Vice President-elect Kamala Harris with President-elect Joe Biden who announced an American Rescue Plan January 14 from his transition headquarters in Wilmington, Delaware.

NASHVILLE, TN – President-elect Joe Biden unveiled a $1.9 trillion “American Rescue Plan” from his transition headquarters in Wilmington, Delaware on January 14.

The third stimulus package includes $1400 stimulus payments to individuals and $20 billion for more COVID-19 vaccines on top of the $8 billion Congress has already approved. It calls for mass vaccination centers and sending mobile inoculation teams into remote areas.

Trump administration officials suggested last week there was a stockpile of vaccine waiting to be shipped that had been held in reserve for second doses. HHS Secretary Alex Azar told state officials last Tuesday to broaden inoculation eligibility criteria and plan for a surge in supply.

The Washington Post reported January 15 that the Trump administration had already begun shipping out the reserves two weeks ago “taking second doses directly off the manufacturing line”.

Several states were planning to vaccinate seniors 65 and up but they didn’t get more doses and now state officials are angry and confused about the Trump administration’s latest snafu.

Biden plans to invoke the Defense Production Act to increase vaccine supplies. He aims to give 100 million shots by the end of his first 100 days in office. “Vaccine rollout in the United States has been a dismal failure thus far,” he said.

“We need to be quick. We need to move fast to speed up our national COVID-19 response. “ Biden said. Pfizer and Moderna have delivered 20 million doses of their vaccine but only about 5 million have been injected into peoples’ arms.

One of the country’s leading epidemiologists said the country wasn’t prepared to rollout the vaccine. “Some of the locations thought this is just going to be another flu vaccine campaign,” said Dr. William Schaffner.

Overwhelmed with caring for COVID-19 patients, many medical providers simply weren’t prepared when vaccines started arriving last month. “This is more elaborate to administer in a variety of different ways and that has gummed up the works,” Schaffner said.

Dr. William Schaffner is Professor of Medicine at the Vanderbilt University School of Medicine 

“There have been number of bottlenecks both at the national and at the local level,” Schaffner said.

“Nationally there sometimes has been uncertainty in vaccine shipments. The locals  are not exactly sure when the vaccine will arrive, sometimes it comes a bit late. Sometime it arrives with fewer doses than were anticipated and sometimes Minnesota’s vaccine arrives in Tennessee and has to be reshipped,” he said.

The Pfizer vaccine has to be stored in subzero temperatures and so those doses went to large medical centers like VUMC that has those freezers and trained staff. Schaffner said the Moderna vaccine is going to local health departments, nursing homes, and smaller community hospitals because it doesn’t have to be kept so cold. But those logistics have taken time.

“I’m not surprised that we’re not doing very well,” said Dr. Robert M. Wachter, chairman of the Department of Medicine, University of California, San Francisco.

“The only parts of Covid that we’ve done well on were the discovery of the vaccine. So we get the science right. We do not seem to get the logistics, the politics, the sociology, and all of the other components that have to come together right,” Wachter said.

Judging by how poorly the Trump administration handled the rollout of PPEs and COVID-19 testing, Wachter said you could have predicted things would go poorly with vaccine distribution. According to the Centers for Disease Control and Prevention (CDC), 21.4 million doses were distributed in the U.S. as of Jan. 6 but only 5.9 million people got a dose.

Wachter said the vaccine rollout would be going better if there was a thoughtful national plan that considered what he called “the last mile problem”.

“How do we get the vaccine from the manufacturing plant in Michigan into a FedEx box and into some central location in California?” he asked. Because there was no national plan, states had to figure out that last mile on their own. “I think they didn’t quite appreciate the complexity of the process,” Wachter said.

“They then handed off a fair amount of the responsibility to local institutions all of which were doing Improv, inventing things on their own,” he said.  “It is one of the things that happen when there is a lack of national guidance. There is just too much wiggle room and that ‘s what we’ve seen.”

For example, the Tribune asked Vanderbilt Medical Center how many Pfizer vaccine doses it had received. They didn’t know and referred us to the Tennessee Department of Health. Nashville’s Health Department Spokesperson Brian Todd said they give shots to people over 75 years old who live in Davidson County. He said they get their vaccines from the Tennessee Department of Health. The Department of Health spokesperson, Shelley Walker, said vaccines are shipped directly to providers from the manufacturer.

Despite the confusion that a scattershot approach creates, it is also inefficient. Wachter said authorities have wasted too much time worrying about which groups should get access first and how to distribute the vaccine equitably. “I think we’ve created something that is more complex than we are capable of handling,” he said.

“How is Walgreens going to figure out that you are a grocery store clerk? Or a preschool teacher or have a pre-existing condition?

Dr. Robert M. Wachter is chairman of the Department of Medicine at University of California, San Francisco

I think where we are now is kind of scandalous. We’ve been able to inject 30% of the vaccine doses that have been distributed representing millions people who should have receive a vaccine by now. Some will get sick, some will go to the hospital and some will die. I don’t’ think we’ve treated this as the emergency that it is.

If you think about a 9-11’s worth of people dying a day or a Pearl Harbor’s worth of people dying a day, every day, we would have attacked that as an absolute emergency. We’ve approached the distribution of the vaccine as a relatively routine process that we’ll kind of stumble around until we figure out the right answer and that has clearly not worked very well,” Wachter said.

At its current pace, Davidson County will vaccinate its population 31 weeks from now. Tennessee, at its current pace, will take 94 weeks to vaccinate the state’s population of 6.8 million.

“This is one of the most challenging operational efforts we have ever undertaken as a nation,” Biden said.  He said that we will have to move “heaven and earth” to get more people vaccinated, with more places to get vaccinated, more medical teams to give the shots, and to increase the supply of the vaccine “to get it out the door as fast as possible”.

Whether Biden’s plan will get it into peoples’ arms any quicker remains to be seen.