When Health and Human Services Secretary Alex Azar announced this week that the federal government would begin releasing coronavirus vaccine doses held in reserve for second shots, no such reserve existed, according to state and federal officials briefed on distribution plans. The Trump administration had already begun shipping out what was available beginning at the end of December, taking second doses directly off the manufacturing line.
Now, health officials across the country who had anticipated their extremely limited vaccine supply as much as doubling beginning next week are confronting the reality that their allocations will remain largely flat, dashing hopes of dramatically expanding access for millions of elderly people and those with high-risk medical conditions. Health officials in some cities and states were informed in recent days about the reality of the situation, while others are still in the dark.
Because both of the vaccines authorized for emergency use in the United States are two-dose regimens, the Trump administration’s initial policy was to hold back second doses to protect against the possibility of manufacturing disruptions. But that approach shifted in recent weeks, according to the officials, who spoke on the condition of anonymity because they were not authorized to discuss the matter.
These officials were told that Operation Warp Speed, which is overseeing the distribution of vaccines, stopped stockpiling second doses of the Pfizer-BioNTech vaccine at the end of last year. The last shots held in reserve of Moderna’s supply, meanwhile, began shipping out over the weekend.
The shift, in both cases, had to do with increased confidence in the supply chain, so that Operation Warp Speed leaders felt they could reliably anticipate the availability of doses for booster shots — required three weeks later in the case of the Pfizer-BioNTech product and four weeks later under Moderna’s protocol.
But it also meant there was no stockpile of second doses waiting to be shipped, as Trump administration officials suggested this week. Azar, at a Tuesday briefing, said, “Because we now have a consistent pace of production, we can now ship all of the doses that had been held in physical reserve.” He explained the decision as part of the “next phase” of the nation’s vaccination campaign.
Those in line for their second shots are expected to get them on schedule since states are still getting regular vaccine shipments. But state and local officials say they are angry and bewildered by the shifting directions and changing explanations of supply.
The health director in Oregon, Patrick M. Allen, was so disturbed that he wrote Azar on Thursday demanding an explanation. “Earlier today, we became concerned when we discovered there were no additional doses available for allocation,” he said in the letter, which was reviewed by The Washington Post.
On a call with Perna earlier the same day, Allen wrote, the four-star Army general had “informed us there is no reserve of doses, and we are already receiving the full allocation of vaccines.”
“If true, this is extremely disturbing, and puts our plans to expand eligibility at grave risk,” Allen added. “Those plans were made on the basis of reliance on your statement about “releasing the entire supply” you have in reserve. If this information is accurate, we will be unable to begin vaccinating our vulnerable seniors on Jan. 23, as planned.”
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But the issue of supply was most troubling to state health officials.
“States were shocked and surprised that they did not see an increase in their allocations, and when they asked for explanations, some of them were told there was not a large stockpile of second doses to draw from,” said an official working with numerous states on vaccination planning who spoke on the condition of anonymity to recount sensitive conversations. “They thought they were getting more doses and they planned for more doses and opened up to 65 and up, thinking they were getting more.”
In an email that reached some state officials on Friday morning, Christopher Sharpsten, an Operation Warp Speed director, called it a “false rumor” that “the federal government was holding back vaccine doses in warehouses to guarantee a second/booster dose.”
But it had been Azar who said Tuesday that “we are releasing the entire supply we have for order by states, rather than holding second doses in physical reserve.”
There was additional confusion. Another change Azar announced this week — making allocation of doses dependent on how quickly states administer them — would not take effect for two weeks, he said.
But Connecticut Gov. Ned Lamont (D) on Thursday tweeted that federal officials had notified the state that it would receive an additional 50,000 doses next week “as a reward for being among the fastest states” to get shots into arms. West Virginia, meanwhile, which is moving at the fastest clip based on CDC data, did not get any additional doses, said Holli Nelson, a spokeswoman for the state’s National Guard.
In a sign that the incentive structure may not be long-lived, a senior Biden transition official, speaking on the condition of anonymity to address ongoing deliberations, said this week the team did not look kindly on a system that “punishes states.”