Margaret Fisher, a special adviser to New Jersey’s health commissioner, has grown accustomed to saying no — no to people vying for vaccines, no to businesses jockeying to reopen and no to anyone asking for predictions about when this plague might end.
But with more vaccine supply on the way, the pediatric infectious-disease specialist is familiarizing herself with a new word. “We’re hoping for a flood by April, and we will be enthusiastically ready to say, ‘yes,'” Fisher said.
State and local health officials who have spent months rationing shots are now racing to be ready for a surge in supply — enough for every adult by the end of May, as President Joe Biden promised last week. They’ve been advised to plan for between 22 and 24 million doses a week by early April, an increase of as much as 50% from current allocations, according to two people familiar with the estimates who spoke on the condition of anonymity because they were not authorized to discuss them.
Biden on Wednesday said his administration would purchase another 100 million doses of Johnson & Johnson’s single-shot vaccine. The doses, expected to be delivered in the second half of the year, will position the country to inoculate children and provide booster shots if needed against new variants of the virus.
“If we have a surplus we’re going to share it with the rest of the world,” the president said during an event with pharmaceutical executives promoting his administration’s efforts to equip states with the supplies they need to end the pandemic.
Preparing for the expanding supply, state and local health officials said they want to avoid the obstacles that hindered the early rollout, as doses sat on shelves, sign-up systems crashed and eligibility rules confounded the public. The challenge is that all three problems persist to a degree, deepening questions about whether they will be able to navigate the next phase of the country’s immunization campaign.
The stakes are arguably higher today, with the effort to stem spread of virus variants and a new president who has made the pandemic his central focus. Enlarged supply will intensify pressure to address yawning racial gaps that have opened in early vaccination data. And holes in coverage, whether of homebound seniors or people in homeless shelters, may become all the more glaring when there are more doses to go around.
More supply also will bring new challenges, chief among them addressing people’s hesitancy to get the shots, which could suppress demand and make it more difficult to achieve the high levels of immunity needed to stop the disease’s spread. States and other jurisdictions also need to have enough sites to receive the vaccines, as well as staff to administer them, record patient data and monitor for possible side effects.
“States are pulling out all the stops,” said James Blumenstock, senior vice president for pandemic response and recovery at the Association of State and Territorial Health Officials.
The central issues, he said, remain staff, space and stuff — with stuff simply meaning the pharmaceutical product. The most vexing limitation, he said, “is still, and always has been, the stuff.”
Of 1,773 providers enrolled to administer vaccines in New Jersey, nearly 1,500 of them have yet to be tapped because there hasn’t been enough supply, Fisher said. Each of the state’s six vaccine mega-sites has additional capacity. And residents ranging from retired nurses to pharmacy students, she said, stand ready to act as vaccinators.
Minnesota is poised to double the number of mass vaccination sites it is operating, said Kris Ehresmann, the state’s director of infectious-disease prevention. And the governor, Democrat Tim Walz, recently signed a bill into law allowing dentists to administer coronavirus vaccine doses.
Envisioning more supply in a period of scarcity involves some mental gymnastics, Ehresmann said.
“We’re trying to be thoughtful around prioritization,” she said. “But the more you prioritize, it limits the flow of vaccine in the system. And there’s going to come a point in next few weeks where you’re like, ‘Hey, there’s all of a sudden tons of vaccine.'”
When that happens, state leaders vowed, they won’t be caught by surprise. Fifteen new mass-vaccination clinics, four of them mobile, are anticipated in Ohio, where Gov. Mike DeWine, R, said the state’s large hospital systems also have the capacity to expand. “We think we’re ready to go,” he said. “As fast as this vaccine comes into Ohio, we’re going to be able to get it out.”
In New York City, where multiple sites are already operating 24 hours a day, officials on Tuesday said they were seeking 2,000 additional staff to administer vaccine doses and provide other support, with recruitment kicking off in some of the hardest-hit communities, including Staten Island and the Bronx.
In some places, the challenges of preparing for a surge in supply are compounded by changed plans about where it will go.
Under a new system headed by the insurance giant Blue Shield, California is sending 40 percent of all doses to its most vulnerable neighborhoods — part of an effort to immunize residents at greatest risk of the coronavirus and reopen the economy more quickly. Paul Simon, chief science officer for the Los Angeles County Department of Public Health, said he wasn’t sure whether the change would require the county to shuffle providers.
“We’ll need to get vaccine out quickly, and so I think some of the big health-care systems that are already in the network can receive increasingly supplies,” he said.
But ensuring that expanded supply reaches hard-hit groups requires foresight, he said, and not simply dumping more doses at mass sites or with major hospitals. He said the county plans to expand the number of mobile units capable of reaching into vulnerable communities, as well as “strike teams that can go out into various locations and vaccinate quickly.”
To counter inequities, Washington state has reserved 20% of its appointments for those unable to sign up online, said Gov. Jay Inslee, D, but that requires staff to work the phones. “We will have to increase our dedication to those efforts, particularly for folks where there is some reluctance,” he said.
States and local jurisdictions aren’t scaling up on their own. As of this week, the federal government is supporting more than 700 vaccination sites, according to a Federal Emergency Management Agency senior leadership brief reviewed by The Washington Post. That includes 16 mass sites across five states, with additional centers planned for Ohio and Georgia.
It also is directing more vaccines each week to retail pharmacies, as part of a program devised under the Trump administration but launched only last month. Of approximately 133,000 vaccine providers nationwide, about 53,000 are pharmacies.
From big cities to small towns, pharmacies have been on hiring sprees. CVS alone set a target late last year of hiring 15,000 employees and now has the capacity to conduct as many as 20 to 25 million vaccinations a month, according to people familiar with its operations.
Administration officials see the direct allocations to pharmacies as central to scaling up the vaccination effort. But the program has been a source of consternation for some state officials. Governors bruised by unexpected changes to their allotments early in the rollout have been eager to tout increased allocations and to exercise control over the distribution of vaccines in their communities.
To ensure that states have visibility into the location of vaccines routed directly through pharmacies, the federal government recently built more detailed figures about different distribution streams into Tiberius, a vaccine-tracking software, according to a federal official familiar with the development. One sign of states reaching their capacity, officials say, is when they start offloading doses onto pharmacies.
That hasn’t happened yet. And a torrent of vaccines still sounds good in New Jersey and other states.
“We’ve been waiting for more for a very long time,” Fisher said.
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The Washington Post’s Lena H. Sun contributed to this report.