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Cindy: You're listening to The Takeaway. I'm Cindy Rodriguez, investigative reporter with WNYC news in this week for Tanzina Vega. Good to be with you. The big question facing Americans right now. How can we get COVID-19 vaccines to more people faster. While we know the development of effective COVID 19 vaccines happened faster than even many experts predicted, now that these vaccines are ready for distribution, the rollout has been bumpy to say the least. According to the CDC, more than 17 million vaccines have been distributed across the United States as of Tuesday morning, but less than 5 million of those vaccines have actually been administered.

From state to state, distribution has varied widely. Only a handful of states have administered more than half of the vaccines they've received while more than a dozen have given out less than 25%. US Surgeon General, Dr. Jerome Adams spoke yesterday about the vaccine rollout on The Today's Show.

Jerome: I really want to tell people that three things we're doing. Number one, we're going to increase funding. More funding. We're going to make sure that congressional funding that was appropriated gets to the states. More locations. We went from 1000 locations the first week to 12,000 locations now, and more priority groups. Your headline today really should be Surgeon General tells states and governors to move quickly to other priority groups. If the demand isn't there in 1A, go to 1B and continue on down. If the demand is in there in one location, move those vaccines to another location.

Cindy: The question for today, how can the US turn things around and quickly get vaccine distribution on track?

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Here with me is Dr. Amesh Adalja, an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security. Thanks for coming on The Takeaway, Doctor

Amesh: Sure. Thank you for having me.

Cindy: Doctor, let's start with hospitals. They were rightly given priority for the vaccine, but now they're getting blamed for the slow rollout and for not vaccinating workers fast enough. You work at several hospitals. Can you give us a look into what's happening there?

Amesh: You got to remember that there's no such thing as a hospital worker whose only job is to vaccinate people, so what hospitals are doing are pulling people with other jobs to run a COVID vaccination clinic and these COVID vaccines are not the same thing as giving employees tetanus shots or hepatitis B shots or influenza shots. There's a lot involved. The same hospitals that are tasked with responding to an inordinate number of patients are being asked to vaccinate.

There's a lot of precautions that they have to put in place. They've got to set up timings for people to be vaccinated. They've got to find a place to vaccinate people in a place where people can stay 15 minutes after they're shot in case they have an allergic reaction. They have to be in close proximity to an emergency department in case a severe allergic reaction happens. It just takes some time to scale this up. Hospitals don't have the resources to do this in a rapid-fire manner. I think they shouldn't be blamed for this.

They're being actually tasked to do something where the government really has failed because there was not much planning done for that last mile of vaccination. It fell to hospitals to set up their own programs and their own prioritization and all of that. It's not surprising to me that there's been lags and delays, but it is speeding up and I do think that the answer here is more resources.

Cindy: What could hospitals do with those more resources?

Amesh: If hospitals had more resources, they could have vaccination basically happening 24/7 instead of at specific times, they could vaccinate more people at a given time instead of having certain slots for people to come to be vaccinated. They would have other people to be able to monitor people after their vaccination so if there is an allergic reaction, it's not the same people that are giving the vaccine that I have to keep their eye on who's around in the room that might be having an allergic reaction.

All of that would make vaccination more seamless and faster, but some of the slowness is because this vaccine is available on an emergency use authorization, and that requires forms, consent, and checking that consent to make sure it's all accurate. All of that does take time, which is very different than when you go to get a flu shot at employee health at a hospital. They basically just jab you as soon as you walk in the door.

Cindy: You yourself have had your first dose, is that correct?

Amesh: Yes.

Cindy: Have you witnessed any reluctance or skepticism?

Amesh: In one of the hospitals I'm on staff at, there's a lot of misinformation being spread amongst certain members of the healthcare staff, including nurses and doctors, where basically every conspiracy theory that you've maybe seen on social media is getting repeated in the hospital hallway. Yes, that does happen. In my experience, it's been a really minimum of people and not something that's generally reflective of what healthcare workers think of this vaccine, but clearly the anti-vaccine movement and all of those conspiracy theories, the healthcare workers are not, unfortunately, immune from it and that has played a role trying to combat that misinformation with facts.

Cindy: Doctor, how do you balance the need to prioritize health care workers and the elderly with also just getting as many people vaccinated as possible who want the vaccine?

Amesh: You have to remember that the overall goal is to get all the eligible populations vaccinated so that this public health emergency is behind us. We crossed the herd immunity threshold and hospitals are not inundated. There is a reason for the priority scheme though, in order to get the vaccine into people where it will have the biggest impact fast, and that's healthcare workers, nursing, home residents, and then moving through other priority groups.

You have to remember that we can't be dogmatically wed to that and if that schedule is an obstacle to people getting vaccinated, if it's causing hospitals consternation on how they're going to vaccinate and how they're going to deal with excess doses, maybe they've unfrozen a lot more doses than they needed that day and they've got some that they're going to either throw out or give to somebody that's not priority group 1A, the answer there is to give it to somebody who's in another priority group. You have to remember, the overarching goal is to get people vaccinated and we can't let an overly bureaucratic process stymie that goal.

It's not right for governors and other politicians to try and penalize hospitals for doing the best they can. I think that's the most counterproductive thing I've heard of is fining hospitals or decreasing their application if they're going outside of the priority group because the goal is always going to be to get the shot into people's arms.

Cindy: Who would be the next priority group, would it be people with pre-existing conditions, for instance?

Amesh: Overall the CDC says priority group 1B would be people that are above the age of 75 years of age, as well as front-facing workers, so meatpacking plants, or in grocery stores or transportation workers. That's the overall phase 1B, but some states are saying we're going to go to maybe above age 65. There is some variation from state to state, but it's generally people that are going to be dealing with the general public, but they're not healthcare workers as well as people of advanced age, because we know they have a high risk for severe complications.

Cindy: Are there states that have done a particularly good job so far?

Amesh: Well, if you look at States and the number of doses that they've allocated North Dakota, South Dakota stand out. They were places that got hit very hard most recently, and they seem to be rolling out their vaccine at a faster pace than many other states. Some states only maybe 15% of their doses have been allocated. Again, that may be a lot of the idiosyncrasies of each state and you likely will see things homogenize soon as states start ramping up and getting things in order. I would say in general, no state is doing the best job. Everybody could do better and we have to do better in order to put this epidemic/pandemic behind us.

Cindy: What are you looking for the Biden administration to do? What can be done to speed things up?

Amesh: The Biden administration can ensure that States have the funding. There was a funding bill passed on Christmas Eve, but it's also just trying to understand what's going on in each state and meeting states where they are. Some States may need different types of help. I think that's going to be important, is having the CDC step into its role of being this coordinating body for the states and allowing the public health response to really be fine-tuned by the CDC, adding its expertise to what's going on in each state.

I think it's also the case that we need more guidance on what to do when you have leftover doses and nobody left in the priority group. Yesterday the CDC did have a press conference or a meeting where they did talk about the fact that the goal is not to have vaccine in the fridge but into people's arms, and we shouldn't be wasting doses or doing anything like that. That type of work, that kind of leadership of how this vaccination program should go would be very useful.

I also think the federal government should think about trying to help coordinate mass vaccination sites, especially as we get into the community-dwelling people, people who aren't in hospitals or nursing homes, who are relatively easy to vaccinate, the people who live at home. Can they be done at stadiums? Can they be done at convention centers? Can we use old school gymnasiums? During H1N1, I got vaccinated at an old school gym. Can we start doing that to make things move much more seamlessly and faster borrowing from what Israel is doing, which is the country that's leading the world in vaccinations.

Cindy: You mentioned H1N1. I'm wondering if there's lessons from past vaccine roll-outs that we could be using right now.

Amesh: We did learn from the 2009 H1N1 pandemic, but I think we're still making some of those same mistakes. Knowing the past, there's these really legendary stories of vaccinating the entire population of New York City with the smallpox case. I think that's from a bygone era where people were able to do things in a much more orderly fashion than we can do today.

Cindy: Back then was there much less skepticism? I mean, the vaccine has been so politicized at this point.

Amesh: The vaccine hesitancy and anti-vaccine Movement has been around since the late 1700s with the first vaccine, the vaccine against smallpox, that Edward Jenner created that also created the Anti-vaccine Movement. They've always been around, but I think in the 1940s, in the 1950s, you have a different era where science was respected, where people hailed Jonas Salk as a hero and had ticker tape parades for him when the polio vaccine was announced.

Today, when a new vaccine is announced, the first thing you find are conspiracy theories and people don't run and embrace vaccines the way they did in earlier eras. I think we should embrace vaccines the way we embrace a new iPhone release that everybody is excited, everybody's lining up, everybody wants to have this great piece of technology, but I think we're far from that era. I think that that's also a part of it, that we know that not everybody's going to take this vaccine because of so much misinformation out there and it is hard to be able to combat it all, especially because the anti-vaccine movement is so organized and they are so proactive.

We in the medical community tend to be very reactive and keep shooting down arbitrary assertions from the anti-vaccine movement rather than actually presenting the positive case for the vaccine.

Cindy: For those of us who do want the vaccine, when can we expect it for the general public?

Amesh: The general public, I suspect likely have access to the vaccine in the summer is when if you have no risk factors, if you're an average risk person, that you'll have access to it. You may see some of that coming out earlier in different states, depending on how the priority groups are. Remember, states are allocated based on their adult population. Some states have more or less of the other priority groups, so you may get it earlier. I am hearing about people getting it early because they're hanging around hospitals, where hospitals have extra doses and they're giving them, but I think for the most people to get, it's going to be the summer.

Cindy: Dr. Amesh Adalja is an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security. Thank you so much, doctor.

Amesh: Thank you for having me.

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