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U.S. vaccine rollout remains sluggish, as new coronavirus strain spreads

The U.S. is stumbling out of the gate in getting the COVID-19 vaccine distributed in 2021, as a more contagious variant of the virus spreads around the country. Dr. Robert M. Wachter, the head of the department of medicine at the University of California at San Francisco, joins William Brangham to discuss the vaccine rollout, and why he thinks the U.S. should delay a second round of COVID doses.

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  • Judy Woodruff:

    The new year has begun, unfortunately, with a halting start in addressing the pandemic.

    The U.S. is stumbling out of the gate, in particular in the distribution of vaccines. A number of other countries are struggling too. In fact, several European nations said today that they are considering delaying a second planned shot of the vaccine in order to reach more people with a first dose, all of this as a seemingly more contagious variant of the virus is spreading in the U.S.

    William Brangham has our look.

  • William Brangham:

    The lines stretched for miles this morning, people waiting in Daytona Beach, Florida, for their COVID-19 vaccinations.

  • Woman:

    It's been a long journey for everybody. And so we're lucky. We're lucky that we're getting it today.

  • William Brangham:

    Countless Americans are waiting for their first shot, as hospitals at the front line of administering them face increasing pressure to move quicker.

  • Gov. Ron Desantis:

    Hospitals that do not do a good job at getting the vaccine out will have their allocations transferred to hospitals that are doing a good job in getting the vaccine out.

  • William Brangham:

    The FDA approved Pfizer and Moderna vaccines for mass inoculations in mid-December, but only 15 million doses have been shipped nationwide. That's far below the Trump administration's year-end goal of vaccinating 20 million.

    But vaccine supply is not the only problem. States, which are charged with administering their own plans, are facing challenges actually getting them into people's arms. The picture looks different across the nation. States like West Virginia are moving quickly, with more than 2,000 per 100,000 already vaccinated.

    In Arizona, and parts of the South, a stark difference. Less than 1,000 people for every 100,000 have gotten their shots. This slow and irregular pace means the gap between delivery of vaccines and actual injections continues to grow.

    In Ohio, Republican Governor Mike DeWine asked hospitals to speed up the job and limit their turnaround to 24 hours.

  • Gov. Mike Dewine:

    Make sure that that vaccine is gone, it's used, in people's arms within that period of time.

  • William Brangham:

    And today in New York, Democratic Governor Andrew Cuomo announced fines for hospitals that fail to administer shots within a week of receiving them.

  • Gov. Andrew Cuomo:

    I don't want the vaccine in a fridge or a freezer. I want it in somebody's arm.

  • William Brangham:

    Skepticism about the vaccine is another problem. DeWine said 60 percent of nursing home staff in the state declined to get the vaccine. In all, only 4.5 million Americans have received the first of the two doses.

    These backlogs have led some leading public health voices to suggest delaying that second shot and using them instead to give a first dose to more Americans. But, over the weekend, the top U.S. infectious disease expert, Dr. Anthony Fauci, warned against that.

  • Dr. Anthony Fauci:

    We don't know whether or not that's going to be good enough. We know what the science tells us. Let's do it the way the clinical trials have instructed us to do it.

  • William Brangham:

    The chief medical adviser for Operation Warp Speed, Dr. Moncef Slaoui, suggested giving two half-doses to stretch out the existing supply.

  • Dr. Moncef Slaoui:

    Injecting half the volume, I think that's a more responsible approach that would be based on facts and data.

  • William Brangham:

    Dr. Fauci also voiced optimism that the pace of vaccination would soon pick up.

  • Anthony Fauci:

    In the last 72 hours, they have gotten 1.5 million doses into people's arms, which is an average of about 500,000 a day, which is much better than the beginning, when it was much, much less than that.

  • William Brangham:

    This hope comes amid fears of surging infection rates driven by holiday travel and gatherings.

    For more on why this vaccine rollout is stumbling and what we might do to address it, I'm joined by Dr. Bob Wachter. He's the head of the Department of Medicine at U.C. San Francisco's Medical School. And he and Dr. Ashish Jha wrote this op-ed suggesting we delay the planned second dose and use all available vaccine immediately.

    Dr. Wachter, great to have you on the "NewsHour."

    Before we get to your idea, let's back up just for a moment. And can you help us understand why, from your perspective, this vaccine rollout is stumbling so badly?

  • Dr. Robert Wachter:

    Well, it is a little surprising and it's not. The part that is not is the rollout of PPE and our rollout of testing also stumbled, so I guess we could have predicted it.

    But I think most of us thought that the bottleneck was going to be over supply, that there was just not going to be enough doses of vaccine that were going to be out there. And it has been surprising how hard it's been to get vaccine into people's shoulders.

    It is complicated. We're a big, diverse country. But I think there has been relatively poor planning. It has been under-resourced. The Senate — or the Congress just passed a bill that is going to provide $8 billion or $9 billion, but that was just last week. That should have been done a couple of months ago.

    And the departments, the departments of health, the hospitals that are responsible for rolling out the vaccine are inundated with COVID cases. So, everybody is really, really busy. There is just not a lot of bandwidth in the system. And I think we underestimated the complexity.

  • William Brangham:

    So, you and Ashish Jha, to address this bottleneck, as you're describing it, proposed this idea that I mentioned before about delaying the second shots and using all of those shots that would have been held in reserve and just giving them to everyone as quickly as possible.

    Why do you think that's the right move?

  • Dr. Robert Wachter:

    Well, I should first say that I didn't think it was the right move as recently as about two weeks ago.

    And the things that changed in my own mind were the extent of the surge that we're seeing now, which is really quite devastating. Probably 50,000 to 100,000 Americans will die this month of COVID. The second thing was, as we have already discussed, the slowness of the rollout.

    If this had been moving swiftly, if we had 20 million people vaccinated by the end of December, which was what we were told would happen, it might be different. But we have four million people vaccinated.

    And the third is this new variant that you have heard about, which is real, is clearly in the United States. The more we look for it, the more we're going to find it. And it is more infectious than the old COVID that we had last year. So, there's a little bit of a race to get more vaccine into people's shoulders more quickly.

    What we know from the trials that led to the approval of both the Pfizer and the Moderna drugs, that the trials were done using two shots three weeks or four weeks apart. But they also looked at what happened to people after they got their first shot.

    And it turned out, by the time they got their second shot, that first shot was working awfully well. It was working — probably, it was 90 percent effective, 85 to 90 percent effective. So, we don't argue that people shouldn't get the second shot. They should. The question is, if you have a vaccine in a syringe ready to go, let's say, a few weeks from now, do you give it to someone for their second dose to bump them from, let's say, 90 to 95 percent effective, or do you give it to someone for whom it will be their first dose and get them from zero to 80 or 90 percent effective?

    When we did that math, we thought you would save far more lives if you did it with broader distribution of the first shots, deferring the second shots for a couple of months, until the supply was more plentiful.

  • William Brangham:

    Let's say we did defer for a couple of months. Do you feel confident that protection from the first shot would last?

  • Dr. Robert Wachter:

    There have been tens of millions of people that have gotten COVID in the world, and the number of documented reinfections now, after almost a year, you can count on a couple of hands, the fingers of a couple of hands.

    They happen, but they are very rare. And that implies that protection — once you have immunity, protection last for at least several months. The level of antibodies that were created by the first shots in the trials were actually fairly high.

    And so there is a little bit of uncertainty. And there's a possibility that some of the effectiveness would wane a bit. But I think there are very few people that think that it would wane so much that a large — that people would be massively vulnerable if they waited a couple of months.

  • William Brangham:

    What about the possible concern that, if you suddenly change the dosing or the scheduling, that you're just going to ramp up the skepticism that is already there about this vaccine? Do you worry about that?

  • Dr. Robert Wachter:

    I think that's a risk.

    And I wish there was a riskless solution. People have said, after they read our piece, you're veering from what we knew was the right thing to do. How could you say that?

    And the problem is, if we stuck with the plan as it is right now, that carries a huge risk. The risk is, we're not going to be vaccinating people for many, many months.

    When I drive down the highway, I like to stay in the lane. It's the right thing to do. But if I see a truck barreling toward me from another lane, I veer out of the way. And so there's no plan here that carries zero risk. It was our judgment at this point that the risk of delay of getting more people, particularly high-risk people vaccinated, outweighs — outweighs the risk of our plan.

    But one of the risks I think that has to be factored in, William, is the possibility that people will see this as yet another curveball. You told me that masks didn't work, and now you tell me they do. You told me I had to clean the mail, and now you tell me I don't.

    That's very real. There are social scientists that I think should be looking very hard at that.

    My own feeling is, the vaccine is so remarkably effective, the safety record is really very, very impressive, that, at the end of the day, some people may want to wait a little bit to see how things go. But the amount of COVID, the number of people that are dying from COVID, I think, at the end of the day, most people are going to want to get their shots.

    But we will have to see.

  • William Brangham:

    All right, Dr. Bob Wachter, U.C. San Francisco School of Medicine, thank you very much.

  • Dr. Robert Wachter:

    Thank you.

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