Q&A: Speeding up the slow COVID-19 vaccine rollout
According to the CDC, more than 17.2 million doses of COVID-19 vaccine have been distributed in the United States, and around 5.3 million people have received a dose.
As the United States nears 22 million cases of COVID-19, according to tracking by Johns Hopkins University, some have criticized the vaccine rollout as slow.
The Children’s Hospital of Philadelphia (CHOP) currently has three sites administering COVID-19 vaccines, with a plan to add two additional sites in the coming weeks, according to CHOP attending physician and chief medical officer Ron Keren, MD, MPH, who said the institution is working with the Philadelphia Department of Health and the Pennsylvania and New Jersey health departments to vaccinate 20,000 CHOP employees as part of the CDC’s administration plan.
“We've been immunizing 300 to 500 people a day,” Keren told Healio. “We've been going continuously, and we've immunized probably around 6,000 people at this point, and we hope to be able to offer the vaccine to all of our employees ... by the end of this month.”
According to Keren, CHOP geocoded the addresses of each of its employees to create heat maps in order to show where higher concentrations of people live.
Although CHOP’s program has seen some success in the initial weeks of vaccine administration, other places have not. Healio spoke with Infectious Diseases in Children Editorial Board Member Paul A. Offit, MD, director of the Vaccine Education Center at CHOP, about the national rollout.
Question: Is there a problem with the rollout? If so, what is causing it?
Answer: Yes, there is a problem with the rollout. I think it's much slower than one would have expected, and there's three components to this. One is mass production, the second is mass distribution and the third is mass administration.
We need to put in place a public health structure to do that, that doesn't currently exist. I think, in retrospect, which should have happened is that months before these vaccines were ready to be given, we should have provided the money to create that infrastructure. And we didn’t. Most recently, Congress passed a $9 billion appropriation for that, but it should have come earlier.
We're not used to this. We haven't done this before. I think we need to mass vaccinate. It's not just a matter of walking into the pharmacy and getting the vaccine at your convenience. We need to line people up and give these vaccines in stadiums or in synagogues, or churches or wherever people come and gather in massive quantities, just one after the next after the next. That requires planning and thought.
Q: Are you in favor of delaying second doses of vaccine, as recommended in a recent Washington Post opinion piece ?
A: No, I'm not. When you look at the phase 3 trial for either the Pfizer or Moderna vaccine, you get the first dose, and depending on whether it's Pfizer or Moderna, you get the second dose 3 or 4 weeks later. There is a period of time when you've gotten only one dose. There was some evidence with Pfizer that about 50% of people who got the vaccine were protected, and then with the Moderna trial, it was 80% and 90%, depending on exactly when you looked.
All you could say is that people were protected for a few weeks, which is something. But if you're going to say, ‘OK, let's just get everybody a first dose, and then we'll get them a second dose when we can,’ that second dose dramatically boosts your immune response. You need that second dose.
So, if you disrupt the program [and] a week or two goes by, that's not a big deal. But if a few months goes by, that is a big deal, because now you may have found out that your one dose, which you knew to be effective, or [to an] extent effective for a few weeks, was not effective for a few months, and you just have a population who now is not protected. I think you've shaken what is already a fragile vaccine [mentality] in this country.
Q: What is your opinion on halving doses?
A: Pretty much the same thing. That's born of a phase 2 study with a Moderna product, where they looked at the immune response to 50 µg of the mRNA vs. 100 µg. Overall, 100 µg is the dose we're moving forward with, and it found that the immune response was similar. They thought, ‘OK, well, if the immune response was similar, then the protective efficacy is probably also similar.’ That, you don't know. That's why you do phase 3 trials. That's why you do trials to see whether or not these vaccines actually work to prevent disease, because for many vaccines that are currently on the market, we don't have an immunological core. Meaning that you can say if I have a certain level of neutralizing antibodies against this virus, I know I'm going to be protected. We don't have that for this vaccine yet. We might, but we don't have it yet. So that puts a lot of faith in that immune response to say that that is also a protective immune response, if you don't know that yet. I think it's a terrible idea. It's even worse than the other idea [of delaying second doses].
Q: Do you feel that this rollout issue was inevitable?
A: To some extent. It's hard to do this. We don't have the infrastructure in place. I do think that the current administration didn't pay much attention to this. I think they thought once they had made the vaccine, they had done their job. I think they realized just how hard it is to mass produce, mass distribute and mass administer a vaccine. They are learning that, and it is hoped the next administration will be more dedicated to that. But we need a plan. We look to our leaders for plans, not finger pointing. And right now, we're just getting a lot of finger pointing.
Q: How is the CHOP vaccination rollout going?
A: We vaccinate 12 people every 30 minutes at a variety of sites. We are vaccinating hundreds of people per week. We’ll have thousands of people just in a couple weeks, so I think we're pretty efficient at it.