The vaccine rollout is failing — is it time to call in the troops?

If we assess the vaccine rollout against our goal of vaccinating as many people as possible in a systematic and equitable way, then the early days of this endeavor have been a failure. States, working through their local health departments and hospital systems, are ill equipped and under-resourced to manage a massive vaccination effort. The result has been confusion, with Americans unsure of whether they are able to get a vaccine and, if so, how to go about doing so. We hear reports of vaccines that are expiring, with states administering only a fraction of what they have been allotted, and other reports of long lines beginning to queue as early as 3 a.m.  

One major concern around performance has been Operation Warp Speed promising 20 million vaccinations by the end of last year, yet less than 4 million actually being given. Facing criticism from policymakers and the public on the slow pace of vaccinations, and acutely aware of the mounting cases and deaths, some experts are recommending we follow the U.K.’s lead and change the vaccine protocol by giving more people the first dose by delaying the second. This misguided approach fails to address the rollout problem at its root cause. 

The issue isn’t vaccine supply. Rather, it is the process of getting “shots in arms” and addressing the problem with how the vaccines are being deployed, while following the science and maintaining vaccine protocols. Changing the protocols will not get us out of this mess.  

Many members of the public – and even some health professionals – have expressed concern about the speed in which it has been authorized. To address these concerns, there has been an unprecedented effort in inspiring confidence on its safety and efficacy, with mixed success. When we start suggesting that now we should change the dosing schedule from three to four weeks to three to four months between injections, or give a half dose rather than a full dose, or mix and match the different vaccines,  we don’t inspire faith in the data. We already face an attack on science. Why do well-designed studies, if we are going to change protocols based on hunches?  

Let’s be honest. We don’t know with certainty if there is adequate and durable immunity after just one dose. There’s a scientific reason for the spacing based on immunology principles. And how do we know that halving a dose actually works? We can’t, because these approaches were never studied in clinical trials. Because these proposed changes are not how the trials were designed, we could be doing much more harm than good by instituting them. People may think they are getting protection, but that may not be the case. We can’t say for sure. Worse, with variants becoming a major concern, we don’t want to be jeopardizing immunity based on educated guesses. 

Understandably, these suggestions are being driven by the grim statistics on the ground. The virus is surging, and deaths and hospitalizations are at an all-time high in many places. But rewriting vaccine protocols on the spot is misguided, particularly since the issue is not lack of supply but how we are utilizing the supplies we currently have. With only a very small percentage of available vaccines being used to date, we don’t need to worry about halving doses or spacing them out. What we need to do is to plan on getting the vaccines we already have into people’s arms.  

Have we learned nothing from the problems we experienced with testing? It took many months before “anyone who wants a test can get a test.” In some places, that’s still not true. We do not have the time to work out the kinks for the vaccine rollout.

President-elect Biden’s plan to vaccinate 100 million people over 100 days is a lofty goal and a massive undertaking. To meet it, we require planning, coordination and execution – skills that the military does well. Just as the National Guard is called in at times of natural disasters, it’s time we utilize their expertise. Instead of debating dosing schedules, let’s talk about the use of school buildings, parking lots and convention centers to serve as vaccine hubs. It’s frankly impractical to think the health care system, which is already at the breaking point dealing with the consequences of COVID infections, can effectively manage this type of massive effort. 

The current problems we are seeing with expired vaccines being discarded, and long lines of seniors waiting hours outside or in their cars, is only going to get worse if we don’t fix the problem now. It’s time to do what we promised, and follow – not change – the science.