Why Can’t We Vaccinate Faster?
One year ago this week, I went into hiding from the coronavirus.
On March 12, I taped one episode of The Daily inside a studio at The New York Times. With the help of a slightly nervous producer who lived a short bicycle ride away, I did the the next on March 13 from my Brooklyn living room, describing my own Lockdown, Day 1.
(That was the week the World Health Organization declared Covid-19 a pandemic, flights from Europe were cut off, and Americans were urged to stay home. Life suddenly got simpler — and a lot scarier.)
Now, exactly one year later, I’m slouching toward immunity.
I got my second shot on February 27, so my boosted antibodies and primed T-cells are now kicking in. Saturday, March 13 is my second-shot-plus-two-weeks point.
The Centers for Disease Control and Prevention has just ruled that people like me can tiptoe partially out of hiding. If we tread carefully, we can see our grandchildren or hold small dinner parties indoors with other double vaccinees.
That’s wonderful news for us.
But the news for the country as a whole is anything but wonderful. Though we have dropped from January’s peak, we seem stuck at nearly 60,000 new cases a day. That is twice as bad as the terrible spring surge that drove us all indoors.
We are vaccinating a little more than 2 million people a day. In a population of 330 million, most of whom may eventually need two shots, that’s not fast enough.
I’m vaccinated only because I got ridiculously lucky.
During my last Daily appearance, on January 27, I lamented that, like many of my Brooklyn neighbors over age 65, I could not find an open vaccine slot.
A colleague who heard that emailed me the next day to say that a few had just opened up at the Brooklyn Army Terminal and if I moved fast, I might snag one.
I did, and got my first Moderna dose at 2:14 AM on January 29, meandering from one trailer to another in the terminal’s parking lot in the freezing cold.
Having listened to and read a lot of other people’s stories, I think I can honestly say that this is the biggest mess of a vaccine rollout I’ve ever covered. It is a Keystone Cops mélange of confusion, delays, legal nitpicking and missed opportunities. We could do better.
Some examples:
As the last patient of the night at the Army Terminal, I wandered along the parking lot’s chain link fence looking for a doorway, feeling like a character from Hogan’s Heroes trying to break into Stalag 13.
Andrea, the nurse who ultimately gave me my shot, very kindly let me stay inside her warm trailer for the 20-minute observation period instead of shivering in the outdoor tent. I wasn’t holding her up: she had four hours to kill until the next patient was scheduled at 6 A.M. She’d brought her Bible to read.
(A month later, on the day of my second shot, it was raining. The forms we filled in were damp, people huddled under umbrellas outside the shot trailers, and the observation tent wasn’t just chilly — it also leaked.)
My girlfriend volunteers in a New York hospital as one of the greeters at their vaccine clinic.
After inoculating its staff, her hospital began calling in its cancer patients, eldest first. The result was heart-breaking, she said.
Multiple times a day, fragile 80-year-old patients would arrive with their equally frail 80-year-old spouses, begging for shots for both. The hospital had plenty of vaccine on hand, but it had to refuse because of state rules enforced by steep fines. The elderly spouses were on their own.
I have friends over 65 who have driven four hours to Utica and five hours to Plattsburgh to get shots. Another signed up through the Duane Reade chain. He got his shot at a pharmacy just a block from his home — but he had to wait weeks longer.
Paul, a 53-year-old friend, signed onto a pop-up website that he had been told tracked “leftovers” at vaccination sites where missed appointments meant doses would be thrown away.
After a false start or two, he ended up at the El Caribe Country Club in Brooklyn’s Mill Basin section — which incidentally plays a pivotal role in the life of Trump’s former consigliere, Michael Cohen, as described in his weirdly engrossing memoir, “Disloyal.”
After being screened at three different tables, Paul was told that leftovers were only for those over 65 or with certain co-morbidities.
Miffed, he started to leave but was told that, if he waited, there might be more leftovers than eligible patients.
“Which I did, and lo and behold, I got vaccinated at the very end of the day as they were packing everything up,” he said.
Paul’s 17-year-old son got vaccinated at the Medgar Evers College site run by Air Force personnel. He brought his paystubs to prove he was a restaurant worker; no one asked to see them.
Hearing that, a friend of Paul’s went straight over with her daughter. Neither had front-line jobs; both got vaccinated anyway.
A cousin of mine in his 20’s has friends who are doctor-shopping, hoping for letters saying they need shots because of various medical problems, like asthma. They apparently do not recognize that they don’t need the letters. You can “self-certify” that you have a condition.
Another friend has a son at Cornell who is due to get a shot this week because he lives in a “congregate setting.” The law treats his frat house as the equivalent of a nursing home.
This is ridiculous.
And the ridiculousness of it puts us in danger. The new variants are spreading fast. It behooves us to outrun them, so that cases don’t go up again and hospitals don’t get crowded again. When hospitals are overwhelmed, survival rates plummet.
We need big, organized, dry, warm, well-ventilated vaccine centers running 24 hours a day.
They need separate lines for people in wheelchairs, separate lines for essential workers like teachers so we can get schools open again, and a backup plan for missed appointments so that not a single shot goes into the garbage.
Everybody I spoke to who has managed to get an appointment at Manhattan’s Javits Center has come away happy about the short waits and military efficiency. Perhaps that is the model to follow.
And we need to not let unnecessary rules push us around.
For example: you are discouraged from getting a Covid shot if you have had any other vaccine recently. Why is that? Vaccines don’t “cancel out” each other.
At the age of two months, in just one visit, a typical American baby gets eight vaccines: hepatitis B, rotavirus, diphtheria, tetanus, whooping cough, HiB, pneumococcus and polio.
As an adult, I’ve had as many as five shots at once in a travel doctor’s office for exotic things like rabies and Japanese encephalitis. Military members get far more.
It’s All About Speed
In poor countries, nearly every battle fought with vaccines — whether against yellow fever, cholera, polio or Ebola — focuses on one goal: speed.
To increase speed, doctors are willing to sacrifice almost everything else: careful record-keeping, the doctor-patient relationship, even vaccine efficacy.
During big polio-eradication drives, which routinely vaccinate more than 1 million children a day, teams walk through train stations and border posts asking only two questions: “Is your child under age 10?” And “May I give him/her vaccine?” The only record-keeping may be that the child’s pinkie nail is inked with a marker that takes a week to wear off.
When people are threatened both by cholera and by fighting and are in full flight, Doctors Without Borders sometimes gives everyone one oral vaccine dose on the spot and then entrusts heads of families with a second set of vials and instructions to take them two weeks later.
In 2018, almost 25 million Brazilians faced a fast-moving yellow fever outbreak when there were fewer than six million shots left in the global vaccine supply. As the virus approached the favelas of Rio de Janeiro and São Paulo, the government switched to one-fifth doses and sent mobile teams into the alleys to buttonhole people, fill in minimal paperwork and inject them where they stood. It worked: By 2019, the threat was gone.
Doctors Without Borders recently completed a study showing that one-fifth doses of yellow fever vaccines save more lives during epidemics than delivering full ones. The protection doesn’t persist as long — but it lasts long enough to stop the spread, which buys time for everyone to get booster doses later.
In my experience, American public health experts place too little trust in their patients. They assume many will fail to get their second doses or will prematurely stop taking precautions.
In normal times, that might be understandable. But during epidemics, most people are highly motivated to save their lives and those of their children and parents. They readily follow instructions like “come back in four weeks.”
The easier you can make it for them — centralizing appointment scheduling, giving out Metro cards or taxi vouchers, letting churches or other social organizations book bloc appointments for members — the better the chances of success.
Striving for perfection saps that.
And while vaccine hesitancy is a big problem at the moment, the best cure for it is first-hand knowledge. Anyone who knows two families, and sees the unvaccinated one suffer three deaths while the vaccinated one suffers none becomes a vaccine-seeker. This is true even in the mountains of Pakistan where the Taliban holds sway: mothers who have seen children with withered legs seek out polio vaccine — sometimes ignoring their husbands’ orders and even death threats. That’s why the polio-eradication campaign tries to hire only mothers as vaccinators; their first pitch is “Yes, I vaccinated my kids and they’re safe.”
Other countries are figuring out that speed is everything.
On December 30, facing a rampaging new variant with too little vaccine, Britain asked its citizens to wait three months between doses instead of one.
Since then, they have “fully vaccinated” only two percent of their population, while we have done 9 percent of ours.
But they are almost twice as good as we are at delivering one dose: 33 percent versus 18 percent.
Their tactic seems to be working: since Jan. 11, cases in Britain have dropped 90 percent and are still going down. Ours dropped 75 percent and plateaued — and the variants are still not yet dominant here.
Evidence is rapidly mounting that one dose of any one of the authorized vaccines provides very strong protection against hospitalization and death.
That is the metric that matters. If no one in Wuhan had died or been hospitalized, we might still not have noticed this new bat virus circulating in people.
Once you become very unlikely to die or suffer major organ damage, Covid-19 becomes a threatening but almost always survivable disease, like influenza. Catching it acts as your second shot.
Johnson & Johnson’s one-dose vaccine appears 100 percent effective at preventing hospitalization or death.
One dose of Pfizer vaccine, according to Israeli researchers, is 85 percent effective at preventing any symptoms after 15 days have passed; it is probably far more effective against death. Canadian researchers found similar results.
One dose of either the Pfizer or the AstraZeneca vaccine reduces hospitalization risk by about 80 percent, even among the frail aged, according to British researchers.
It would seem obvious that giving 200 million Americans better than 80 percent protection against death would save more lives than giving 100 million Americans complete protection and leaving 100 million with none.
And, since one dose appears to also lower transmission risk, even more lives will be saved.
If we move fast enough, manufacturing may become the limiting factor.
Moncef Slaoui, the former chief scientific advisor to Operation Warp Speed, has suggested doubling the already available supply of the Moderna vaccine by giving out half doses.
In early trials, he noted, 50 microgram doses produced antibody levels just as high as 100 microgram ones; the company went with the larger one because it was unsure how well the vaccine would ultimately work and because it would increase shelf life.
Moderna’s vaccine turned out to be vastly more effective than the company envisioned, and shelf life is a non-issue when speed is vital.
And the fussing over brands is ridiculous. All the vaccines are based on the spike protein. But some Americans have become as brand-obsessed as if they were Prada bags or Cabernets.
Why bother? When we get flu shots, do we ask if we’re getting the Sanofi-Pasteur, the GlaxoSmithKline, the Protein Sciences, the MedImmune or the ID Biomedical of Quebec?
I don’t. I do ask for the more powerful “senior shot.” There are two brands, which work in different ways — one has extra vaccine, the other contains an immune-system booster. I take whichever is available.
I also don’t ask whether that year’s shots are 40 percent effective or 60 percent effective. That is a measure only of its efficacy against any infection with one of four different influenza strains (all of which are farther apart genetically than various Covid “variants” are from each other).
I get an annual flu shot because it is much better than that at preventing death.
A 2018 New Zealand study often cited by the C.D.C. showed that, over the course of four flu seasons, with both good and bad matches, flu shots reduced the chances of being admitted to an intensive care unit by 82 percent.
I’m not afraid of missing a few days of work or of feeling miserable. I very much want to avoid I.C.U.s, which are the approach ramp to the morgue.
That — rather than fussing over side effects, reinfection, asymptomatic transmission or matching second shots — ought to be our national goal.
This is a lethal disease; more than anything else, we need to pull its fangs as quickly as possible. With the biggest threats gone, we can reopen schools, workplaces and restaurants and get the economy moving again. And then we can turn to helping the rest of the world do the same.
