The Second Shot Squeeze

It's a key milestone on the path towards giving Americans access to the first such shot to work in a single dose. According to the Food and Drug Administration, which reviewed the company's trial results, the vaccine was seventy two effective in the US based trial arm of its global study. The f d A found the vaccine to be effective against severe disease and said it worked better against mutant

coronavirus strains then previously reported. New York City health officials said six per cent of the city's coronavirus cases are due to the UK variant, which is believed to be more contagious. While that number is higher than officials liked. They said the number has remained steady in recent weeks. Meanwhile, the city's middle school students will return to the classroom on Thursday, bringing New York one step close to a

semblance of normalcy. Since the pandemic shuttered many school buildings for nearly a year. High school buildings will remain closed. Finally, the Czech Republic is preparing to impose a stricter lockdown to prevent the collapse of its medical system. So far, the government's measures have failed to contain one of the

fastest spreading and deadliest outbreaks in Europe. Almost exactly a year after the first COVID nineteen case appeared in the country, the crisis is worse than ever and the situation requires a tougher response, according to Prime Minister Andre Babish. And now for today's main story. Almost a month after US vaccination campaigns ramped up to give COVID nineteen shots to more than a million bull of day, their second doses are now coming. Do that's putting a strain unstated rollouts

and leaving some people without complete immunizations. I spoke to John Tozzi, who told me that as President, Joe Biden accelerates purchases and distribution, critical weaknesses in the system are starting to show. With vaccine rollout firmly underway, many Americans have begun to receive their first shot of a COVID nineteen vaccine, which is certainly a success, but I want to know has prioritizing getting that first shot too Americans meant that the US is now in trouble of making

sure people get their second dose of the vaccine. Well, I wouldn't say that we're necessarily in trouble, but there have been some challenges, as everybody kind of knew there would be with the two dose vaccine. You know what

we've seen in the last couple of weeks. I mean, really, when you look at the vaccination campaign, the initial rollout didn't really hit its stride until kind of the middle of January, on the middle and end of January, when we were sort of beginning to consistently deliver a million

doses or more a day. And what happened in February is that now all those people who were who were getting their first doses in January are due for their second shots either three or four weeks after the initial vaccination. So it's sort of created this um new pressure on the supply while there are still many millions of people who haven't gotten their first dose. So we've seen in a couple of places that this has just led to

some complications and challenges. And so let's let's walk through some of the science behind the two doors the two dose vaccine here in terms of say the Fieser or the Madarna vaccine. You know, what is the timetable that is recommended between the first and second shot and why is that timetable perhaps so important? So in the clinical trials that the drugmakers used to study these vaccines, uh last year, the Fiser shots were spaced three weeks apart

and the Madernal shots were spaced four weeks apart. And I'm not an expert in the science, but my understanding is that, you know, the sort of first dose kind of prompts an initial immune reaction, and then the second dose seals that it makes it more stronger and more

durable and more effective. That's that's our our understanding. Um. So those are the timetables that were used in the trials, and because they're what we're used in the trials, that's what's recommended that doesn't mean that if you get your second door, so the Fiser vaccine twenty two days later rather than twenty one days later, it's not going to work. Right.

There's you know, there's flexibility, and the CDC has actually said, I mean, the CDC has said people forget their doses on the recommended time frame, but if not, up to six weeks is sort of an acceptable range where things should be okay. There's some other evidence from other research that, particularly with the astra Zeneca vaccine in use in the UK,

that um, you know, longer time frames may be acceptable. So, you know, we're kind of dealing with this situation where what was studied in trials is now um you know, which is a very controlled situation, is now in a more um you know, in the real world. You can't always reach people at the precise interval or the supply may up be there. So I think the public health world is trying to figure out kind of how how

to handle that. Yeah, and I mean, certainly the very difficult logistics of administering a two dose vaccine are becoming evident, and to what extent are we seeing the perhaps necessary effects are necessary consequences of trying to make the decision between whether to hold back some supply of vaccine to guarantee people can get a second dose of a vaccine versus prioritizing getting as many people a first dose as possible and not worrying perhaps about supplies of the second

dose until later. Is that kind of what we're starting to see in the real world the effects of that

that decision. Yeah, I think to some extent, if you go back to the middle of December, when the vaccines were first being delivered, UM, the government held back half the supply, in fact, initially even more than half the supply to make sure there would be uh second doses available in time, because they were very concerned about, you know, whether there was kind of manufacturing, reliable manufacturing to to make the new supply. Then in January, Uh, that kind

of shifted. The US had more confidence in the manufacturer's ability to kind of reliably make new supply of of the vaccines UM, and there was a real urgency to get the public vaccinated because cases were so high, um and climbing so quickly. Uh, certainly in December and January, so you know, we we move from holding back a second dose reserve to now second doses are you know, as as best as we can tell, being supplied more or less out of uh, you know, newly manufactured vaccines.

And I think there were some states that have you know, and and some facilities that have their own you know, reserves that may kind of cover them for a certain period out. But you know, it's no surprise that if we if we are not holding reserves, that at some point there are trouble getting enough doses to the right

place at the right time. You know. We talked to a hospital system in Michigan where they actually had to cancel appointments for second doses last week because they did not get the allocation that they expected from the state UM. And I think those situations are incredibly common. But you know, if it's if it's your second dose that you're waiting

on UM and obviously matters matters to you. Yeah, And I mean this brings up kind of a question of maybe across the board numbers, you know, we're we're hearing about how more and more Americans are able to be vaccinated UM as we moved through February and into March. But what kind of data is available thus far about say, the number of Americans who have been able to get their second dose and even more specifically, their second dose

within the recommended timetable for their vaccine so UM. As of today Wednesday, according to the CDC website, about forty four forty five million Americans have gotten at least one dose, and about twenty million of them um have gotten both doses,

so a little less than half. Just to keep in mind, you know, many of those people, you know, people who just got their vaccine in the last three or four weeks, they're not due for their second dose yet, right, so you'd expect the number to be UM to be to be a lower. We don't have a clear sense of how many people are sort of overdue for their second dose.

The CDC has said that most people are getting it in the recommended three or four week intervals, and that only a small percentage is sort of beyond the six week time frame that they've kind of identified as the you know, the sort of upper or outer limit. You know, we don't have hard numbers around that we know from from Texas earlier this month, even before the storms, there there were um several thousand people who were who were overdue a lot of states don't seem to be tracking this.

I think it may be something that it will take a few weeks or even months to sort of understand with better data. You know, how many people got one dose and then for whatever reason, did not get or weren't able to get a second dose on time. We have heard about whether a second shot of these two dose vaccines, say fives or maderna, is actually necessary at all, and and that you're you're good to go, You're protected

enough after receiving your first shot. What is what are some of the arguments there, you know, I think the argument against that, against stretching doses or or you know, only going uh for one dose of the vaccine is that the trials were done with two doses, and and that is what the evidence shows offers protection. Now, we do know from the trials that there is some protection after the first dose, you know, because the people in

the trials um got two doses. We don't have good evidence over how long that that immunity might last, you know, how durable it is. You know. So in the US, certainly, UM the authorities are not recommending skipping the second dose or stretching out the interval beyond you know what's indicated. You know, we know that other countries have been experimenting with that and doing that the UK. I think we're beginning to get some evidence from some of those situations.

But in the US, the decision has been not to try and stretch the supply by only giving people one dose. And you know, I heard the CDC director UM Rochelle Lensky yesterday on a congressional panel. She got a similar question, and she said, if the if the drug makers had found, you know, a durable immunity after one dose, they would have much preferred to have a single dose vaccine is easier, it increases the supply. UM. You know, so there's a

reason that that two doses were used in the trials. UM. You know, for people who are we're trying to reach and UM protect against the virus, particularly priority populations like healthcare workers and you know, elderly folks, people in nursing homes. UM. You know, the idea of UM stretching the doses. Uh, it's not what the US authorities are recommending. Right now. As we move forward through the vaccine rollout in the States,

you know, we are seeing kind of an ever changing eligibility. UM. More and more states are opening up restriction is to allow more of their populations to get their first dose. I mean, to what extent are you expecting that the logistical hurdles of making sure not only people can get their first shot, but their second shot on time? I mean, how much are you expecting that this is going to just become more complicated and potentially more problematic as we

continue through the vaccine rollout. Um, It's hard to say. I think, you know, one really good news item on the horizon is that the Johnson and Johnson vaccine, which is being you know, considered by the FDA this week for emergency authorization, is a single dose. You know, if that is authorized as as it's expected to be, you know, that is a much simpler and much faster way to

immunize people. You Know. The other thing is, I think the systems and just the sort of infrastructure around vaccination has been improving. You more people are getting vaccinated. UM, I think some of the you know, I T systems and you know, booking websites like that's still pretty chaotic in some places. And you know, we certainly heard from people who went in for their first dose and then we're not given an appointment for their second dose and

had trouble booking it a little bit. I think that's still going on, but I don't think it's hard to say whether it's going to get worse or whether it's gonna get better. I think, you know, as we increase the volume of vaccinations and increase the supply, you know, hopefully some of these things will will become smoother in time. That was John Tozzi, and that's it for our show today.

For coverage of the outbreak from one bureaus around the world, visit Bloomberg dot com slash coronavirus and if you like the show, please leave us a review and a rate it on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by Tophur foreheads Magnus Hendrickson and me Laura Carlson. Today's main story was reported by John Tozzi. Original music by Leo Sidrin. Our editors are Rick Shine

and Francesca Levi. Francesco Levi is Bloomberg's head of Podcasts. Thanks for listening.