Inside President Biden’s expansive and expensive plan to combat COVID-19 are a few hundred billion dollars to increase vaccination. Despite the scientific triumph of developing, authorizing, and manufacturing millions of doses of two new vaccines for a new disease in under one year, the country has fallen down in getting those shots into peoples’ arms. About 38 million doses have been distributed, but only 17.5 million administered. Yet there are inexpensive alternatives to Biden’s plans. Here are five.
First: Simplify the rules. A welter of federal, state, and local guidelines has left providers unsure of who can receive vaccinations, who can administer them, and where they can be administered. Some providers have discarded vaccines rather than administer them out of government-mandated priority order.
But a few states like West Virginia and the Dakotas have done much better than others. The secret? Focus on age rather than arcane categories of different types of workers and workplaces. As West Virginia Governor Jim Justice said on “Face the Nation,” “this thing is all about age, age, age.” People 65 and older account for 81 percent of COVID-19 deaths. West Virginia has made the vaccine available to people 70 and older and plans to lower the age to 65 this week.
Last week, Health and Human Services Secretary Alex Azar finally moved to simplify the CDC’s confusing and overly prescriptive guidelines, recommending that all persons 65 and older be vaccinated. Hopefully, states and localities will follow through.
Second: Don’t vaccinate people who recovered from COVID-19. Current guidelines say vaccinate everyone, regardless of previous infection by SARS-CoV-2, the virus that causes COVID-19. But all the available data indicate people infected will develop a protective immune response that lasts for at least six months. And natural immunity from infection is generally superior to vaccine immunity. There are almost 25 million confirmed U.S. COVID-19 cases and potentially eight times as many actual infections as confirmed cases. Performing serologic tests for antibodies to confirm the immune status of people who had confirmed or suspected COVID-19 cases will forestall vaccinating people who are already immune and free up doses to vaccinate at least 25 million unprotected people.
Third: Use what you’ve got. President Biden has proposed mobilizing the Federal Emergency Management Agency (FEMA) and the National Guard to set up thousands of federally financed vaccination centers and mobile vaccination units and hiring 100,000 public health workers to encourage vaccination and testing in order to vaccinate 100 million people during his first 100 days in office. But it is unlikely large numbers of centers and mobile units can be set up in a short period of time. Moreover, the National Guard has no particular vaccination expertise that can be immediately mobilized. Finding, hiring and training 100,000 new health workers will take more than 100 days.
Rather than establishing new government programs, we should utilize the existing health system that every year vaccinates hundreds of millions against the flu at physicians’ offices and other health facilities, in local pharmacies, supermarkets, and groceries, and at workplaces. The National Association of Chain Drug Stores claims retail pharmacies could deliver 100 million COVID-19 doses in 30 days. Even if this is over-optimistic, other existing private entities could make up the balance. Governor Justice attributed West Virginia’s ability to administer over 70 percent of the vaccine they received to utilizing local pharmacies and health departments.
Fourth: Be flexible. Allowing providers to exercise judgment and deviate from the rules has allowed Israel to outpace the rest of the world in COVD-19 vaccinations. Israeli providers broke up the Pfizer 1,000 dose trays into smaller dose lots that can be more easily used by small providers and in more remote areas. Unlike American vaccinators who discarded excess vaccine after they had used the prescribed five doses per vial, Israelis used windfall sixth and seventh doses from overfilled vials. And Israelis vaccinated additional people out of prescribed order, rather than waste vaccine.
Finally, be prepared to mandate vaccines for workers who are in regular contact with vulnerable elderly and sick people. There are disturbing reports that some staff in medical and long-term care facilities are refusing vaccinations. Many hospitals and long-term care facilities require staff to be vaccinated against the flu. There are no statutory or constitutional barriers to employers requiring vaccination against communicable diseases as long as accommodations are made for people with medical contraindications or legitimate religious objections. If staff continue to refuse to protect the people in their care, these facilities should impose COVID-19 vaccination mandates.
President Biden’s goal of increasing vaccinations is laudable, but we need not spend a lot of money to accomplish it. Let’s try these five simple steps.
