Here we are, at the end of February 2021, reaching a goal that was to have been met in December 2020—to fully vaccinate 20 million Americans. How did we get here? At today’s Congressional Health Subcommittee Hearing on The Path Forward on COVID-19 Immunizations, Dr. Ashish K. Jha provides perspective on the America’s vaccination roll out thus far and details how we can improve vaccine distribution in the months ahead.

Some crucial points from Dr. Jha’s testimony:

Americans have experienced immense suffering and lost hundreds of thousands of lives because of missed opportunities and critical failures:

• The failure to test adequately and reduce viral transmission

• The failure to prevent hospitals from exceeding capacity and turning away patients

• The failure to get vaccines into arms efficiently, as soon as they became available.

But there is good news: we have two highly effective vaccines approved and a third likely to be approved today. Vaccinations are getting into arms. We are seeing drops in infections and deaths. And we know that controlling this virus requires ongoing screening testing, social distancing, masking and other steps until we can relax measures and build back lives and livelihoods.

Fast Discoveries, Slow Vaccine Roll Out

America developed highly effective vaccines with history-making speed only to be totally unprepared to then vaccines into vaccinations. 

The Trump Administration invested  $12.4 billion in Operation Warp Speed to develop and manufacture vaccines — investments that ultimately led to the Emergency Use Authorizations for the Moderna and Pfizer-BioNTech vaccines (although the Pfizer/BioNTech vaccine was not part of OWS) 

But the Trump Administration largely ignored the role the federal government must play in the equitable and efficient distribution of vaccines, failing for months to either directly invest in infrastructure to distribute vaccines or to support state efforts to do so. This left states vastly unprepared—short on staff, with an exhausted public health workforce and no concrete plan for implementation. 

The roll out of vaccines was disorganized through much of December and early January, until Congress stepped in and authorized resources, and states started implementing distribution plans. Since then, vaccine distribution and administration have started to improve. And, under the Biden Administration support and coordination from the federal government is much improved.

As of February 24th, 2021, roughly 79 million doses have been delivered and 66 million doses administered. About 19 million individuals have been fully vaccinated, representing 6% of the population. These numbers fall far short of the Operation Warp Speed targets of 20 million fully vaccinated Americans by the end of December of 2020. 

State by State: Lessons & Disparities

With states left on their own, vaccine distribution has varied widely. In Connecticut, 7.6% of residents are now fully vaccinated and 16.3% have received at least one dose. But in other states, like Utah, only 4.6% of residents are fully vaccinated and about 11.1% have received one dose.

States also vary in how efficiently they are using their vaccine supplies. In New Mexico, over 98% of doses delivered have been administered and in West Virginia, over 96% of delivered doses have been administered — compared with Alabama, which has only administered 73% of doses delivered. 

And just as the COVID-19 pandemic has disproportionately affected racial and ethnic minorities, such as the Black and Latino communities, these disparities persist with vaccine distribution. 

While we don’t have data from all states—to this day, states are not required to collect and report vaccination data by race/ethnicity—the latest statistics from the CDC illustrate the ongoing disparities. More detailed demographic data is available for about 50% of all administered doses, and it shows that only 5.8% of vaccinations have been administered to members of the Black community despite their 12.7% share of the U.S. population. In contrast, 65% of vaccinations have been administered to non-Hispanic whites.

The complexity of scheduling vaccination appointments also undermines equity. Online portals to schedule vaccinations frequently crash, preventing people who are eligible but with less time or digital skills from scheduling an appointment. The digital divide leaves too many without high-speed internet access at all. And, when appointments do become available, they are often offered at times that are difficult for essential workers to attend.

Moving Forward

To move forward, we must respect and strengthen the state-federal partnership: our country’s public health system depends on it. State governments can take the lead, with the federal government providing technical and financial support. It will require commitment and contribution from both sides.  
Equity must be the reality and not just the aspiration in vaccine distribution. That means targeting communities disproportionately impacted by COVID-19 through pop-up and mobile clinics, engaging people in their communities with grassroots education and inoculation programs with trusted leaders and organizations, and collecting and publicizing racial and ethnic demographic data on vaccine rollout to better understand progress and implement solutions. 

And we must learn from the successful state models. We must promote clear and consistent public health guidance and invest in distribution infrastructure, including mobile clinics and other innovative approaches. Equally important is balanced state-led decision-making with local agencies, and streamlining user access to vaccination.

And lastly, we must maintain robust safety monitoring to ensure vaccines are safely and effectively meeting the challenge of this pandemic. 

We are closer to the finish line than we’ve ever been, and it is thanks to evidence-based tools that we know work: wearing masks, washing hands, social distancing, and safe and effective vaccines. We need to work with our friends, our families, and our neighbors to encourage trust in what is likely the greatest scientific achievement of our lifetime. 

If we are able to come together as a nation, we will soon end this pandemic and be able to look back on this period as a testament to the unique and powerful strength, ingenuity, and resilience of the American people.

February 26, 2021