In medical centers and hospitals, in pharmacies, in schools and even on baseball fields, from Monday to Sunday and at holydays, the vaccination campaign in the United States has accelerated to administer nearly three million daily injections. Since it began in December, 101.8 million people (30% of the population) have received at least one dose and, of these, almost 58 million are already fully vaccinated. News of States that broaden the range of citizens who can opt for inoculation are frequent, reinforcing this feeling that, at last, the pace of this long and painful crisis is changing: New York began with thirty-something last week and will do so with those over 16 as of this Tuesday; Texas has already expanded coverage for any adult and most states will do so before the end of April.
“I do not know of any expert in medicine, virology or vaccines who could have predicted that, in a single year, we would have three effective vaccines and there would already be hundreds of millions of people vaccinated in the country. It is something miraculous and surprising, ”explains by phone Dr. Robert Wachter, head of the Department of Medicine at the University of California.
The United States, which failed to contain the virus and has already exceeded 550,000 deaths, has made a demonstration of scientific and economic power in the vaccine race. The keys to success today combine multiple and diverse factors, ranging from the multimillion-dollar injection of the federal government, which dared to share risks with the pharmaceutical industry, to a law that allows intervention in the production of factories dating from the Korean War, through unnatural alliances of rival companies. And including some individual contributions as made in USA like that of country star Dolly Parton and, incidentally, an icing on “America First” in trade policy.
The so-called Operation Warp Speed (whose name refers to the fantasy, taken from science fiction, of traveling at speeds greater than that of light) has been, even for the experts most critical of Donald Trump, a success of the Republican Administration within erratic management of the pandemic. It basically consisted of giving more than 10 billion dollars to a group of pharmaceutical companies to research and develop these vaccines, with colossal pre-purchase agreements without any guarantee of efficacy. For Amesh Adalja, an infectious disease expert at the Johns Hopkins Bloomberg School of Public Health, “that is probably the factor that has made the biggest difference between the United States and many other countries, even though the United Kingdom and Israel are vaccinating faster. The government secured doses of a vaccine when they still did not know if they would work and some are not even approved by the United States Drug Administration (FDA, in its acronym in English) ”.
In July, for example, the Executive announced an agreement to purchase 100 million doses of the vaccine developed by Pfizer-BioNTech for 1.95 billion dollars, with the option to buy 500 million more. Moderna’s is the one that has received the most public funding. Promoted in collaboration with government researchers, it obtained 955 million dollars for its development and 1,500 million for the manufacture, distribution and delivery of 100 million doses. (It is in this one that Dolly Parton also put her grain of sand). The Administration provided Johnson & Johnson with more than 450 million for development and 1 billion for production and distribution, with an order for 100 million doses included in that amount. Astrazeneca and Oxford injected 1,200 million for research, production and preorder of 300 million doses. To Sanofi and GSK, 2,000 million. To Novavax, 1,600 million. These last two are still pending to achieve their first vaccine on the market.
“This could all have been a scandal if the vaccines hadn’t worked, but it worked out well,” says Dr. Wachter.
A law of the Korean War
The first batches were manufactured with the help of the Defense of Production Act, a rule that dates from the Korean War (1950) and that grants the president of the United States the power to force companies to accept and prioritize contracts necessary to national defense. The pandemic prompted the White House to invoke it, first to speed up the production of masks and then to secure certain materials for the production of the vaccine.
Even so, the first phase of distribution was disappointingly slow. The Trump Administration had pledged to end 2020 with 20 million immunized citizens, and the number barely exceeded 2.5 million. What experts call “the last mile of vaccination” failed, that is, the stretch that goes from the vaccine to the vaccinated person. “There was a lot of emphasis on purchasing, but then the distribution to the States was not well planned, nor the personnel nor the financing necessary to administer it,” says Professor Adalja, from Johns Hopkins.
With the new Democratic Administration, inaugurated on January 20, the United States stepped on the accelerator. On the one hand, it reinforced aid to the States and multiplied the federal vaccination centers and opted for the network of local pharmacies; on the other, the system as a whole and the authorities had learned to do better after the first few months. Shortly after arriving at the White House, Moderna announced that it could deliver 200 million doses by the end of May, a month ahead of schedule.
Additionally, Biden’s team made two crucial decisions. He again used the Defense of Production Act to make it easier for Pfizer to obtain the necessary machinery to expand its Kalamazoo, Michigan, plant and pressured a J&J supplier to work against the clock and recover the delay that the company was accumulating for the jam in the packaging part of the product. It has also sponsored a unique alliance between this company and its rival, Merck, for the latter to help manufacture the vaccine the former. According to Merck, the Government will help with 269 million dollars to adapt its facilities.
100 million doses
President Biden defined this agreement between competitors as “the kind of collaborations that we saw in World War II. The 100 million doses that he promised in his first 100 days in the White House, a calculatedly cautious forecast, reached the arms of Americans weeks ago and he will probably fulfill those 100 days in office getting double what he promised, 200 million doses. . He believes that there may be vaccines for everyone at the end of May and that July 4 will be something more than the commemoration of the Independence Day of the United States, the birthday of this country: he hopes that it will serve to celebrate the independence of the virus.
In this optimistic scenario, pressure is mounting for Washington to help countries with supply problems. The United States administers the Pfizer, Moderna and J&J vaccines, although it has millions of doses of AstraZeneca, which has not yet been approved by the FDA. Dr. Anthony Fauci, director of the Institute of Allergology and Infectious Diseases and a reference advisor for Trump and Biden, estimates that the United States could meet their needs without resorting to AstraZeneca units. For now, the Government will export 2.5 million of them to Mexico and 1.5 million to Canada, its neighbors and partners in the trade agreement signed in the North Atlantic Treaty.
Biden has pledged to provide financial support to other companies, such as India’s Biological E, to manufacture more, in an agreement announced at the Quad Summit, a virtual meeting to address this issue in which the United States, India, Japan and Australia participated. .
Vaccine diplomacy has not, so far, gone much further. “If we have a surplus, we are going to share it with the rest of the world,” Biden said last March. “First we are going to make sure that we can take care of the Americans, but then we are going to try to help the rest of the world,” he added.
At the current cruising speed, immunization of Americans could reach 90% by the end of July, although risks and challenges remain. “We still find 20% or 25% of the population reluctant to the vaccine, we also see specific failures in the system [como los 15 millones de dosis de J&J arruinados esta semana por un error humano] and we are supplying the vaccine during bank hours, when we should do it in 16 and 18 hour days. This is a race against the virus and its variants, “says Gregory Poland, director of the Mayo Clinic’s vaccine research group, who is also an advisor to several pharmaceutical companies. “The other problem,” he adds, “is that each state does it differently. In his opinion, “the idea of going from phase to phase and from group to group is intellectually attractive, but what you need is the more first doses in the arms, the better.”
The fatigue of this long year of pandemic and restrictions poses the last danger. Vaccination is not progressing as fast as the desire for normality and infections have risen again – at a rate of 65,000 cases a day last week – close to the peak of last summer, while many states have begun to relax restrictions.