As Massachusetts hopes of vaccinating almost everyone by the end of the summer, Dan Barouch, MD, PhD (Center for Virology and Vaccine Research, BIDMC) noted that the shortages could continue for a while.

Boston Globe – January 28, 2021

State’s hope of vaccinating almost everyone by the end of summer depends on a lot going right

Massachusetts’ hope of vaccinating almost everyone by the end of the summer — a national target set by President Biden this week — depends on a lot going right.

Not only will the federal government have to find a way to crank up supply, but the Baker administration will have to dramatically step up its game in getting shots into arms. Based on the current pace of weekly shipments of the two-dose vaccines — and the large quantity of surplus doses sitting in freezers — the state would still be vaccinating residents late into the year, and possibly into 2022.

But analysts tracking thepipeline expect the supply will expand in the coming weeks and months. Biden has promised to boost state vaccine supplies from both vaccine makers Pfizer-BioNTech and Cambridge-based Moderna by 16 percent starting next week. And health officials say a third potential vaccine, a single-shot regimen developed by Johnson & Johnson and Beth Israel Deaconess Medical Center, could become available as soon as February.

For residents eager to be inoculated and eventually return to normal life, a bigger bottleneck may be Massachusetts’ struggle to master the formidable logistics of mass vaccination. So far, less than half of the 1,108,975 Pfizer and Moderna doses shipped to the state have been injected, according to federal data updated Thursday by the Centers for Disease Control and Prevention.

“We’re only using half of what we’ve been given,” said David Williams, president of Health Business Group, a Boston management consulting firm. “It’s not an excuse to say because supplies are slow, we can just sit back. We should assume there’ll be more supply, and we owe it to the citizens of Massachusetts to be ready when it comes.”

With the potential addition of new vaccines, from Johnson & Johnson and others, some analysts project the United States could have enough doses to vaccinate almost everyone by Sept. 30. That’s roughly in line with Biden’s stated goal of fully vaccinating 300 million Americans by the end of the summer.

Governor Charlie Baker hasn’t committed to a firm timetable to complete the program; in fact, Baker’s three-phase plan runs only through June. “As the federal vaccine distribution program kicks into high gear over the next few months,” he said in his State of the Commonwealth address this week, “anyone who wants a vaccine will be able to get one at a site near them.”

But as complaints about the state’s balky rollout have mounted, officials are opening scores of new injection centers, including seven mass vaccination sites, to speed the state’s progress. The expansion comes as much larger populations become eligible for shots, including seniors, essential workers, and residents with chronic health conditions. About 1 million residents are now eligible for bookings, the governor said.

Baker said the vaccination sites will have the capacity to deliver 300,000 doses weekly by mid-February, though that is farmore than the state expects to receive from the federal government in the next couple of weeks.

Already, there are signs of shortages at the new vaccination sites even while hospitals and pharmacy companies have hundreds of thousands of unused doses.

Legions of residents over 75 were unable to book vaccine appointments through a patchwork system cobbled together on a state website Wednesday, the day registration began. And, doctors’ offices said they had no shots to give. Atrius Health, a network of more than 700 doctors, e-mailed patients saying it “has not yet received sufficient vaccine supply from the state, and we are unable to begin scheduling our patients 75 and older.”

Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, who helped develop the experimental Johnson & Johnson vaccine, said the shortages could continue for a while.

“The short-term future of our country in the next few weeks is going to be extremely challenging” because there aren’t enough vaccine doses available to meet the national demand, Barouch told theNetwork for Excellence in Health Innovation in a webinar Wednesday.

But he was optimistic that more doses will be coming from more drug companies soon after that and said the “long-term future is bright.” With two vaccines already created and cleared for emergency use in less than a year, he added, vaccine development for COVID-19 “is proceeding faster than for any pathogen in history.”

Biden administration officials are negotiating to buy 200 million more doses fromPfizer-BioNTech and Moderna. They’re also awaiting results, expected by early next week, from the large-scale clinical trial of the Johnson & Johnson vaccine. Both developments could accelerate the flow of COVID-19 vaccines into Massachusetts and other states.

One industry watcher questioned whether the United States will even need additional doses from Pfizer and Moderna if the Johnson & Johnson vaccine is authorized for emergency use next month.

“J&J claims to have a lot of production capacity. We could use that,” said Alan Carr, an analyst at Needham & Co.

The US government has committed to buying 100 million doses of the Johnson & Johnson vaccine as part of a $1 billion deal involving the federal program Operation Warp Speed. The government has an option to buy another 200 million doses under a separate agreement. To date, it’s agreed to purchase 200 million doses of the Moderna vaccine and 200 million doses of the Pfizer-BioNTech vaccine.

Taken together, the government has purchased or has the option to buy enough COVID vaccines to vaccinate 500 million people, far more than the entire US population. Scientists estimate that 80 to 90 percent of American adults would need to be vaccinated — around 300 million people — to defeat the virus by achieving what’s known as “herd immunity.”

But uncertainties remain. No one knows what the results of the Johnson & Johnson trial will show. And there are no guarantees of success: On Monday, another drug giant, Merck, halted work on its own COVID-19 vaccine, citing inadequate immune responses.

A fourth potential vaccine may also be on the horizon, according to Biden’s new White House task force on COVID-19. In its first press briefing on Wednesday, the committee said pharmaceutical firm AstraZeneca and the University of Oxford will likely provide results of a late-stage US trial of the two-dose vaccine in March.

For states, the challenge remains efficiently administering the vaccine doses they receive. So far, the bulk of shipments to Massachusetts have gone to hospitals and pharmacy companies that have run vaccine clinics at long-term-care facilities. But hundreds of thousands of vials remain in freezers. An unknown number have been reserved as second doses for people who’ve had their first injection.

Starting next week, when the second phase of the vaccination program launches, shipments will go to more sites — some managed by contractors such asCIC Health and others by local public health agencies — and greater numbers of residents will be demanding shots.

The task will be not only assuring there’s enough vaccine, but also hiring enough vaccinators and making the sites accessibleto residents, including those in low-income communities.