Biden's gamble on COVID-19 vaccines depends on a lot going right

WASHINGTON — President Joe Biden has promised Americans they can sign up for COVID-19 shots by May 1 and return to a semblance of normal life by Independence Day. He's gambling that his administration can make it happen — and he will bask in the achievement or suffer the consequences. Success will require coordination among federal and local governments, industry and, most crucially, citizens themselves. "It's a risk politically, but it's very important for politicians to level with the American people," said Ali Mokdad, a professor at the University of Washington's Institute for Health Metrics and Evaluation. "But you have to give the people hope. You have to tell them that if they get the vaccine and wear a mask, yes, we will open our country." Vaccine supply from companies including Pfizer, Moderna and Johnson & Johnson is projected to surge in coming weeks, with enough for every American before June and millions coming beyond that. But the nation must channel the tsunami. Even now, many Americans must wait in long lines, while others stumble through wonky appointment websites. Authorities must expand access without letting the vulnerable get elbowed to the back of the line. The vaccine-hesitant must be converted. "Is this high risk, high gain? I don't think so. I actually think they're being extremely careful," said former Health and Human Services Secretary Donna Shalala. "So far, they've been overperforming." The best way to blunt the virus's force is to protect those most in danger. People 65 and older account for about four in five pandemic deaths. About 65% of them have gotten at least one shot, but the cost of not finishing the job would be enormous. Meanwhile, Black Americans, who also have died disproportionately, have gotten far fewer shots per capita than their white counterparts. "It needs to be a coordinated action, where not only are you pumping in vaccines, but you're also strengthening local infrastructure," said Arnold Monto, an epidemiology and public health professor at the University of Michigan who also advises the Food and Drug Administration on vaccines. The risk of failure is greatest in Democratic-dominated states. Democrats are nearly twice as likely to seek a COVID-19 shot as Republicans, and the more of them you have, the larger the task. In New York, New Jersey and California, appointment postings still vanish within minutes, suggesting many at-risk residents remain in the queue. In New York, 56% of the population wants a vaccine, even though 28% have already had one, according to a Massachusetts Institute of Technology survey last month. In Tennessee, only 40% still want a shot. "Some states will have faster timelines than other states," White House Press Secretary Jen Psaki said at a briefing Friday. Speaking about the July 4 target, Psaki said the president still doesn't envision packed concerts or sports stadiums for a while. "It is a baby step toward that, and our team felt confident that we could get to that point." Jeff Zients, Biden's COVID-19 response coordinator, signaled Friday that the U.S. could steer additional doses to places more able to handle them. Shots are now sent separately to states, pharmacies and community health centers, and one of those streams could expand at the expense of the others. "The allocation that we'll make on a going-forward basis will be based on performance of the different channels," he said at a briefing Friday. Even with limited eligibility, the vaccine rollout has already been marked by crashing websites, accidental overbookings and general confusion. Appointments are booked across dozens of different platforms, from simple party-planning sites to the Byzantine multipage arrangements that require users to verify they aren't inoculation-seeking robots. Many have seen problems with the volume of traffic. Microsoft Consulting Services apologized last month after its platform was behind crashes on a Washington, D.C., government site. Now, states must decide when to open these wobbly systems to more people. Those with soft demand face the easiest choices. Even before Biden's remarks Thursday, Gov. Ron DeSantis had said that Florida was likely to open general access to vaccines in April. Utah's Spencer Cox said every adult would be eligible April 1. In Alaska, open season has already begun. "When supply comes, we we will be in a good position to move it," said Joseph Kanter, a Louisiana Department of Health official. "Where the work is cut out for us, we know, is to help build vaccine confidence." In February's MIT survey, about 71% of Americans said they want a vaccine or have already gotten one, up from just 57% at the start of December. But urgency may fade if people think broad vaccinations mean they don't need a shot themselves — and a stubborn cohort remains, many of them Republican. Former President Donald Trump didn't get publicly vaccinated like Biden, Vice President Kamala Harris and former Vice President Mike Pence. He was the only ex-president absent from a public service announcement released Thursday to encourage Americans to get the vaccine. Even if Biden's May 1 pledge seems feasible, he can't ultimately control state policy or vaccine production, and will likely take the brunt of the blowback if the deadline is missed. He also, of course, can't control the virus itself. Data from testing company Helix suggest that the highly contagious B.1.1.7 variant first identified in the U.K. is dominant in states including Florida and Texas. The U.S. is still posting about 10,000 deaths a week, and at current levels of vaccine rejection, there's no guarantee it will reach true herd immunity soon, if ever. But it is plausible that America will reach one key milestone by Independence Day: 100 deaths a day, which is the approximate average daily toll of influenza in a typical year. COVID-19 deaths are expected to reach that level around June 26, according to the University of Washington institute. "We need to be humble in the face of Mother Nature — we don't understand all the things that can happen in the next 12 months," said Andrew Noymer, associate professor of population health and disease prevention at the University of California Irvine. "I think we can have a normal July 4, and probably will have a normal July 4. But that's not a watertight guarantee. ___ For more articles like this, please visit us at bloomberg.com ©2021 Bloomberg L.P. Distributed by Tribune Content Agency, LLC