How Trump Left The Country With No Real Vaccine Distribution Plan

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January 22, 2021 2:57 p.m.
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Millions of Americans would be getting vaccinated by early 2021, bringing the COVID-19 pandemic to its final end, the Operation Warp Speed official promised.

“We’re on track to deliver hundreds of millions of doses by January 2021,” Paul Mango, the official, told reporters on an Aug. 13 press call. 

The Trump administration, we now know, would fail spectacularly to meet that goal.

Repeatedly, officials passed up chances to use the federal government to get vaccines into the arms of Americans, or to help the states responsible for disseminating the shots finish the so-called “last mile” of distribution — the critical final steps before the vaccines are injected into patients’ arms.

The Biden administration is now confronted with a serious problem: how to pick up the pieces and build a new, federally managed vaccination effort starting, virtually, from scratch.

TPM has for months tracked the myriad failures in the effort to plan and fund distribution, speaking with state and local health officials who have been lobbying for such a plan since spring 2020.

It’s a vexing problem, and one that comes after the Trump administration decided that once Operation Warp Speed delivered the vaccines to the states, it was entirely up to the states how they reached patients.

“It is up to the States to distribute the vaccines once brought to the designated areas by the Federal Government,” then-President Donald Trump said last month.

That left the country without a national vaccination strategy — and instead with a mosaic of 50 states, each going its own way to solve a national problem, many struggling with exhausted staff, underfunded programs, and a lack of logistical expertise.

The magnitude of the problem became painfully clear in December 2020. The Trump administration set a goal of vaccinating 20 million people by the end of the year, a task that would require 40 million doses of the vaccine. Yet only 16 million doses reached the states, and, of those, only 2.1 were injected into patients.

But the story of how the Trump administration fell so far short of even its own targets and left the Biden administration to pick up the pieces can only be understood through the lens of promises like those given by Mango and others over the summer, which envisioned the production of massive quantities of vaccine without a thought for how they were to be distributed.

No money, lots of problems

The problems first started to emerge in the months after the passage of the CARES Act last year. The Act included $27 billion for vaccine development, but not a penny for distribution.

As the year wore on, the pandemic strained local public health departments, depleting them of staff, cash, and the ability to plan for a vaccine that — for much of 2020 — could have been anywhere from months to years away.

None of that was reflected in Operation Warp Speed, the Trump administration’s program for accelerating vaccine development.

That program — by shoveling huge amounts of public money at a number of vaccine developers and guaranteeing to buy the supply of those that didn’t receive tranches of cash — did succeed in helping to spur the fast creation of COVID vaccines.

But there was scant attention paid to what would ultimately happen to the vaccine, once it arrived.

High expectations crash into reality

That was laid bare by the chasm between expectations set by the Trump administration and the reality.

One Operation Warp Speed official said on a July call that the military was planning “every detail for every contingency” in distribution.

“I hope the American public can be reassured — I don’t see how we can work details more than we have been to address all of these different contingencies based on the vaccine,” the official said. 

Others boosted the amount that would be available.

On an Aug. 28 call, Mango said that the program’s “objective” was to “deliver tens of millions of doses of vaccine before year’s end.”

But details of how the shots would be distributed never came fully into focus.

In September, CDC Director Dr. Robert Redfield said that the agency had around $600 million to distribute to help with the effort, but that billions more would be required.

But even out of that $600 million, only $340 million was ever distributed in 2020. The first tranche of that went out to the states in September. Congress, too, repeatedly failed to pass new funds, with abortive negotiations starting and stopping through the summer and into the fall.

But it wasn’t just a lack of money confounding states. “They didn’t provide guidance of this is how you could do it,” Josh Michaud of Kaiser Family Foundations told TPM earlier this month. “That was left mostly to states — that piece, designing the actual implementation.”

Instead, the focus throughout the summer and fall stayed on approving the vaccine in time for the November 2020 election.

“We think we can start sometime in October, so as soon as it’s announced, we’ll be able to start,” Trump said in September of distributing the shot.

That effort failed. And when the first large-scale clinical trial data came back in November showing that Pfizer’s and Moderna’s shots were overwhelmingly effective, it was cause for celebration — and for boasting, with the administration calling it a “modern-day miracle.”

The country had a vaccine.

But even then, the cracks were showing.

Nearly a quarter of states, Rachel Levine, then Pennsylvania secretary of health and now assistant secretary for health in Biden’s Department of Health and Human Service, told Congress in December, had seen serious problems when they conducted mock distribution scenarios to plan out what they’d do with their shipments.

Trump administration officials had quietly moved back from the summer estimate of “hundreds of millions” of doses distributed by January to a more modest goal: 20 million vaccinated by the end of the year.

How many doses are there?

No money had yet been distributed to the states to get the shots into arms by Dec. 14, the first day that vaccinations began across the country.

Various groups representing the states and immunizers had demanded in October that Congress pass $8.4 billion for the states to distribute the shot.

“I don’t want to know what would happen,” Clare Hannan, head of the Association of Immunization Managers, told TPM in October about the consequences of no money being allocated to the effort. “That funding should have been provided already.”

But it didn’t come to be until late December, when President Trump signed a bill into law that appropriated $8.75 billion for the effort. That money is still filtering its way down to the states.

The money came far too late to avoid serious problems at the local level. Public health departments were unable to hire vaccinators in time, while some have been forced to reassign staff that would be running COVID testing or contact tracing and to vaccination duty at the expense of those programs. 

End-game

Destined for two static populations — nursing home residents and front-line medical workers — the first wave of vaccinations was supposed to be the easy part.

It was also, TPM found, the only part that the Trump administration planned in any detail, engaging in a partnership with CVS and Walgreens to send employees of the pharmacies into nursing homes to vaccinate the residents.

By planning only the first part of the first phase, the Trump administration left the Biden administration to start from square one planning  the more complex, mass vaccination phases.

What’s more, the pharmacy partnership has run into serious roadblocks. In Illinois, only 20 percent of doses allocated to the pharmacy partnership have been administered, while West Virginia, which opted out, has vaccinated all its willing long-term care residents and staff.

Serious problems in federal distribution have also stymied the rollout.

Under the Trump administration’s system, states only learn of their final allocation totals the day before they receive the shipment.

That’s meant slower vaccination as state officials struggle to plan for mass vaccinations on incredibly short notice.

It’s also meant that state problems in getting doses into people’s arms obscured a more central failing: the Trump administration did not distribute the amount of vaccine that it promised it would by the end of the year, sending around 16 million to the states by Dec. 31.

Even that amount, thanks to the fluctuating totals, was difficult for many state public health officials to handle.

“We’re just hoping for the best,” Guilford County, North Carolina Public Health Department chief Iulia Vann told TPM in early January, saying that her county never had a clear idea of how many shots it would receive. “We try to put a little bit more appointments on the schedule than the doses that we have and the number of people that we have reached out to, because we know that not everybody is going to come out and get vaccinated.”

More broadly, it’s raised the question of how many doses of vaccine the Trump administration left the country with.

Pfizer accused the Trump administration of leaving “millions of doses” idling in storage in December. When confronted with the failure to distribute 20 million doses by the end of the year, Trump officials parried by saying that an additional 20 million were being held in reserve.

Under enormous pressure due to the vaccination campaign’s plodding progress, Operation Warp Speed officials said that they would release the extra doses.

But even that, it appears, was a lie. In its last days in office, the administration had exhausted its supply.

Kate Riga contributed to this story. 

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