Getting Vaccinated in Los Angeles
As I am over 75, I just got my first shot on Tuesday. The process was as follows. I e-mailed my primary care doctor. His nurse notified the vaccine clinic. They called me back two days later and offered me the first available appointment in three days. I took it. I showed up and waited in line, read and answered and signed some questionnaires, then got a shot. It took half an hour. Then while I waited for 15-20 minutes to assure no adverse reactions, they set up my return appointment for my second shot; I drove home euphoric. My arm hurt a bit the next day, and today it’s fine. Some friends went to one of the big drive-thru vaccine sites at the Forum yesterday for their appointment; it was fast and efficient, they stayed in their car the whole time.
That’s the good news. The bad news is that the overall distribution is very slow and confused, and it's going to take some time for the incoming Biden team to straighten it out. https://www.thedailybeast.com/worse-than-we-imagined-team-trump-left-biden-a-covid-19-nightmare There is a huge pent up demand for the vaccine now, and there is very little available supply. https://www.nbcnews.com/news/us-news/we-need-more-cities-hospitals-feel-pinch-covid-19-vaccine-n1255146 Those best connected, most aware, and most internet savvy will get the scarce shots, while those least connected to the health care system and least able to navigate the internet to get appointments will get left behind.
Flash back one month, shortly after the vaccine was approved. I contacted my doctor’s office; they had no information. My wife contacted her doctor’s office; they had no information. My inside friends said “patience, this is all brand new”. The federal and state governments and the local public health departments, the manufacturers and the distributors have had several months to work out the logistics.
The early roll out for the health care providers in hospitals went well, but for the surprising resistance to vaccinations by some staff. https://www.nytimes.com/2021/01/14/business/covid-vaccine-health-hospitals.html The roll out for nursing home patients and staff was less effective, again running into staff reluctance to be vaccinated. https://www.nytimes.com/2021/01/16/business/covid-vaccine-nursing-homes.html Those were the low hanging fruit of easy to identify and vaccinate populations. Now we are in a race against time to get as many vaccinated as possible against a virus that is mutating in unforeseeable ways as we all (or some of us) try to hibernate inside and mask up outside.
What has happened, and how quickly can the new Biden Administration fix it? The early roll out was slow in getting people vaccinated, and there were reports of lots of unused vaccines going to waste or going to big donors of the facility. https://foreignpolicy.com/2021/01/12/morning-brief-united-states-covid-19-vaccine-rollout-slow-progress/ The CDC then recommended open enrollment for all persons over 65. https://www.healthline.com/health-news/cdc-now-says-everyone-over-65-should-get-access-to-covid-19-vaccine The next day California’s Governor jumped on the over 65 bandwagon. https://abc7.com/california-vaccines-covid-vaccine-who-gets-the-first-coronavirus-in/9628571/ A week later, the LA County Board of Supervisors decided to open enrollment to all over 65. https://laist.com/latest/post/20210118/covid-vaccine-solis-executive-order-over-65-LA-county One in six Americans are over 65; these are the baby boomers; so that is a huge population seeking vaccines. https://www.statista.com/statistics/457822/share-of-old-age-population-in-the-total-us-population/ One in ten Californians work in health care, and they were the first priority for vaccination. https://www.kff.org/other/state-indicator/health-care-employment-as-total/?currentTimeframe=0&selectedRows=%7B%22states%22:%7B%22california%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D So we now have ¼ of the population eligible for vaccinations, and not surprisingly a shortage of supply.
Manufacturing enough vaccines quickly is part of the problem. https://www.labiotech.eu/medical/covid-19-vaccine-manufacture/ The supply shortages cannot be readily and quickly fixed. https://www.nytimes.com/2021/01/21/health/biden-covid-vaccine-supply.html The vaccines require ultra cold storage and transportation; they are new, two shot vaccines and require a learning curve; there is an excellent summary of all the logistical and distribution challenges at https://www.pbs.org/newshour/health/the-challenge-of-distributing-covid-19-vaccines-that-need-to-be-frozen
The Johnson and Johnson vaccine has not yet completed clinical trials; it is hoped they will have FDA approval for emergency use by the end of January. However substantial supplies of it are not likely until the end of April due to manufacturing challenges. https://www.nytimes.com/2021/01/13/health/covid-vaccine-johnson-johnson.html Once it comes on line; it requires only refrigerator storage, and it’s a single dose vaccine. So it will be easier to ship, store, distribute and vaccinate.
Oxford University and AstraZeneca have developed a much less costly vaccine without the cold storage challenges. https://www.prevention.com/health/a35118263/astrazeneca-vs-pfizer-vs-moderna-covid-19-vaccine/ It has been approved for emergency use in the UK at the end of December, and is already in wide use there. It is less efficacious than Pfizer or Moderna, but a lot easier to use. It may be approved for emergency use by the FDA in February, but federal regulators have been leery of some safety issues and lack of transparency by the developers, and want to first see the results of large American clinical trials. https://www.wsj.com/articles/astrazeneca-and-oxfords-bumpy-partnership-hangs-over-covid-vaccines-future-11609336498
Keep in mind, we will need to vaccinate the whole world to stop this virus, and the AstraZeneca vaccine may be best for huge swaths of underdeveloped nations that lack the infrastructure of the highly developed nations like the US. We are an interconnected world, and what happens in a huge, far-away Indian manufacturing facility for the vaccine affects us all. https://www.cnn.com/2021/01/22/asia/india-fire-vaccine-serum-institute-intl-hnk/index.html.
Lucien Wulsin
1/21/21
PS: The pressure is now on the Biden administration to increase its initial goals of 100 million shots in a 100 days. Recently, we are getting close to a million shots a day, and the delivery system’s overall performance is improving; however the biggest immediate bottlenecks may be supply as there is plenty of demand and the delivery system is improving. https://www.buzzfeednews.com/article/danvergano/national-covid-vaccine-rollout-biden