October 17, 2021

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Biden sticks to vaccine goals nearly met by his predecessor – The Washington Post

7 min read

“My eyes got big when I saw that,” Kavita Patel, a physician who served in the Obama White House, said at the time. “That’s not going to be easy to fulfill.”

Six weeks later, the same target appears much less ambitious because of greater manufacturing certainty and the increased pace of inoculations in the final days of the Trump administration. To defend the objective, Biden and his top aides have selectively interpreted that progress and issued broad-brush promises about expanding the availability of critical supplies, part of an effort to emphasize a break with the policies of their predecessors.

Even with vaccine shortages and bottlenecks in delivery, the pace needed to meet the new administration’s goal — 1 million doses administered per day — was already achieved Friday and four other days of the previous eight, according to Washington Post data. The accelerating speed of the program undercuts assertions by some Biden advisers that they were left no plan by the Trump administration and suggests they need only to keep their feet on the pedal to clear the bar they set for themselves.

“I don’t think they would have set those goals if they had any concern about being able to meet them,” said Dan Sena, a Democratic strategist who helped chart the party’s takeover of the House majority in 2018. “I think Americans across the country are going to remember two things: the day they got vaccinated and day they went back to school or to work.”

To ensure success, top Biden aides have presented unflattering portraits of the state of the immunization campaign begun by their predecessors and promised to overhaul the use of the Defense Production Act, a Korean War-era law used to compel production of critical items.

But the Trump administration used the law 18 times in relation to vaccine production, according to current and former officials. Biden said this week that he was invoking it, which aides said meant directing agencies to explore prioritizing certain contracts. His plan envisions the possible use of this authority in a number of categories, but does not identify specific manufacturers or a timetable for what they would be able to produce, and at what cost to the rest of the supply chain.

Aides have stressed the need to acquire more specialized syringes to extract extra doses of the vaccine made by Pfizer and German company BioNTech. Those syringes enable six or seven doses from vials that otherwise might contain five.

Biden, when asked whether he was aiming too low, bristled at the question. “When I announced it, you all said it’s not possible. Come on, give me a break, man. It’s a good start.”

On Thursday, White House press secretary Jen Psaki said the Trump administration had averaged about 500,000 vaccinations a day — half the 1 million daily needed to meet Biden’s target. But the seven-day average has risen steadily, from 482,865 two weeks ago to 1,022,342 Friday, according to Post data.

Before leaving the administration Wednesday, Paul Mango, former deputy chief of staff for policy at the Department of Health and Human Services, said he looked at the numbers and saw that nearly 3.5 million vaccinations had been completed over the previous 72 hours.

“We’re averaging 1.1 million a day now,” he said. “They would have to slow down not to meet their target.”

What changed in the new year? The initially slow rollout of the vaccines has sped up, which federal health officials promised it would, in part as states, localities and providers have trained workers and set up clinics. “We need to remember that these are new vaccines on new platforms with slightly complex requirements for storage, handling and administration,” Nancy Messonnier, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, said at the end of December.

Supply of the shots, while still far outstripped by demand, has expanded modestly. Manufacturing has become more regular after initial hiccups. Pfizer and Moderna, the two companies whose products have been authorized for emergency use, have each agreed to provide 100 million doses to the federal government by the end of March. Because both vaccines are two-dose regimens, that allotment is enough to fully vaccinate 100 million people.

That means that if the Biden administration were to oversee the administration of only 100 million shots in its first 100 days, a sizable portion of the projected supply would remain on the shelves. More important, 1 million vaccinations per day is not nearly enough if the aim is to halt virus transmission in six months, said Peter J. Hotez, a vaccine scientist at the National School of Tropical Medicine at Baylor College of Medicine.

A better target, he said, would be 300 million vaccinations in the first 100 days — an aim he acknowledged would require additional supply. “We don’t have the vaccine for it,” he said. “Nor do we have the infrastructure.”

Psaki said Friday that the administration would work to surpass its target, and it has already announced a raft of policies intended to ramp up distribution and bring additional federal resources to bear on the effort. “We’re not picking up our bags and leaving at 100 days,” she said.

What Biden said in December, as he unveiled his health team, was that he would aim for “at least” 100 million shots, suggesting he was setting a floor, not a ceiling. The goal, which Biden said he had developed in consultation with Anthony S. Fauci, the nation’s top infectious-disease specialist and a medical adviser to his White House, was packaged with other aims for his first 100 days, including a request that everyone wear masks for that period.

Since then, the goal has generated significant confusion, in some ways mirroring the uncertainty about the vaccination goals that the Trump administration had promised to achieve by the end of 2020 — 20 million people fully vaccinated, 20 million shots administered, or 20 million shots distributed to state and local authorities. The previous administration ended up falling short on every version of that promise.

CDC officials were supportive of Biden’s 100 million target and considered it a “stretch goal” that was attainable, according to a federal health official who spoke on the condition of anonymity to share internal deliberations.

The framing around the 100 million was deliberately vague, the official said. It was often left unstated whether 100 million shots meant 50 million people fully vaccinated with two doses, or 100 million first shots, the person said, adding, “There was meant to be wiggle room.”

Meanwhile, the president-elect’s transition team was communicating with manufacturers about their anticipated supply, as well as with national pharmacies about their capacity for immunizations, according to people familiar with the discussions.

What Biden meant was simply that 100 million shots would be administered, said Atul Gawande, a former transition adviser and a surgeon affiliated with Harvard Medical School and Boston’s Brigham and Women’s Hospital. He defended the objective and said the risk of overpromising was acute.

“Setting expectations is a crucial part of all of this,” Gawande said. “The message from the previous administration was that by spring, you’d see the general public being vaccinated — and much of life returning to normal as early as the beginning of summer. That assumed everything would go perfectly.”

Modeling done by the transition team indicated 100 million shots would mean about 33 million people fully immunized and 67 million fully or partially immunized, according to two people familiar with the estimates. That’s out of an estimated 260 million people in the United States considered eligible to receive a coronavirus vaccine, although not all are expected to accept it.

Officials knowledgeable about the White House response said there is confidence in the target but reluctance to revise it upward, especially before congressional negotiations over another relief package designed to boost resources for vaccination sites and staffing.

There is also uncertainty about whether a third vaccine candidate, developed by Johnson & Johnson, might soon make more doses available. Critically, it is a single-dose regimen that is easier to store and administer. The company could announce trial results within days, setting the stage for emergency clearance if those results are favorable.

Experts disagreed about what a reasonable target should be for the first 100 days but said uniformly that Biden should communicate honestly about what his administration can achieve — as well as what his predecessors already put in place.

Patel, for her part, said she remains apprehensive about the original aim.

Julie Morita, a former transition adviser and executive vice president of the Robert Wood Johnson Foundation, the nation’s largest health philanthropy, said the administration can reassess its aspirations, “either down or up, depending on what’s learned” about the reliability of manufacturing estimates and the capacity of vaccinators.

“If a good chunk of the speedup happened under the Trump administration, let’s celebrate that and say the challenge is now to maintain it,” said Matthew Ferrari, an epidemiologist at Pennsylvania State University. “We need to be transparent about every aspect of the pandemic, the response and its consequences.”

Given barriers to distribution and access that remain pronounced, however, Ferrari said 100 million doses seemed like a reasonable target.

If the new team gets situated and sees additional possibilities, said David Kimberlin, a pediatric infectious-disease specialist at the University of Alabama at Birmingham, “they should say, ‘It’s looking doable, and we’re aiming now for 200 million doses.’”

“I think they are just trying to lower expectations, which I think is a very smart strategy,” said one former Trump official involved in Operation Warp Speed, the initiative aimed at speeding development of vaccines and therapeutics. “We saw what happened to us when we set the expectations high.”

Amy Goldstein contributed to this report.

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