The U.S. should not hold back half of its vaccine doses — distribute them now

The Trump administration could deliver a coronavirus vaccine to all at-risk health-care workers in the United States and everyone over 75 in December. But the Health and Human Services Department is only shipping out 45 percent of the available vaccine — a decision that will leave about 22 million Americans without any immunity during the deadliest period since the pandemic began.

The reason for holding back more than half of the vaccine, they argue, is that it is a two-dose regimen and they want to make sure they have second doses available for everyone who gets the first. So instead of pushing out as many doses as possible immediately, they are holding back 55 percent of available supply – 50 percent for second doses and about 5 percent as a “safety stock.” As a result, they will distribute only about 18 million doses this year when about 40 million will be available.

That is insane. We are at the peak of the pandemic. On Dec. 17, 3,406 people died of covid-19 — the highest single-day death toll since the pandemic began. Holding back 55 percent of your available vaccine during the pandemic’s peak is like holding back 55 percent of your available ammunition on D-Day, because the troops will need those bullets a month from now when the Nazis are on the run. When soldiers are fighting and dying on the beaches, you give them all the ammunition you can right away — knowing factories back home are churning out more. A bullet delivered at the height of the battle is worth more than a bullet delivered a month after the battle has died down. The same is true in a pandemic. A vaccine delivered today at the height of the pandemic is worth more than a vaccine delivered a month from now — because more people are dying now than will be dying next month.

This is especially true because we know that the first vaccine dose provides significant immunity. Moderna reported the vaccine was 80.2 percent effective after the first dose, and experts believe the Pfizer vaccine has a similarly high efficacy rate. So why are we immunizing fewer than half the Americans we could be during the worst period of the pandemic? Today almost 52,000 nursing home residents a week are getting covid-19, and about 21 percent of them die. Getting vaccines to nursing homes a month earlier could save more than 40,000 lives alone.

Defenders of saving doses say we don’t know how long immunity lasts from the first dose, so we need to make sure we have second doses available. But there will be 50 million more doses coming in January that can be used for that second dose, and 60 million in February. Moreover, the Institute for Health Metrics and Evaluation (IHME) model suggests that by the end of January the pandemic will begin rapidly declining. We need to provide as much immunity to as many people as possible now.

The only reason to hold back doses is to hedge against the risk of a manufacturing failure. But should that happen, we have a much bigger problem as a country than not getting people second doses. And the theoretical risk of a delay in delivering second doses pales with the actual risk to vulnerable Americans of not getting a first dose while the pandemic is raging. Arthur Caplan, a professor and founding head of the division of medical ethics at the New York University School of Medicine, tells USA Today, “I will accept a bit of risk in terms of supply to get to that goal as long as manufacturers will promise that the second doses are highly, highly likely to be available for those who got the first dose. . . . Vaccinat[ing] as many as possible in the midst of a horrific deadly plague to maximize lives saved has to be our moral priority.”

Everyone should get their second dose. Yet even if there was a slight delay, there is no evidence it would cause any harm (though admittedly there is also no evidence it wouldn’t). The reason companies gave the second dose less than a month after the first was to ensure people in the trials actually returned for the second dose, and to get to trial results faster. But there is no scientific reason the second has to be delivered a month after the first one.

It may make sense to reserve 5 percent of the vaccine in case of distribution problems, but 55 percent is absurd and inhumane. Next year, the vaccine will become a tool for preventing future outbreaks. But right now, we have a small window in the next few weeks to save lives during the current pandemic wave. That window is closing fast. We need to get protective immunity into the population while the crisis is still going on. Instead, we are leaving millions unvaccinated in a crisis.

It is time for President Donald Trump to step in. If he lets the HHS withhold tens of millions of vaccine doses this month, Americans will needlessly die. The president needs to order the department to release those vaccines — now.


Follow Marc A. Thiessen on Twitter @marcthiessen.


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