On Eve of Vaccine Campaign, Some States Still Uncertain of Supply

(Bloomberg) -- Many U.S. states don't have a clear picture yet of how many doses of the Covid-19 vaccine they’ll get, even with the Pfizer Inc. shots on the cusp of being authorized for emergency use by regulators.

Once that happens, it’s expected to trigger a complicated operation to quickly deliver millions of doses to sites in all U.S. states and territories as far away as Guam. Yet a number of state and local governments haven't provided a clear accounting of how many shots they’ll receive, and federal officials have been equally close-mouthed to the public about the breakdown. While several states have supplied the numbers, others say the estimates they’ve received are too fluid to share.

As of Thursday, Philadelphia, for one, hadn’t yet received a final number on its initial allocation, according to James Garrow, a spokesman for the city’s public health department. New Jersey officials also said the exact amount of doses they should expect isn’t yet confirmed. Indiana, meanwhile, said it was told to expect an initial allocation of 55,575 doses, but a health department spokeswoman noted that the allocation numbers change frequently. 

“We have no idea” what future allocations might look like, Philadelphia's Garrow said in an email.

The federal government has said it will have enough supply of Pfizer-BioNTech SE vaccine and one expected soon from Moderna Inc. to deliver the first part of a two-dose immunization to 20 million Americans by the end of December, or about 8% of U.S. adults. But health officials note that use of the Pfizer vaccine presents unique challenges. It must be stored at 94 degrees below zero Fahrenheit, requiring dry ice and special freezers, and it requires a second shot, as do most of the leading vaccine candidates.

“Logistically, it's much more difficult” than the swine flu campaign in 2009, said David Lakey, who was Texas health commissioner during that outbreak and now serves as vice chancellor for health affairs and chief medical officer at the University of Texas System. 

A recent Government Accountability Office report said 38 states were worried about not having enough supplies to administer and distribute vaccines, though the federal government is in the process of shipping needles, syringes, and alcohol pads. States also have received no dedicated funding for the vaccination effort, even though the director of the Centers for Disease Control and Prevention last summer told Congress as much as $6 billion would be needed.

Spread Evenly

Generally, federal officials have said the shots will be spread evenly throughout the U.S. in proportion to states’ adult populations. Most of more than 30 states that Bloomberg News obtained data from are expecting enough initial doses for about 1% of their adult residents.

The final allocation numbers for the first batch of Pfizer doses, available to states through an electronic system called Tiberius, may not be accessible to some state officials, according to a person familiar with the situation who declined to be identified discussing private information. Additionally, some states are taking allocations on behalf of Native American tribal nations, which can distort states’ data, the person said.

Still, many states are confident about the supply they'll have on hand. New York state, for instance, has said it expects an initial allotment of 170,000 doses of the Pfizer vaccine to arrive as soon as this weekend. North Carolina was allocated 85,800 Pfizer doses for the first week, and a state health department spokeswoman shared how those doses would be divvied up by hospital.

Illinois Gov. J.B. Pritzker in a tweet last week shared a graphic showing how the state would prioritize counties with the highest death rates per capita. Washington, D.C. disclosed how many boxes of vaccines each hospital in the district would initially receive.

Pfizer will ship a minimum of 975 doses per container, meaning many of the initial supplies will go to large health systems who can quickly vaccinate that many employees. Some hospitals are preparing to receive the first shipments in a few days without knowing how many to expect. Stanford Medicine put in a request to California officials for 5,000 Pfizer doses and is still awaiting confirmation of a final number, said Lloyd Minor,  a doctor and dean of Stanford University's School of Medicine. Emails notifying people that it’s their turn to get vaccinated are already teed up.

Vaccine Delivery

The first shipments will be 2.9 million doses of Pfizer’s shot. For each dose that’s distributed, another one will be held back as a booster shot for the people who got the first doses. That will be be delivered before it’s due three weeks later. A separate reserve of a half-million doses is also being withheld for emergencies in case of catastrophic loss, a spokeswoman for the Department of Health and Human Services said.

Some have questioned the tradeoff of holding doses in reserve with the pandemic raging in the U.S. Pfizer’s two-dose regimen has been shown to be 95% effective at preventing Covid-19 illness when doses are spaced 21 days apart. Data from the company revealed this week that the vaccine also seems to confer some protection after only one dose.

Administering more than half of the shots available today would mean having faith that sufficient doses will be manufactured in time to deliver recipients’ boosters 21 days later. The risk that subsequent doses might be delayed should be weighed against the benefit of inoculating more people more quickly, said Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh.

“The decision is not, do we give everyone one shot?” Gellad said. “The decision is, do you take a risk that the second shot will be delayed?”

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