000 in the U.S. Nearly 130,000 people are hospitalized with it now. And the best hope for moving past the pandemic, mass vaccinations, is going slower than had been expected.

    Stephanie Sy looks at what can be done now.

  • Stephanie Sy:

    Good evening. Judy.

    Another grim milestone was passed in the U.S. today. Daily deaths from COVID-19 topped 4,000 for the first time, the highest rate of COVID positive diagnoses right here in Arizona. The shaky rollout of the vaccine has yet to put a dent in the surge.

    And, today, we learned that the incoming Biden administration is planning a new strategy to release all available vaccine. That would free up doses for more people, but critics of the move say it could risk delaying the second dose, which the FDA has advised against.

    So far, 21 million vaccine doses have been distributed. Nearly six million have now gotten that first dose. And that includes about 600,000 in long-term care facilities.

    Dr. Paul Offit is the director of the Vaccine Education Center and an attending physician at Children's Hospital in Philadelphia. He is also a member of the FDA's Vaccine Advisory Committee.

    Dr. Offit, thank you so much for being with us this evening.

    Is it a good idea to release and administer every dose possible right now?

  • Dr. Paul Offit:

    I think what the Biden plan is doing is, they're making a big bet, and I think an unnecessary bet.

    What they're saying is that we know the two doses of vaccine, whether it is the Pfizer or Moderna vaccine, induces about 95 percent protection against disease. We know that. One dose is given three weeks after the first. The other one is given four weeks after the first, depending on the company.

    What they're saying is, I'm going to put all the first doses out there. Now, they're assuming that they're going to be able to mass-produce, mass-distribute, and mass-administer that second dose in a timely manner, where then you're still getting that second dose three or four weeks later, or maybe five weeks later, or six weeks later.

    What worries me is that it might not be then. It might be two months later, or three months later, or, worse, that some people wouldn't get a vaccine at all.

    And we know that that second dose is critical to inducing an excellent immune response and likely a longer-lasting immune response. So, I think it's — given how much trouble we have had making this vaccine so far, I think putting it all out there initially, and hoping you can get that second dose in time, I think disrupts the program and may do far more harm than good.

  • Stephanie Sy:

    Well, a Biden administration official told me today, Dr. Offit, that they are depending on manufacturing continuing to ramp up.

    And just this week, in fact, Moderna told The Wall Street Journal that they are ramping up to 600 million doses this year. That's 100 million more than they had planned for. So, if that were the case, and they were able to manufacture at this pace, could they keep this second dose schedule, and would you change your opinion?

  • Dr. Paul Offit:

    Well, it assumes that there's no glitches in manufacturing, which historic — history tells us is not necessarily a good idea.

    This is — it's not only a novel vaccine approach, in the sense we have no other commercial vaccines, like with an mRNA approach before. It's not easy to scale up. I mean, that sort of lipid nanoparticle in which the messenger RNA sits hasn't been scaled up before.

    And it certainly can be associated with problems. I hope they're right. I hope that there's no glitches. I hope we mass-produce and mass-distribute and miss-administer in a way that people don't lose any time in getting that second dose. But you can see how that could be concerning, given how much problem we have had so far.

  • Stephanie Sy:

    Sure.

    And we have had other experts on our program, even this week, saying, given the surge we're seeing, given this new variant that's more contagious we're seeing, it is time to consider freeing up more of these doses.

    In fact, someone I know you have worked with, Dr. Robert Wachter, said to us earlier this week that the data he had seen showed that the first dose could be 80 to 90 percent effective.

    This is all very confusing, I think, to the public. Can you clear it up for us?

  • Dr. Paul Offit:

    Sure.

    So, these were two-dose — this is a two-dose vaccine. So, if you look, there's a period of time between the first and the second dose — for Pfizer, it's three weeks, and, for Moderna, it's four weeks — when you can see whether or not there's any efficacy. And you could see that, with the Pfizer vaccine, there was about 50 percent efficacy. You could see that, with a Moderna vaccine, it was about 80 percent efficacy.

    But that was just for a few weeks. That's when you have just gotten the vaccine and you have an immune response. You don't know whether that's also true for two months later, three months later. It's probably not true.

    If you look into phase one studies, where you get one vaccine, and then you get the second dose, there's a dramatic boost with that second dose. So, it's — the first dose does not, frankly, compare all that favorably to the kind of immune response you see with just in convalescent serum for people who've gotten just — survived the infection.

    That's why the companies went to a second dose. Otherwise, we could have gone with a one-dose vaccine. So, I think you're taking unnecessary risk here that you're going to have a delay in getting that second dose.

  • Stephanie Sy:

    Millions of doses have been distributed. And yet they're sitting on pharmacy shelves, in hospital storage. What can realistically be done to make this vaccine rollout more efficient, get it into more people's shoulders?

  • Dr. Paul Offit:

    No, and that's the problem.

    That's it. I mean, we're talking about sort of giving a first dose. We have enough trouble giving a first dose as it is now, period.

    I think we're being — we're asking the public health system to do something that it's really not currently equipped to do, which is to mass-distributed and mass-administer this. We have to find a way to give this vaccine in stadiums and auditoriums and churches and synagogues and line people up to do this, and get volunteers to do this, and put the money into it and the personnel into it that allows us to do that.

    That's the problem. That's what I wish we would focus on now, rather than putting — putting people, I think, at some risk for the fact that they may not — may get either a delayed second dose or not get a second dose.

    And imagine that, if you give just a first dose, which does not induce all that dramatic of an immune response, and you have people two or three months later who think that they're protected, and aren't, and behave in a manner where they think they're protected, and aren't.

  • Stephanie Sy:

    Well, we are still awaiting more details of the incoming administration's plans. And I think the devil will be in those details.

    Dr. Paul Offit joining us from Philadelphia, thank you so much. Thank you.

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