President-elect Joe Biden plans to release nearly all available doses of COVID-19 vaccine when he takes office, reversing the Trump administration’s strategy of holding back half the supply to ensure second doses are available.

The potentially risky move is meant to boost a nationwide COVID-19 vaccination program that has gotten off to a slow start, with only about 5.9 million doses administered out of 29.4 million distributed, according to the U.S. Centers for Disease Control and Prevention.

“The President-elect believes we must accelerate distribution of the vaccine while continuing to ensure the Americans who need it most get it as soon as possible,” T.J. Ducklo, a spokesperson for Biden’s transition, told CNN.

Biden “will share additional details next week on how his administration will begin releasing available doses when he assumes office on January 20th,” Ducklo added.

One infectious diseases expert noted that supply is not the only issue hampering the vaccine rollout.

“I do think it is important to get all of those out as fast as possible so we can accelerate the process of vaccination,” said Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, in Baltimore. “However, it’s not just an issue of doses, it’s about turning those doses into actual vaccinations, so we do still need more support at the state level to actually implement vaccination programs. We are in a race with this virus, so anything that speeds vaccination should be applauded.”

Both the Pfizer and Moderna vaccines require two doses administered a few weeks apart. The risk is that some people will get their first dose, then be unable to find a follow-up dose.

But experts aren’t worried about that happening.

“It is very important that people who get the first shot of the vaccine get the second shot. However, I don’t think this federal government holding back supply is going to accomplish this in the most efficient fashion,” said Dr. Eric Cioe-Pena, director of global health at Northwell Health, in New Hyde Park, N.Y.

“In our health system, we were able to do both shots with most staff without reserving vaccine. The hardest part about our supply chain is going to be early on, the supply should be getting better and better. It does not make sense, given that reality, to hold back vaccine supply for second doses because it is unlikely to be a major factor months from now,” Cioe-Pena added.

And Dr. William Schaffner, a former board member of the Infectious Diseases Society of America, said he doesn’t think getting the second dose later than intended will ruin a person’s immunization.

“If you miss and you come in later, no problem, you don’t have to repeat the first dose,” said Schaffner, a professor of infectious disease at the Vanderbilt University Medical Center in Nashville, Tenn. “We just don’t want you to get the dose too soon. That’s not optimal for your immune system.”

But another expert said that too long a delay between doses might be foolhardy.

“Expansion of vaccine availability and administration is vital, and releasing all doses may allow for that. But, hopefully, as part of such a plan there will be assurance that more vaccine doses will be produced to ensure patients get their second dose,” said Dr. David Hirschwerk, attending physician in infectious diseases at North Shore University Hospital, in Manhasset, N.Y. “A slight delay of days or even a few weeks in the second dose would likely be fine, but once longer delays occur the situation gets cloudier.”

With both vaccines, the first shot activates your body’s immune system and kicks off its response to the coronavirus, and then the second shot boosts that response to create immune memory that will ward off future infections.

The vaccines by Pfizer and Moderna are both about 95% effective after two full doses.

The Biden team believes that vaccine manufacturers will be able to keep up with demand and produce enough second doses to cover those as they emerge from the waiting period.

The American Hospital Association estimates that the nation needs to vaccinate 1.8 million people daily from now through the end of May to reach herd immunity, according to a letter it sent Thursday to U.S. Health and Human Services Secretary Alex Azar, urging expedited administration of the COVID-19 vaccines.

Under the American Hospital Association scenario, 75% of Americans — some 246 million people — would need to get the vaccine to create herd immunity, in which enough people are immune from the coronavirus to prevent community outbreaks.

Biden complained last week about the slow pace of the vaccine program, which missed the Trump administration’s goal of vaccinating 20 million people by the end of 2020.

“The Trump administration plan to distribute vaccines is falling behind — far behind,” Biden said. “If it continues to move as it is now, it’s going to take years, not months, to vaccinate the American people.”

The CDC has decided that health care workers and people working or living in long-term care facilities will be the first folks to get the COVID-19 vaccine. There are about 21 million health care workers and about 3 million people at long-term care facilities, so their inoculations will account for the first 48 million doses of the two-dose vaccine.

The U.S. Food and Drug Administration earlier this week reiterated that both doses are required to provide full immunity against COVID-19.

“We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19,” FDA Commissioner Dr. Stephen Hahn and Dr. Peter Marks, who heads FDA’s vaccine division, said in an agency statement.

“These are all reasonable questions to consider and evaluate in clinical trials. However, at this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence,” the statement continued. “Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from COVID-19.”

More information

The U.S. Centers for Disease Control and Prevention has more about COVID-19 vaccines.

SOURCES: Amesh Adalja, MD, senior scholar, Johns Hopkins Center for Health Security, Baltimore; Eric Cioe-Pena, MD, director, global health, Northwell Health, New Hyde Park, N.Y.; David Hirschwerk, MD, attending physician, infectious diseases, North Shore University Hospital, Manhasset, N.Y.; William Schaffner, MD, professor, infectious disease, Vanderbilt Medical Center, Nashville, Tenn.; U.S. Food and Drug Administration, statement, Jan. 4, 2021; American Hospital Association, Jan. 7, 2021; CNN; Associated Press; Washington Post

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