The other day, we reported on an interview with from Dr. Scott Gottlieb, a former director of the FDA under President Trump who frequently appears in the press to offer analysis and commentary on the rollout of the COVID vaccine, along with federal COVID policy more broadly.
Yesterday, the focus of the interview was a criticism lodged by Dr. Gottlieb against the Biden administration's target of 200MM Americans vaccinated by the end of the month. Hours after our post, Bloomberg News shared a startling piece of analysis: Across the US, unused vaccines are already starting to pile up. Should we see daily vaccination numbers continue to decline, that would suggest the demand cliff that Dr. Gottlieb anticipated has perhaps already arrived.
So far, 37% of American adults have gotten at least one dose, and the country is one of the world leaders in vaccinations. But even some states that are doing well are struggling with what Bloomberg described as "stubborn pockets" where uptake is low.
Bloomberg offered the state of Virginia - infamous for its purple blue-meets-red divide between the Washington DC suburbs and Richmond vs. the rest of the state - as a "microcosm" of the "demand gap" plaguing America.
In Virginia, for instance, 83% of vaccines supplied to the state have been used - but the number of people getting shots differs sharply from city to city. That difference is especially stark in Charlottesville and Lynchburg, separated by a mere hour’s drive on U.S. 29 past vineyards and open farmland.
"Virginia is sort of a microcosm of the country,” said Costi Sifri, director of epidemiology at UVA Health in Charlottesville. "We’re going to have this same type of challenge played out in every state in the country. How do we close the vaccine gaps that are going to occur geographically?"
In Charlottesville, a mostly Democratic area that is home to the University of Virginia, vaccine appointments are tough to snag even with two mass clinics right in town. In Lynchburg, 70 miles south and dominated by conservative Liberty University, open appointments at an old TJ Maxx are easy to find. The disparity has led to in-state vaccine tourism where residents in northern Virginia flock south to snap up shots that would otherwise go unused. The wide availability of vaccines also signals that areas like Lynchburg may be running out of residents willing to get vaccinated.
Bloomberg's choice of imagery here is particularly evocative. If you had to choose where to get vaccinated, which would you prefer: a jam-packed campus health center, or the musty back-rooms of a TJ Maxx?
And while you mull that over, consider this: nationwide, the percentage of vaccines going unused week to week has risen from 19% in February to more than 20% today. The rate varies substantially across states, with Alabama and Georgia seeing unused rates nearing 40%. And while Bloomberg humorously tiptoes around the politics factor,
Fortunately, federal officials are already working on a "solution".
Federal officials are in the early stages of rethinking distribution. Vaccines have so far been doled out based on population.
"We're going to go through stages, as we vaccinate higher and higher portions of populations, where it will make sense for us to continue to watch where vaccines are needed, how vaccines are distributed, the best way to reach more people," Andy Slavitt, senior adviser for the White House’s Covid Response team, said at the end of March.
Meanwhile, doses pile up. West Virginia - lauded for its rollout of shots early on - has gone from using all but a tiny percentage of its supply in mid-February to 26% of doses unused, a daily average of 352,000 unused doses over the last week. Some states have never gotten their vaccination strategy in gear. Alabama, Georgia and Mississippi represent a band of southern states that have struggled to work through their supplies.
States don't control all of the distribution inside their own borders. Mississippi says it has used 77% of the doses it has requested. But when the doses sent directly by the federal government to pharmacies and other locations are counted, only 65% of doses in the state have been used, according to Bloomberg's analysis.
Taken together, the worst-performing quartile of states holds 14.1 million unused doses, meaning that 31% of doses delivered in those states are yet to be marked as used. In the best-performing quartile of states, only 11% of doses were unused.
While US states clearly have more jabs than they need, of the 700 million vaccine doses that have been distributed across the globe, over 87% have gone to high-income or upper-middle-income countries, while low-income countries have received just 0.2%. More than 100 countries around the world haven't gotten their hands on a single dose.
Why can't countries simply make their own vaccines? Well, it's complicated, but one man is overwhelmingly responisble: Bill Gates. And his insistence on preserving vaccine-related IP, the focus of a battle over IP rights happening at the WTO.
Here's another idea. With US vaccine supplies already outpacing demand, why don't we start sending more of these vaccines abroad. While the US has promised jabs to Mexico and elsewhere, the global need is vast, and if the status quo endures, billions of people likely won't have access to vaccines until 2024.