Donald Trump’s About to Botch the COVID Vaccine Rollout
by DAVID AXE
Rolling out a coronavirus vaccine, which looks closer than ever after promising results from Pfizer were announced this week, was going to be tricky no matter what.
The process is in even more trouble under lame-duck, election result-denying Trump. While Democrats and experts have been sounding the alarm on how delaying the transition process could impact everything from national security to the budget, experts say the interregnum could send vaccine distribution off the rails.
While the U.S. Food and Drug Administration approves vaccines, the Centers for Disease Control and Prevention decides who gets them first, and how. That’s especially important when it comes to the novel coronavirus, which has disproportionately affected rural and minority communities that, in many cases, are hard to reach.
“The vaccine must go to those most vulnerable, to those most likely to suffer severe consequences, to those most exposed, and to those most likely to spread infection,” Jeffrey Klausner, a professor of medicine and public health at UCLA who previously worked at the CDC, told Angry Planet.
The CDC has a plan for doing just that. The agency uses a “social disadvantage index” to identify the neighborhoods, towns, and reservations that should be first in line.
But the CDC’s distribution plan requires funding, close supervision, and clear, consistent messaging from authorities in order to get people to the nearest clinic, and quickly. And Lawrence Gostin, a Georgetown University expert on public-health law who’s worked with the WHO and CDC, said he’s worried about what happens when a president isn’t paying attention — or actively seeks to foment chaos on the way out.
“I could see him thwarting widespread and equitable distribution of the vaccine,” Gostin told Angry Planet.
Neither the White House, the FDA nor the CDC responded to a request for comment.
Storage is a key sticking point in any vaccine-distribution plan. Rural areas and communities of color tend to lack the cold storage required by the leading vaccine-candidates, including the messenger-RNA vaccine that Pfizer is developing.
Distribution of a very cold vaccine has “never been done before in this country,” as Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, told Angry Planet. The CDC is encouraging remote rural clinics to install freezers, but each freezer costs up to $15,000. Many clinics in poorer communities can’t afford them.
Anticipating a shortage of cold storage, Pfizer has developed special dry-ice shipping containers to help keep vaccine doses viable while they’re on the road or sitting around in a clinic with no freezer. The containers will keep the vaccines at -100 degrees Fahrenheit for 10 days.
But handling these containers is sensitive business. Once opened, the containers can be used for two weeks, as long as someone refreshes the dry ice every five days. But re-icing has to be fast. The boxes can be open only for a minute at a time no more than twice a day.
Experts said a vaccine rollout between now and Jan. 20 might not get the level of care it needs with the government firing officials left and right and the president’s own son embracing vaccine truther-dom.
“When Pfizer did its trials, it was very careful to make sure the sites doing it knew what they were doing” with the frozen doses and special containers, Offit said. “When we enter a real-world situation … will it have the same level of supervision?”
Communication is another looming problem. It’s one thing to develop, ship and store a vaccine. It’s another thing entirely to convince people to get vaccinated in numbers great enough to make a difference on a population level.
There, too, the CDC under a lame-duck Trump very well might drop the ball, experts say — especially in states with big rural and indigenous populations
“I think the biggest concern for Alaska will be how much vaccine we can receive, what the prioritization will look like from CDC, and how readily Alaskans roll up their sleeves to get vaccinated,” Tom Hennessy, a University of Alaska epidemiologist, told Angry Planet.
“If we need to get to 60 percent of the population to be immune to stop the pandemic, then we need a safe and effective vaccine in good supply, with a high degree of public trust to get to that goal,” Hennessy added.
But increasingly “CDC” and “public trust” aren’t words you hear together. For months, the CDC and the FDA have repeatedly caved — or appeared to cave — to political pressure from the White House.
The CDC was slow to get behind masks as an effective defense against the coronavirus. The FDA granted emergency-use authorization to unproven therapies, such as hydroxychloroquine, after Trump and allies touted the drugs. It took the FDA weeks to push back against Trump’s claim that a vaccine would be ready by the Nov. 3 election.
The lack of public trust in health agencies, and the slim chance that Trump will reverse that distrust while his focus is almost entirely on contesting the election, could have dire consequences for America’s most vulnerable communities.
The CDC “will remain dysfunctional until there is a change of leadership,” argued Otto Yang, an expert in infectious diseases at UCLA. But any change of leadership is two months away, on the far end of a likely tumultuous lame-duck period for Trump.
If there’s an upside to the chaos and neglect that seem likely to define the last two months of Trump’s pandemic-response, it’s that the incoming Biden administration is already preparing its own, much more comprehensive strategy.
Biden has long promised to pay closer attention to his own science advisors and free up qualified agency leaders to implement science-based plans. “The newly elected administration will make decisions based on science and evidence and for this reason I am more hopeful than I have been since the pandemic began,” Alberg said.
“There is a lot of hard work to be done and the changes will take time, but at least we are headed in the right direction,” Alberg added.
But if the U.S. pandemic-response might improve starting with Biden’s inauguration on Jan. 20, the intervening weeks of confusion — especially as they impact a delicate vaccine approval and distribution process — could cost thousands of Americans their lives.
“Given the Trump administration’s continued failure and the ineptitude of the current federal health leadership at the cabinet and agency levels including at CDC, expectations should be low,” Klausner said.
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