[music].

Brian: Brian Lehrer on WNYC. It took less than a year to develop a coronavirus vaccine. That was supposed to be the hard part, but it turns out the logistics of getting actual shots into people's arms have been a lot more challenging. The rollout of the vaccine has been a mess, as we all know, and the Biden administration is inheriting a dysfunctional system in which state governments, for example, get so little advanced notice about the number of vaccine doses they'll receive that they barely have any time to plan their vaccination campaigns.

Will this jeopardize the president's goal of 100 million vaccinations in his first 100 days? Why is the new criticism of the Biden plan that 100 million in 100 days isn't aggressive enough? With me now is Caroline Chen, healthcare reporter for ProPublica, who we have taken to calling their vaccine correspondent. Hi, Caroline. Always great to have you with us.

Caroline: Hi, pleasure to be on show again.

Brian: 100 million vaccinations in 100 days. Is it possible, based on what your reporting might indicate?

Caroline: It is possible, at least according to what Pfizer and Moderna are contracted to supply to the US government, it should definitely be more than possible. They're supposed to supply 100 million doses each by the end of March. We should have the supply to do that, technically. Honestly, we really should be getting to that level of vaccination if we are to curb the pandemic. I think it's a good goal to have.

Brian: From what I've read, the Trump administration was already getting 800,000 to 900,000 doses a day out there. That's in Leana Wen's column in The Washington Post today. Is a million a day for 100 days actually not ambitious enough? It's not that much more than 800,000 or 900,000 a day. Some critics are starting to ask, "Is it ambitious enough?"

Caroline: I think there's a difference between what's allocated, what's distributed out there, and to what's actually getting into arms. I think what's really tricky and what's been a stumbling point is that there has been doses that have managed to get out into the public, two states, but have sat on shelves. I think as every stage has been difficult, of course, as you said, we've gotten vaccines, that's great. Then there has been the distributing them to the states, and then now we have to get them into people's arms. To me, honestly, it's good to have this goal. It would be great if we could exceed it. I would just like to see vaccines getting into arms and I'm not too fussed about specific numbers.

Brian: The Biden administration announced yesterday that it's going to try to boost vaccine production through an executive order that he signed yesterday to use the Defense Production Act. That's one way. Is it clear to you what he's actually ordering what companies to do? That's my understanding of the Defense Production Act, it uses federal power to tell companies in the private sector, "You have to do this because it's a national emergency."

Caroline: Yes. There are parts of this that include things like making sure that there are needle syringes as the right amount. The government is providing these kits that get sent along with the vial. The manufacturers are providing the vials that have the actual vaccine. The government is also sending along to the states kits that have things like the syringes, the alcohol swipe, pads, what else is in there? A little bit of PPE. For example, the syringes for the Pfizer vaccine. We now know that originally, they thought they were going to have five doses per vial. It turns out that you can get six doses out of each of them.

The actual syringe, you want to make sure that it's, I think, long enough to be able to get the full amount of available dose out of each vial. Making sure that you don't have any shortfalls. Any of this ancillary supply, as well, is really important because you wouldn't want to have the vials but not have enough syringes. Really when you think about a vaccination campaign, there are so many components to it. Even for the vaccine itself, you need to have enough glass bottles for the vials. You need to have enough paper for the labels. There's so many components to it that people are not thinking about often.

Then along with that, there is personnel. Obviously, that doesn't have to do with the defense production aspect, but something that I noticed in his plan is he has talked about bringing in FEMA to also help operate more sites so that there's going to be many, many more locations that people can get their vaccinations from. So many different components to organizing a campaign.

Brian: Listeners, we can take some vaccine and vaccine rolled out logistics questions for Caroline Chen, healthcare reporter for ProPublica, who's been covering vaccines. 646-435-7280. If you have a question or a story that you think might contribute her reporting, you'll take tips from our listeners, right, Caroline?

Caroline: I'll take as many tips as you guys have.

Brian: 646-435-7280. There's some calls are coming in. "Last week, the Mount Sinai Health System here in New York canceled vaccination appointments for people aged 65 and older, those who were able to sign up. What happened there, and is it known how many appointments were canceled at Mount Sinai or a city-wide or even statewide?"

Caroline: I don't have an exact number for Mount Sinai, but we know that it's not a Mount Sinai problem. The story that we published this week, I'm really losing track of time here. I've published two vaccine stories this week. It's called How Operation Warp Speed Created Vaccination Chaos. You can find that on our site at ProPublica. To me, I want to just show what was happening up the chain because when your hospital, say at Mount Sinai, cancel your appointment, you're really mad at Mount Sinai. You're like, "Why did you tell me there was an appointment when there wasn't an appointment?"

I noticed in that email that Mount Sinai sent out, they said, "Well, we don't have control over the supply." That's true. What has been happening so far is actually that Operation Warp Speed had set up this system where they only tell states week-by-week how much supply they're going to get. This whole rollout has been run on a week-by-week system. Every Tuesday, Operation Warp Speed would get the final information from the manufacturers of how much they have for the following week. Then they would allocate it out to the state. The numbers would appear on their screens at about noon on Tuesday, and then there's some sub-calculations that happen.

Every state would then get a maximum cap of, "You can only order up to this amount." They have to then put in their specific orders of, "I would like you to send this much to Mount Sinai and this much to Northwell and this much," the subdivision by Thursday if they wanted their shipments to come by next Monday. Then you only know every week. I was talking to all these vaccination sites, these hospitals or these local level, county-level vaccination sites and they'd be like, "Well, I don't know what I'm getting week-to-week." It's really hard to plan ahead when you have no idea what's coming to your door from week-to-week.

This lack of forward planning ability means you're stuck, really. There's no buffer in the pipeline. There's no forward planning ability. In a way, I'd just want to explain to readers that they're stuck.

Brian: How does the new administration fix that?

Caroline: There's one thing I saw, they brought this 200-page national strategy document and it does say there, "Moving forward, the federal government will provide regular projections of the allocation states and localities will receive." Now, that sounds great. I think that the states and localities would love that. It doesn't really say how they're going to do that. This is something that I'm reporting on and would love to find out more information. That's what I'm working on. I do wonder, and it has been floated this question of, "Can you ask the manufacturers to commit to a weekly target so that there's a little more consistency?"

Actually, if you look at the numbers that have come out, the total numbers, they've actually become fairly steady. Has that actually been more of a problem with the allocation formula that the government has been using? Either way, whatever the actual problem has been, at least we know that the Biden administration is aware of this problem, and they say that they're going to provide regular production. I think this is something that we have to see it play out. Biden administration has only been in the office for a few days, but this is something I'm definitely going to be keeping a close eye on because it's really been one of the biggest stumbling points for the States.

Brian: Suzanne, a nurse in Norwalk. You're on WNYC. Hi Suzanne.

Suzanne: Hi Brian. Thank you very much. I'm a huge fan. I'm a registered nurse at a federally qualified clinic in Connecticut. I am the nurse who has been administering COVID vaccines, the Moderna COVID vaccine, since December 28th. One of the components of scheduling and one of the things that makes the administration complex is that every vial that we get contains 10 doses. The vial contains the COVID vaccine without a preservative. Per the manufacturer's instructions, from the time of puncture of that rubber stopper, we have six hours to vaccinate 10 people. We can't just put the vaccine back in the refrigerator and use it again the next day.

We have to throw it out. We got six hours. The clock is ticking from that first puncture. Just as an example of what happened the last day, I think it was the 11th of January. Over the course of one day, we scheduled on and off 14 people of our staff. By the end of the day, of those 14 people, only nine could actually receive the vaccine because the others were planning to get pregnant or trying to get pregnant, were breastfeeding. One had a low platelet count. It's like, we start with 10 and then we dropped to nine and then we add three and then we dropped to 11.

By the end of that day, we only administered nine and we had to waste one dose, which was crushing for all of us. It's complex. It's not easy to get that lined up. You have to prescreen.

Brian: Is there a solution to that, Suzanne? I know this is happening in a lot of places.

Suzanne: My only idea is it's the multi-dose vial that's tough. I don't know, I'm not asking for pre-drawn syringes or anything like that, but if they could put the 0.5 milliliters in one vile, that might help. That might help because then you would that whole thing about wasting a dose.

Brian: Suzanne, thank you so much. I think that's really illuminating. Caroline, I see that one of your stories this week is titled How Many Vaccine shots go to Waste? Several states are encountering.

Caroline: We had heard stories like this and it's really, absolutely not, in many cases, the fault of the healthcare workers. As Suzanne was just illustrating, how difficult it can be to manage these doses, especially with their storage constraints. They are quite finicky. It is important to count. Particularly, in cases if there are large amounts of waste, it could be a cold storage issue where a site is not managing it well, or they have refrigeration issues to be able to notice. We were just curious at ProPublica, we were like, "Well, how many doses are going to waste? Are there particular spots in the country that aren't doing a good job?"

We started calling around and asking, and it turns out that even though the CDC says on paper that vaccinators are supposed to be reporting it if they have to waste a dose or throw out a dose, that there's some states that just don't count at all. They just don't ask people to report this at all so we have no idea.

Brian: What could be a solution to that?

Caroline: Well, they could just ask them to do it. For the Federal Vaccines for Children Program, for example, this is regularly catalogued and reported. It's not like this would be a totally novel system, but it is a patchwork around the country. There are some states like Pennsylvania and Arkansas, where we said, "Hey, do you ask your providers to report when they have to throw out a dose, whatever the reason?" They were like, "Yes. We do. Here's the total number. Here's the breakdown." Really quickly and easily, they were able to respond to us.

Then there were other states like Washington and Maryland where they were like, "No, we don't ask people to report this to us." Depending on where you are in the country, it's all over the place.

Brian: Here's Mira in New Brunswick, a dentist. Mira, you're on WNYC. Hi.

Mira: Hi, Brian. I'm available to give vaccine shots, but I was looking to see where I could volunteer. I decided that we are eligible to do that. The second thing is, I did go for my Moderna first shot and the place that I went to it was community center. I don't want to name it, but they said that two people had canceled and they were going through the waitlist to call people. I was also thinking that, is there a statewide waiting list or something? Where people could maybe put it in before the end of the day, to inform people that the centers have unused vaccines and people could go there and maybe get their shots. This shouldn't be difficult in this day and age, with computerization.

Brian: Mira, on your first point, are dentists trained to administer vaccinations or administer injections?

Mira: We do give anaesthetic injections, but I don't know if we are allowed to in the State of New Jersey, I'm not sure. There was mentioned in some places that I said, that they are trying to recruit people to administer the vaccine.

Brian: Mira, thank you. Caroline, to her two points on that first one about people, I've read also and heard elsewhere that there's a disconnect between people who are trained or could be trained to administer injections and those number of people available to actually do it. That's one of the bottlenecks.

Caroline: That's a good question. I don't know the answer specifically for New Jersey, whether or not, specifically, a dentist would be able to do that. I am aware, I've spoken to a source in New York who is a volunteer. Part of the issue that the source has brought up is actually the login site for New York has given them some difficulty in being able to sign up to volunteer. Which just reminded me how tricky it is, that every part of the system needs to be able to work, that you need to have good communication. You have to have sign-up portals that work and you need to be able to then coordinate all the volunteers.

One of the things that I've been thinking about through this whole process has just been the amount of time states had to prepare and it seems that a lot of states have waited a little bit until the last minute to somebody try to have to throw together these vaccination programs. I wonder if we could have maybe started earlier a little bit with recruiting things like providers. To the second point about waitlists, I do know that this is happening in a number of states. I had talked to Dr. Roberts, the health commissioner in Columbus, Ohio. Last week when her vaccination site was still in 1A, so that was just for healthcare providers they'd gotten permission from the local mayor to put police officers on the waitlist, for example.

Anytime they had an extra shot at the end of the day, they'd call over to the station and say, "Hey, is there somebody who can make it over in the next half hour so we don't have to throw out this dose?" I know that this is happening either formally or informally around the country, where pharmacies are calling people that they have, patients that they have relationships with who are very elderly. I think this concept of a wait-list is happening and makes sense as a way for people to not waste their dose. The CDC has really put out this message now that you shouldn't let the priority guidelines be so restrictive that you end up throwing out a dose. It's much better to not waste a dose.

That's really important as a message, that you shouldn't throw out a dose because you're like, "You're not in a priority group."

Brian: By the way, Mira, I don't know if this helps you in New Brunswick, but someone called in the other day and said the New York City Medical Reserve Corps, I think I have the name right, New York City Medical Reserve Corps is looking for volunteers to administer vaccinations. It sounds like that's for the city. Maybe there's something like that in the New Brunswick area. I guess neither Caroline, nor I, know it specifically. Caroline Chen covering vaccines for ProPublica, our guest. Caroline, I want to read you a little bit of a Twitter thread from the New York City Council Health Committee Chair, Councilman Mark Levine.

He writes, "There are Alarming signs that COVID vaccinations in New York are disproportionately leaving behind people of color. We need to see data on the racial breakdown of vaccinations, and we need to take action now to fix yet another egregious case of inequity in this pandemic." He adds to it, "Many mistakes are leading to racial inequity in New York city's vaccine rollout eligibility that leaves out key groups of essential workers. Too few sites in communities of color, inadequate trust building efforts." He adds, "Equity demands that we extend vaccine eligibility to include groups that have been left out. Food delivery, restaurant workers, taxi drivers, Amazon warehouse workers, mail, and parcel carriers and incarcerated people."

Caroline, I'll bet a lot of people listening right now are really shocked to hear that those groups, since some people are eligible on the basis of their job, that those groups aren't in those lists.

Caroline: I think something that I have worried about from before the vaccine rollout started was, who's going to be able to get the vaccine. Something that you mentioned just now as I was listening was that question is, "Can we get data?" I had written a story with two of my colleagues about the fact that, similarly to this question of vaccine wastage, the CDC says that they would like to get racial and ethnicity data on people who receive the vaccine, but this is not actually enforced in any way and a lot of States don't actually collect this data. We won't know to what degree uptake is of the vaccine is reaching those who are most vulnerable in many States.

This is really unfortunate. I don't know if New York is even collecting, let alone going to make public the data on racial and ethnic breakdown of vaccine recipients. Something that we have already started to see, if you actually go to Chicago website, is that they do provide the home zip code of their recipients. That has been very worrying, because if you look at that by the map you can start to see that people who've received the vaccine compared to where people have gotten COVID and died, the maps do not overlap. It's really sad.

Brian. Really sad and outrageous. It's racial inequity, again.

Caroline: That, to me, really indicates that the vaccines is not reaching the people who need it most. What I think, I'll try to keep this short, but when I think about phase 1A, which is healthcare workers and long-term care facilities, to me, those are what I call, quote-unquote, captive audiences. We know where they are. We know where the healthcare workers are. For the most part they're in hospitals and clinics, we know where they are. Long-term care facilities, we know where they are. We can get to those residents. When we think about essential workers in all those categories you just mentioned, they're much harder to find. We need to bring the vaccine to them.

We cannot wait for the vaccine for them to come to the vaccine because they may not be able to pay for traveling a long way. They may be working multiple jobs and not have time. It's now our job to make sure that the vaccine gets to them.

Brian: We have to get at least one good news story in this conversation because there are thousands and thousands of people in New York getting vaccinated every day and in New Jersey. Alicia in Westchester, you're on WNYC. Hi Alicia.

Alicia: Hello? Can you hear me?

Brian: I can hear just fine. Yes.

Alicia: Hello. Hi. I wanted to mention that I got my appointment through Zocdoc website and I was actually able to make three appointments. In Mount Sinai, I had the vaccine yesterday and they say, "Well, since you we are going to cancel your other two appointments." Yes, of course. It was fairly easy to make the appointment. I just wanted to mention that, maybe people go through that website.

Brian: Zocdoc?

Alicia: Zocdoc, yes. Z, Zocdoc.

Brian: Z-O-C-D-O-C. Well, I don't know if you know that one, Caroline, but yes. Some people are getting appointments. I'll tell a personal story. My father got a vaccine on Tuesday and the way he got it was more or less, I'm thinking of this like FreshDirect at the beginning of the pandemic. You couldn't get a delivery slot so you just kept hitting, refresh, refresh, refresh every few minutes. You'd go back to the site and hit refresh, refresh, refresh, and eventually you'd get a slot. That's what my dad did with this clinic in Queens. I don't know, Zocdoc or one way or another. Then of course people are at risk of canceling you because of a shortage of supply. My father got his,, Alicia got hers. They are actually delivering vaccine somewhere this week.

Caroline: I have hope that with Biden as his administration taking this very seriously, of course we'll have to see how they fall through with their intentions. Not to end on a note of doom and gloom here, it does seem that they're marshalling massive resources to try and really make this roll out a big commitment. Look forward to seeing what happens in the coming weeks and joining you for a more optimistic update.

Brian: Caroline Chen will keep joining us if she is willing, with her excellent reporting on vaccines for ProPublica. Caroline, thanks a lot for today.

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