The Health 202: Now there should be enough Pfizer and Moderna vaccines for every American adult

President Biden announced the purchase yesterday at the National Institutes of Health, saying there will be sufficient doses for every adult by the end of July.

“We remain in the teeth of this pandemic,” he said, observing that January was the deadliest month of the pandemic, in which “we lost over 100,000 of our fellow citizens.” 

But 600 million of the contracted doses are from vaccine makers whose products haven’t yet been approved by the Food and Drug Administration. They include 300 million doses from AstraZeneca, 100 million doses from Johnson & Johnson, 100 million doses from Novovax and 100 million doses from Sanofi.

Of those, Johnson & Johnson’s vaccine is the closest to gaining emergency approval from the FDA. That would make it the third coronavirus vaccine approved for use in the U.S. It’s possible that vaccine or other candidates may not get FDA approval in a timely manner – a troubling thought as demand for the vaccine in the U.S. far outstrips supply.

By purchasing 100 million more doses each of the already-approved Pfizer and Moderna vaccines, the Biden administration is making it more likely there will be a steady stream of vaccine being made available in the spring and summer, even as the other vaccines move through the approval process.

Andy Slavitt, senior adviser to the White House coronavirus task force:

“In securing the additional doses, the government used options built into contracts negotiated last year by the Trump administration,” Isaac Stanley-Becker, Lena H. Sun and Laurie McGinley report. “Biden said last month that he would seek the additional doses, part of a strategy to double down on the two vaccines that have already won federal clearance and not count on candidates from other companies becoming available.”

Ten percent of Americans have now received at least one coronavirus vaccine shot, two months after the FDA approved the first coronavirus vaccine. About 1.5 million doses are being administered on a daily basis — well within the range needed to achieve Biden’s stated goal of 100 million doses in his first 100 days as president.

Here are other actions Biden has taken to try to speed immunizations during his first three weeks as president:

Defense Secretary Lloyd Austin has approved a request from the Federal Emergency Management Agency to deploy 1,110 troops to support vaccination sites. They’re supposed to begin operations early next week.

“The service members, the majority of whom will be medical personnel, are expected to be stationed at five FEMA megasites, two of which are in Oakland and east Los Angeles,” our colleagues reported.

Biden has vowed to create 100 new FEMA or National Guard-supported sites in 30 days. There were already 175 federally supported vaccination sites throughout the country as of Feb. 4.

These centers, which serve nearly 30 million Americans, most of them low-income, will start directly receiving vaccine doses instead of having to go through states, the Biden administration announced earlier this week.

The program’s first phase aims to allocate 1 million doses while increasing the number of places for people to get shots, our colleagues reported.

“Equity is our north star here,” said Marcella Nunez-Smith, chair of the White House covid-19 Health Equity Task Force. As supply ramps up, she said, vaccine doses will become available to all community health centers that want to participate.

Under the Trump administration’s approach, states were asked to enroll with state health departments as vaccine providers and then communicate to the federal government how many doses were needed and where they should go.

But in many places that process didn’t work well, Amy Simmons Farber of the National Association of Community Health Centers told me last month. She said supplies vary from county to county and many health centers have received their supplies with little notice, making it challenging to prioritize and plan.

The group said it “deeply” appreciates the move. 

“Community Health Centers deeply appreciate the recognition by the White House Coronavirus Task Force of their role in targeting populations that have been disproportionately affected by covid-19,” NACHC President Tom Van Coverden said.

Several thousand pharmacies across the United States are receiving direct shipments of vaccine doses, in the first phase of a strategy intended to simplify the ability to get shots, White House officials announced earlier this month.

Jeff Zients, coordinator of the White House’s covid-19 response, has said 1 million doses would be sent to pharmacies starting yesterday, on top of a modest increase in vaccine allocations to states. It started with a group of 6,500 stores but could swell to perhaps 40,000 chain drugstores, independent pharmacies and supermarkets with pharmacies, he said.

“The decision to send vaccine doses straight to pharmacies is based on the premise that they may be more familiar and easier to navigate — especially for older Americans who are a current priority in the mass vaccination campaign — than websites run by public health departments,” Amy Goldstein and Laurie McGinley write.

Last week, Biden announced he would invoke the DPA to ensure Pfizer has access to needed equipment to scale up production of its vaccine. 

President Donald Trump already used the emergency power on a limited basis to give Pfizer priority for some crucial products, including lipids, the oily molecules needed to produce the vaccine. Biden officials said they’re expanding it to include more equipment, for example, filling pumps and filtration units.

Yet federal health officials have warned Biden’s invocation of the DPA isn’t a quick fix to ease vaccine manufacturing.

“During the transition, Biden and his advisers promised aggressive use of the law, which was invoked 18 times by the Trump administration in relation to vaccine production,” Isaac Stanley-Becker reports. “Current and former federal health officials said departments had already made extensive use of the law’s authorities, and warned that any new action might not have an immediate payoff, while causing unwanted ramifications throughout the medical supply chain.”

The administration is expected today to notify states that they will no longer be able to compel their residents to work or volunteer in exchange for receiving Medicaid benefits, Dan Diamond and Amy Goldstein report.

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services under Trump, invited state Medicaid directors in 2018 to apply for permission to create programs that would require people receiving the safety-net benefits to work, volunteer or undergo job training. The Biden administration is expected to withdraw this invitation, according to a draft of the plan obtained by The Post. Biden officials will also notify 10 states already granted permission to go forward with work requirements that the permission will be retracted.

“In practice, the moves have little immediate effect because work requirements adopted in three states — Arkansas, Kentucky and New Hampshire — have been ruled illegal by two levels of federal courts, and other states have held back during the legal challenges to the policy. A case on such requirements is now before the Supreme Court,” Dan and Amy write.

“Still, the swift rescinding of the Trump administration’s effort to remake the safety-net program represents a particularly sharp pendulum swing on the ideological divide over the proper roles of government and individuals living under economic strain.”

Around 6:45 p.m. on Dec. 29, Hasan Goskal, the medical director for the Harris County Public Health department’s covid-19 response team, opened up a new vial of vaccines to give to an eligible person who arrived at a county vaccination event. But Moderna doses come 10 or 11 to a vial and must be used six hours of being removed from the freezer. After Gokal delivered that last shot, the clock was ticking to find 10 more eligible patients, or waste precious vaccine.

“Scrambling, the doctor made house calls and directed people to his home outside Houston. Some were acquaintances; others, strangers. A bed-bound nonagenarian. A woman in her 80s with dementia. A mother with a child who uses a ventilator,” the New York Times’s Dan Barry reports. “After midnight, and with just minutes before the vaccine became unusable, the doctor, Hasan Gokal, gave the last dose to his wife, who has a pulmonary disease that leaves her short of breath,” he continues.

For his efforts, Gokal was fired from his government job and charged with a misdemeanor crime for stealing the doses. (A judge dismissed the charge as groundless last month, but a local district attorney has vowed to present the matter to a grand jury.)

Gokal says that when a supervisor and the human resources director summoned him to tell him of his firing, they said he should have returned the doses or thrown them away and questioned the “equity” in the list of people he vaccinated.

“Are you suggesting that there were too many Indian names in that group?” Gokal asked, he told the New York Times. Exactly, he said he was told.

The delay is causing consternation among public health and pharmaceutical experts, “say the agency needs a permanent head as it grapples with life-or-death decisions about coronavirus vaccines and treatments, while doing its day job of regulating products that account for 20 cents of every consumer dollar,” Laurie reports. “A permanent leader also would help rebuild the credibility and morale of an agency whose reputation was hurt by the Trump administration’s relentless pressure and bashing, health-care experts say.”

The two people most frequently mentioned for the post are longtime FDA drug regulator Janet Woodcock, whom Biden has named as acting commissioner, and Johns Hopkins health expert Josh Sharfstein, a former top FDA official and former top Maryland health official.

Supporters are lining up behind the two front-runners.

Yesterday, 95 cancer experts — including the doctor who treated Biden’s son Beau Biden after he was diagnosed with brain cancer – threw their weight behind Woodcock in a letter to the president. Woodcock is known for prizing innovation and is often described as the more industry-friendly of the two. Supporters say she helped oversee the approval of dozens of breakthrough treatments in cancer. But she faces opposition from anti-opioid advocates who say she was too permissive in approving opioid medications and failed to rein in drugmakers who falsely claimed that narcotic painkillers were not addictive.

Sharfstein, meanwhile, has gained endorsements from some public health officials, who point to his experience on issues such as tobacco and vaping.

While Biden initially promised to have the majority of schools open for in-person learning in his first 100 days, he and his aides have repeatedly loosened their definition of an open school, making it easier to meet the target, Laura Meckler and Annie Linskey report.

Teachers unions all around the country are resisting a return to classrooms, even as many teachers receive the vaccine and kids tally months of virtual-only classes. 

“Biden has repeatedly said he won’t push schools to open until his administration produces new safety guidelines and until Congress provides billions of dollars to implement the recommendations,” Laura and Annie write. “Now, he is on the verge of getting both the guidelines, being released Friday, and the funding. But it is unclear whether that will be enough to bring recalcitrant teachers and their unions along or how hard the president will push them.”

Under the administration’s loosened definitions, schools where children are in buildings even one day a week will count as “open.” Opening “most” schools means 51 percent, a metric the nation has probably already reached. And high schools, which are the most likely to be online only, aren’t counted in the measurement at all.

“The people familiar with Mr. Trump’s health said he was found to have lung infiltrates, which occur when the lungs are inflamed and contain substances such as fluid or bacteria. Their presence, especially when a patient is exhibiting other symptoms, can be a sign of an acute case of the disease,” the New York Times reports.

Meanwhile, Trump’s blood oxygen level was dipping into the 80s.

While it was previously reported that Trump had trouble breathing and ran an fever on Oct. 2, when he was admitted to Walter Reed National Military Medical Center, the new details shed light on an episode his administration repeatedly sought to downplay. Trump’s physician, Sean P. Conley, told reporters at the time that there was “nothing of major clinical concern” on Trump’s X-ray and CT scans.

Mascots have a long history in public health campaigns worldwide. In the 1960s, the U.S. Centers for Disease Control and Prevention unveiled the “Wellbee” to promote the oral polio vaccine, Miriam Berger reports.

More recently, the United Kingdom adopted a mascot memorable for its shock effect — Mr. Testicles, used to promote the U.K. Male Cancer Awareness Campaign.

Now, countries around the world are adopting mascots to promote coronavirus-related health campaigns. In Brazil, Zé Gotinha, known as Joseph Droplet in English, is the country’s vaccine-touting mascot.

Japan has Koronon, an anti-coronavirus cat.

In Thailand, Covid-kun, a red-pronged blob, educates children about the virus.