Joe Biden's Big Goal On Vaccines Will Need To Get Even Bigger

"100 million shots in 100 days" works fine as a slogan, but herd immunity sometime in 2021 will likely require an even quicker pace.

A hundred million shots in a hundred days.

President-elect Joe Biden’s signature pledge for fighting the coronavirus pandemic dates back to December, a time when it felt audacious and maybe even a little brash given that the COVID-19 vaccines did not have federal approval yet. More than a month later, the goal still seems lofty, given all the well-publicized stories of confusion, delays and shortages from across the country.

But the pace of vaccination in the U.S. has picked up since the start of the new year. When Dr. Anthony Fauci, the nation’s top infectious disease expert, assured the public this weekend that Biden’s goal is “absolutely a doable thing,” he may have actually understated the case.

Nobody is taking Biden’s goal for granted, and nobody should. It would still represent progress. But getting the nation back to something resembling normality in the next year will require an even quicker pace of vaccination. And that won’t be easy.

Why Getting To A Million A Day Would Be An Achievement

The math is reasonably straightforward. A hundred million shots over the next hundred days, as Biden has promised, works out to 1 million shots per day. That’s higher than the current rate, although the gap is much smaller than it used to be.

As of Tuesday, the seven-day average for vaccines administered was 807,000, according to tracking by Bloomberg News. That average has been mostly rising since December, when the two vaccines now in use, one from Moderna and one from Pfizer-BioNTech, first got federal approval.

The average rate could easily hit Biden’s goal of 1 million a day sometime in the next few weeks ― if current trends continue.

“Something many of us thought was aspirational now seems a lot more likely to happen. But we shouldn’t stop there.”

- Amesh Adalja, Johns Hopkins Center for Health Security

That’s still a big “if,” to be clear, because of all the problems still plaguing the rollout. One is an inconsistent supply, both from the federal government to the states and from the states to local providers. This past week, providers everywhere, from New York to Texas, had to cancel appointments because they didn’t get the number of shots they expected.

The process of administering vaccines in nursing homes and other types of long-term care facilities is also taking time ― and goes a long way toward explaining why so many states have large portions of “allocated” vaccines that haven’t yet gone into arms.

Michigan, which is one of the few states to break out long-term care figures clearly, is a case in point.

As of Monday, 563,000 of the state’s vaccine allocation had not been administered. That’s a bit more than half of its total. But 188,000 of that unused supply isn’t actually under Michigan’s direct control, according to state officials. It’s earmarked for long-term care staff and residents, to be delivered by CVS and Walgreens as part of a federal partnership.

The pharmacy chains have said they need about 12 weeks to finish vaccinations at long-term care facilities, a timeline that puts completion sometime in March. Smaller states, such as West Virginia, have managed to vaccinate their long-term care populations more quickly, mostly by relying more heavily on independent pharmacies. But the dominance of the chains in more densely populated parts of the country means that sort of strategy wouldn’t make a big difference in most larger states.

Why Getting To A Million A Day Wouldn’t Be Enough

Against the backdrop of these and other challenges, and given how long it took the Biden transition team to get critical COVID information from the outgoing Trump administration, getting to 100 million doses in 100 days would represent an achievement. But it still would not mean the U.S. is on track to get the pandemic under control this year.

Again, it’s a question of math. There’s no fixed figure for “herd immunity,” but it likely means vaccinating somewhere between 200 million and 275 million Americans, which works out to 400 million to 550 million shots, given that both Moderna and Pfizer-BioNTech require two doses. There would be progress along the way, as greater vaccination would reduce the spread of disease, but the U.S. population would not get to herd immunity until sometime in 2022.

Meanwhile, a novel strain of the virus is spreading more quickly than the version that’s been circulating for the past year, making the need for vaccination even more urgent.

“The 1M/day for 100 day US plan isn’t fast enough,” physician and writer Eric Topol wrote earlier this week on Twitter.

A new vaccine from Johnson & Johnson could expedite the process, because it requires just one dose. But approval is at least weeks away and quite possibly months, depending on the result of clinical trials, which is why accelerating the vaccine pace likely depends on intervention from Biden and his team.

The COVID-19 response plan he released last week suggests that he is already thinking along those lines. It calls for the Federal Emergency Management Agency to run mass vaccination clinics, for example, and envisions creating a 100,000-person public health workforce that would reinforce staff at state and local health departments. That could make a big difference, since right now those departments are overwhelmed trying simultaneously to handle testing, contact tracing and vaccines.

Although the details on each of these proposals remain thin, the overall message is clear. Under Trump, the federal government largely handed administration off to the states without providing the resources they needed to do the job. Under Biden, the federal government will get more directly involved in planning and, where necessary, distribution ― and it will make sure governments at all levels have the money they need.

Just how much difference that will make remains to be seen, which may be one reason Biden’s team isn’t raising expectations now that its original goal is within reach. And after a year of the Trump administration wildly overpromising on the vaccine, under-promising has a certain logic to it.

But getting the rate of vaccination well above a million shots a day feels pretty essential ― for the future of Biden’s presidency and, more important, the lives of countless Americans. It doesn’t have to happen right away. But it can’t take too long either.

“Something many of us thought was aspirational now seems a lot more likely to happen,” Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, told HuffPost. “But we shouldn’t stop there.”

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