Huge, Fast and Random: Inside the U.S. Vaccine Rollout

The United States has implemented the sixth-fastest vaccine distribution program in the world, administering just over 100 million vaccines and reaching a quarter of all adults. In terms of the total number of shots to the weapons, this is by far the largest deployment in the world to date.

But national and national data analyzed by the Financial Times shows the rollout has been uneven, as some governors prioritize speed while others focus on vaccinating older people who are more likely to end up in the city. hospital and die.

California, for example, has been slower than most to open vaccine eligibility, but 66% of people over 65 received a first dose – a third more than Texas or Tennessee.

Meanwhile, Alaska oversaw one of the nation’s fastest-growing distribution programs, but gave a smaller proportion of its population over 65 a first shot than many other states – just 55 percent. . And he vaccinated a much larger proportion of people below that age: 20%.

The results highlight how the US federal government oversaw a large, rapid but disorganized deployment, with little central control over who should be vaccinated and when.

This contrasts sharply with the picture of the UK, where an equally rapid program has seen nearly everyone over 65 receive at least one dose of a coronavirus vaccine.

“The UK has focused entirely on reducing hospitalizations and deaths, and therefore focused on its elderly population,” said Dr Leana Wen, professor of public health at George Washington University.

She added, “The United States is much more free to know who gets the doses, but there are also benefits to that. If you immunize a younger, more mobile population, you are more likely to reduce community transmission. “

After early start issues with quality control, vaccine production in the United States has steadily increased since its launch in December.

By the end of 2020, the country was vaccinating around 300,000 people per day, according to data collected by Bloomberg. By the time Donald Trump stepped down in January, he was at nearly 1 million. Now it has grown to just over 2m.

US President Joe Biden visits a Pfizer vaccine manufacturing plant in Michigan in February. © Brendan Smialowski / AFP via Getty Images

Government officials and industry leaders say two things in particular helped make the deployment to the United States one of the fastest in the world, despite the challenges of managing a vaccination campaign in a so big country.

The first is how the Trump administration spent billions of dollars at the start of the pandemic, contributing to the development of vaccines and in return obtaining a first refusal for hundreds of millions of doses.

Charles Michel, President of the Council of the EU, this week accused the United States to impose an export ban on vaccines, but US officials say the reality is simpler: America has already bought a lot of doses.

The second factor is the extent to which the government has closely monitored the manufacturing process and the supply chain, helping to spot and resolve issues before they become crippling.

The Trump and Biden administrations used the Korean War-era Defense Production Act to ensure that vaccine manufacturers and administrators got priority from critical items such as glass vials and specialized syringes.

Andy Slavitt, a senior Covid-19 adviser to US President Joe Biden, said: “We keep asking vaccine makers, ‘Have you had enough, have you had enough?’ Finally, they might say, “In fact, it turns out that in three weeks we won’t have enough staff to do quality checks on the packaging.” “

“This is how we were able to establish a rhythm of anticipation of problems before they arose.”

But as production numbers have increased, the federal government has been able to exercise much less control over who gets the vaccine. The United States Centers for Disease Control and Prevention has issued guidelines for priority vaccine groups, but states control their own distribution programs and many have adapted or ignored national guidelines.

Chart showing that in the United States, Covid-19-related deaths increase sharply with age, but vaccinations do not.  60% of deaths occurred in people aged 75 and over, compared to only 25% of vaccinations

Data analyzed by the FT show that while England administered at least one dose to 94% of people over 65, the comparable figure in the United States is around 60%. According to the CDC, those over 65 account for 81% of all Covid-19-related deaths.

This may be partly explained by the UK’s decision to extend the gap between the first and second dose from three weeks to 12. While 4 percent of those over 65 in England (data at l UK scale not available) received a second dose, 29 percent of those in the US did.

But another factor is that some states have chosen to expand eligibility more quickly, resulting in very different vaccination rates for different demographics across the country.

States that have been slower to open up eligibility have sometimes been slower to take up arms, but they have often better targeted the most vulnerable.

There are also differences within the over 65 age group. Florida, for example, opened eligibility to everyone over 65 on a first-come, first-served basis at the start of deployment, which triggered long queues at vaccination sites.

Critics have said older and more frail people will be left out, and the most recent statistics seem to back it up. Florida has vaccinated 62% of people aged 65 to 84, but only 54% of those over 85.

States also vary widely in how quickly they vaccinated black and ethnic minority populations, who are also at a higher risk of dying from the virus. Data from the Kaiser Family Foundation’s health think tank shows that while New Mexico vaccinated 12% of its black population, Texas only vaccinated 5%.

An FT analysis last month of data from five major metropolitan areas showed that people living in poorer, predominantly black neighborhoods were vaccinated at a slower rate than wealthier and whiter ones.

Experts predict the problems won’t last much longer, with President Joe Biden planning sufficient doses for each adult by the end of May.

Columbia University virologist Dr Angela Rasmussen said, “The deployment may have been haphazard, but we will overcome these state supply issues fairly quickly.”

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