• The Star Staff

States told to vaccinate everyone 65 and over as deaths surge


By Sheryl Gay Stolberg and Abby Goodnough


The Trump administration, racing a surging COVID-19 death toll, instructed states on Tuesday to immediately begin vaccinating every American 65 and older, as well as tens of millions of adults with medical conditions that put them at higher risk of dying from coronavirus infection.


The federal government will release all available doses of the vaccine instead of holding about half in reserve for second doses, Alex Azar, the secretary of Health and Human Services, said, adding that states should start allowing pharmacies and community health centers, which serve largely poor populations, to administer the shots.


The announcement came as COVID-19 deaths have soared to their highest levels in the pandemic, and the incoming administration of Joe Biden has promised a far more aggressive, federally driven vaccination effort.


The announcement came with a cudgel: States will lose their allocations, Azar warned, if they do not use up doses quickly. And starting in two weeks, state vaccine allocations will be based on the size of a state’s population of people 65 and older, not on its general adult population. It was unclear, however, whether that would hold past Jan. 20, when Biden takes office.


“This next phase reflects the urgency of the situation we face,” Azar said. “Every vaccine dose that is sitting in a warehouse rather than going into an arm could mean one more life lost or one more hospital bed occupied.”


Biden’s transition team had said just days ago that the incoming administration would release almost all doses from the government’s reserves. Azar responded at the time that doing so would jeopardize the system set up to ensure second doses would be available.


Tuesday’s reversal reflected the slow start of the vaccine rollout, though the pace has picked up considerably over the past week. Some states, including Florida, Alaska, Michigan and Texas, have already begun vaccinating people 65 and older — who number more than 50 million nationwide — leading to long lines and confusion over how to get a shot.


The new policy could exacerbate that confusion. Many states have been following their own carefully laid timelines for getting the vaccine to various priority groups — including teachers, emergency responders, grocery store employees and other types of essential workers, whom Azar did not mention in his announcement.


The Centers for Disease Control and Prevention recommended last month that after vaccinating health care workers and residents of long-term care facilities, states should vaccinate people older than 75 and certain “frontline” workers who cannot do their jobs from home. Only after that, the CDC advised, should states turn to people ages 65 to 74 and adults of all ages with high-risk medical conditions. The CDC recommendations were not binding, but many states have largely been following them while demand still far exceeds supply.


An advisory group that came up with the recommendations had emphasized that essential workers were often low-wage people of color, who had been hit disproportionately hard by the virus.


“A lot of our members are feeling like this is just beginning to move too fast,” said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials. “What we’re going to get to is a first-come, first-served approach to vaccine distribution, and that’s just not going to be equitable.”


How Azar’s enforcement threat will work is unclear; in two weeks, Biden will already have been sworn in as president.


Biden is expected to announce details of his own vaccination plan — which will include federally supported mass vaccination clinics — this week. The Biden transition team declined to comment on Tuesday on the new Trump policy. But a person familiar with the president-elect’s plans said Biden had also been planning to expand the universe of those who are eligible to be vaccinated.


Nearly 380,000 people have died from COVID-19 in the United States since the start of the pandemic. In recent days, the number of daily deaths in the country has topped 4,000.


As of Monday, about 9 million people have received at least one dose of a COVID-19 vaccine, the CDC said, far short of what the federal government initially promised. At least 151,000 people in the United States had been fully vaccinated as of Jan. 8, according to a New York Times survey of all 50 states. But Azar said Wednesday that the country was “on track” to reach the rate of 1 million vaccinations a day in a week or so. He said the perceived delay in using up doses is at least partly because of slow data collection.


The idea of using existing vaccine supplies for first doses has raised objections from some health workers and researchers, who worry that front-loading shots will raise the risk of second injections being delayed. Clinical studies testing the vaccines showed the shots were effective when administered in two-dose regimens on a strict schedule. And while some protection appears to kick in after the first shot, experts remain unsure of the extent of that protection, or how long it might last without the second dose to bolster its effects.


But others have vocally advocated explicit dose delays, arguing that more widely distributing the partial protection afforded by a single shot will save more lives in the meantime.


New guidelines released on Monday by the CDC now note that while people should get their second shots “as close to the recommended three-week or one-month interval as possible,” there is “no maximum interval between the first and second doses for either vaccine.”


The update perplexed experts, who said that while other, previously licensed vaccines that involve multiple doses could be administered months or even years apart, no evidence yet exists to clearly support this strategy for COVID-19. “They will need to back this up with data,” said Marion Pepper, an immunologist at the University of Washington.


Health officials in Britain are now allowing intervals between the first and second doses of Pfizer’s vaccines of up to 12 weeks. Last week, the World Health Organization said the injections could be given up to six weeks apart.


In response to queries about dose delays, representatives from Pfizer and Moderna have repeatedly pointed to the company’s clinical trials, which tested dosing regimens of two shots, separated by 21 days for Pfizer and 28 days for Moderna.


“Two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95%,” Steven Danehy, a spokesman for Pfizer, said this month. “There are no data to demonstrate that protection after the first dose is sustained after 21 days.”


On Tuesday afternoon, Kristen Nordlund, a spokeswoman for the CDC, said the agency’s guidance would allow “flexibility” as the vaccine rollout continues.


But, she added, “We are not trying to promote delays of the second dose as a strategy to get more people vaccinated with the first dose.”

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