More than 22 million doses of Covid-19 vaccine have been distributed in the United States so far, yet only 6.7 million Americans have received the first of the required two doses. Many observers, including President-elect Joe Biden, have argued that the shortfall calls for additional spending and rapid government intervention to speed things up. But experience shows that governments do a poor job at disseminating vaccines. The solution is not more government, but less.
The federal government did an admirable job facilitating the development and manufacture of new Covid-19 vaccines in record time. This achievement included commitments to purchase and distribute, free of charge, 200 million doses from Pfizer and Moderna, as well as doses from other companies when their vaccines are authorized by the FDA. Two hundred million doses, enough to vaccinate 100 million people, should be available by March 31.
Unfortunately, state governments have done a poor job of getting the vaccine into peoples’ arms. Governors have complained that they are not receiving as many doses as they were promised, but they have routinely failed to utilize the doses they have received. A combination of restrictive rules over who can be vaccinated and administrative incompetence means that many doses are sitting unused in the freezer.
New York is typical. It has administered less than half the vaccines it has received. While Governor Andrew Cuomo has blamed local leaders, county executives complain that state officials have bypassed long established county-level vaccination plans. The state’s public-health law requires counties to develop vaccination plans each year, including training and practice sessions. But New York authorities ignored county plans, preferring to micromanage vaccinations at the state level.
Cuomo complicated matters by threatening to fine hospitals that don’t use vaccines within a week of receipt; he would also fine them if they vaccinate anyone out of the strict priority group order set down by the state. This stricture puts providers in a double bind. Hospitals may have trouble finding enough people in the eligible group willing to be vaccinated within the arbitrary one-week limit—a task made more difficult by partisan criticisms of the vaccine development effort that undermined public willingness to be vaccinated—but will be punished if they try to avoid wasting the vaccine by administering doses out of order.
President-elect Biden’s plan to set up federally run vaccination sites and mobile vaccination units is unlikely to improve vaccine utilization in the near term. Outside of the Veterans Administration, the Indian Health Service, and military hospitals—none noted for efficiency—the federal government does not normally provide direct health services. Federal vaccination sites and mobile units don’t exist, and setting them up will not occur overnight.
In the initial weeks after approval of the Pfizer and Moderna vaccines, their limited supply had to be rationed. The federal government set up the Pharmacy Partnership for Long-Term Care Program to provide on-site vaccination of residents and staff of long-term care facilities. These residents are especially vulnerable—they constitute less than 1 percent of the population but 40 percent of Covid-19 deaths—and hard to reach through conventional health-delivery systems. Moreover, the program assures cold chain management, especially important for handling Pfizer’s vaccine, which requires ultra-low temperature storage.
Now the time has come to cut out the state middlemen and loosen counterproductive regulations. Our private system of health-care delivery is superior to creating a public alternative. Every year, about half of the U.S. receives flu shots. The most common vaccination setting is physician offices (67.6 percent for children and 34.3 percent for adults). Another 32.2 percent of adults get vaccinated in pharmacies, local supermarkets, and grocery stores, with an additional 13.3 percent in other medical settings, and 14.9 percent in the workplace. There is no reason not to rely on these channels for Covid-19.
Private entities could be instructed that they are free to vaccinate anyone 45 years and older. People younger than 45 constitute 58 percent of the population but account for only 2 percent of Covid-19 deaths. Nearly everyone who died in this younger age group had other medical conditions—co-morbidities—that made them more vulnerable to Covid-19.
Vaccinating people 45 and older, with vaccines also made available to younger people with co-morbidities, would protect the most vulnerable part of the population. People who know or have reason to think that they had Covid-19 before, and whose immunity is confirmed by serologic testing that demonstrates antibodies, could be safely excluded.
As the vaccine supply expands with increased production and approval of additional vaccines from other makers, the age cutoff could be liberalized. But using the 200 million doses available in the first quarter of 2021 to vaccinate 100 million previously unexposed people 45 and older, should, when combined with those people already immune, get us most of the way toward reaching the estimated 70 percent immunity in the population needed to halt the pandemic.
The federal government has already reached agreements with pharmacies, grocery stores, and retail outlets nationwide, including giants like Costco, RiteAid, Walgreens, and Walmart to administer the vaccines. Physicians’ offices and employers should also be given access if they are capable of safely storing and administering the doses.
There is no need to reinvent the wheel. Let existing private mechanisms vaccinate Americans—and let’s end the Covid-19 pandemic.
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