At the eastern edge of Baltimore, Emergent BioSolutions is manufacturing almost all of the yet-to-be approved Johnson & Johnson and AstraZeneca coronavirus vaccines for the U.S. population — an anticipated hundreds of millions of doses in the coming months. But in a sign of the complexities in a global supply chain that is struggling beneath the weight of demand, most of those doses will not go to residents of this city, or even the state of Maryland.
Instead, the active vaccine ingredients created in the company’s biomedical reactors just north of the Johns Hopkins Bayview Medical Center are shipped to plants in other states and possibly other countries. After the two vaccines are authorized for emergency use by the Food and Drug Administration, which in the case of Johnson & Johnson could happen as soon as this weekend, they will be distributed across the United States.
Americans have struggled to discern the logic behind their country’s long-awaited vaccine rollout. Every day, millions scour the Internet for scarce appointments while simultaneously reading news of unused doses and widespread reluctance to get the shot.
The scarcity of medicines that many hope will end the pandemic has led to intense debates over efficiency and equity. Federal, state, county and city health officials — not to mention national retailers and pharmacies — have adopted overlapping and sometimes contradictory rules about whom they will vaccinate, and how.
The Emergent plant is just one hub in a wildly decentralized scheme of production and distribution. Yet it is one that crystallizes the strange mix of hope and angst that Americans feel at a moment when the end of the pandemic — if not quite in sight — is finally imaginable.
Those feelings are acute in Maryland, where Republican Gov. Larry Hogan’s push to expand eligibility for the shots has both quickened initially sluggish vaccination rates and stoked fierce competition for available doses.
More than 2 million people in the state, or roughly a third of its population, are now qualified to receive roughly 80,000 vaccine doses Maryland gets each week from the federal government.
To some in Baltimore, the prolific creation — and rapid departure — of scarce medicines in their backyard is especially jarring.
“We need it here,” said Katreia Allen, a security guard at a Dollar Tree near the Emergent plant. “I think we should get it first.”
Nearly 900 of Maryland’s approximately 7,700 covid-19 deaths have been in Baltimore. But less than 6 percent of the city’s population has been fully inoculated, and concerns about racial and economic justice in vaccine prioritization have been at the forefront for elected officials.
Earlier this month, Mayor Brandon M. Scott wrote a letter asking that Johnson & Johnson sell 300,000 of its vaccine doses directly to the city, bypassing the federal allocation system to “create a national model for equitable vaccine distribution” and enabling city officials to speed the delivery of shots to residents of color, in particular.
But the pharmaceutical giant has shown no signs of heeding that suggestion, which may not be possible because of its obligations to the federal government amid an ongoing national vaccine shortage.
Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said he hopes that by the summer that shortage will be eased. But in the meantime, he said, situations like the one in Baltimore can’t help but elevate people’s sense of powerlessness and injustice as vaccinations trickle out to a lucky few.
“I think the feeling of it not being fair is exacerbated,” Offit said, “when you see it being made right in front of you and you still can’t get it.”
400 million doses
The messages come to Sean Kirk almost every day. Relatives, acquaintances — many know that the 45-year-old is immersed in the mass production of coronavirus vaccines, and many want to have their questions answered.
Will the drugs be safe? What’s holding up the rollout? And perhaps above all: When will inoculation be widely available?
“Look, I’m a vaccine guy. I get texts all the time, because they know I’m in the middle of this,” said Kirk, Emergent’s executive vice president of manufacturing and technical operations. “I have the same desire for my family, and the economy, and for my kids to go back to school. But I also know the inside baseball, that this was always going to be a ramp. It was never going to be an on/off switch. I spend a lot of time explaining that to family and friends.”
On a recent weekday at the Emergent plant, Kirk was preparing to explain the fine points of vaccine creation to Maryland’s governor, who would be touring the facility in the afternoon. A few hours before Hogan arrived, Kirk walked through the manufacturing process with a Washington Post reporter in a room with a view of one of Emergent’s bioreactors.
The scene was reminiscent of meth kingpin Walter White’s Superlab in the TV series “Breaking Bad.” Technicians in head-to-toe protective gear — goggles, baby-blue coveralls, white gloves — milled around a towering, cylindrical vat that contained a distilled version of the Johnson & Johnson vaccine.
Both the Johnson & Johnson and AstraZeneca drugs are made using modified adenoviruses that cannot replicate in the human body. By contrast, the two vaccines currently approved for use in the United States, from Moderna and Pfizer-BioNTech, use messenger RNA that instructs the body’s cells to create a protein found on the virus that causes covid-19.
Both technologies spur the body to mount an immune response that reduces the likelihood of disease. And although the Moderna and Pfizer-BioNTech vaccines have demonstrated greater effectiveness in clinical trials, their rivals have other advantages.
Adenovirus vaccines are less prone to spoilage than mRNA varieties, simplifying the logistics of transportation and storage (especially in rural areas). And the Johnson & Johnson vaccine, crucially, is administered in a single dose. AstraZeneca, Pfizer-BioNTech and Moderna designed their medicines to be used with a booster shot.
The Johnson & Johnson vaccine is now under review for emergency authorization by the FDA. On Wednesday the agency released a review of the drug that found it was safe and effective and completely prevented hospitalizations and deaths in a large clinical trial. Authorization of the vaccine could come as soon as this weekend, but White House coronavirus response coordinator Jeffrey D. Zients has said that only a few million doses will be ready by then.
The company has pledged to deliver 100 million doses to the federal government by the end of June. AstraZeneca, which is in the home stretch of U.S. clinical trials for its vaccine, has agreed to provide the country with 300 million doses. Emergent is the primary manufacturer of those medicines.
From Baltimore, the “viral vector” for the drugs — a concentrated stew of the tamed pathogens that provoke an immune response — is frozen and shipped to other plants for further processing and placement in vials. AstraZeneca declined to reveal details of its supply chain to The Post, but information provided by Johnson & Johnson indicates that the vaccine ingredient produced in Baltimore is sent to the Midwest, and perhaps overseas.
On the day of Hogan’s visit, vaccines were also inbound: The governor brought with him a team from Rite Aid to inoculate Emergent’s more than 300 employees, who are eligible as essential workers in manufacturing. It was another odd illustration of America’s complex vaccine allocation system: A national drugstore chain administering the Moderna vaccine to workers at a Baltimore company who were themselves making different vaccines bound for other states.
Many others in the city were not so lucky, as Hogan acknowledged in remarks to reporters.
“I know it’s very frustrating. Everybody would like to get the vaccine immediately. We understand that,” he said. “The issue is, far more people need, and want, and qualify for the vaccine than we have vaccine.”
‘Take care of home first’
James Redmond is among those who need, want and qualify for the vaccine.
He has been unable to get it.
The day after Hogan’s visit, Redmond was smoking a cigar in the parking lot of a strip mall in the Highlandtown neighborhood near Emergent. Leaning on a cane, a surgical mask pulled down around his chin, the 77-year-old said he last called the city health department about a week ago and was unable to schedule a shot.
“I’m going to get it. All’s I’m gonna do is wait,” Redmond said.
Though he has accepted the delays stoically, Redmond said he had seen a television news segment about the Emergent plant while he was waiting at the carwash and found himself perplexed.
“You think with all the people manufacturing it, you would have seen it out on the street way before now, without all this backlog going on,” he said.
Redmond lives in a community that has experienced both disproportionate harm from covid-19 and disproportionate trouble finding the shot. Some, like him, are Black. Others, in a neighborhood where Spanish is heard as often as English, are Latino. Many are poor. The effects of virus shutdowns have hit hard. “WE MISS YOU SAY SAFE” reads a sign with a missing letter outside the deserted and fenced-off Highlandtown Middle/Elementary School No. 237.
Micah Dowtin, a 35-year-old glass repairman who was enjoying a lunch of wings and fries in his parked truck, was baffled when he learned that hundreds of millions of vaccine doses were being manufactured nearby.
Dowtin wasn’t yet sure whether he would seek the shot — he said he’s worried about potential side effects, despite evidence that serious reactions are rare — but his mother, who is almost 70, wanted the vaccine and had been unable to get it.
“I don’t understand why they would be producing it here and then shipping it out to other places when there are people here who don’t have any,” Dowtin said. “You’re supposed to take care of home first, right?”
It was the same sentiment captured in the mayor’s letter to Johnson & Johnson asking that the company reserve some of the medicine created in Baltimore for city residents. A Johnson & Johnson spokesman declined to comment on the letter. A spokesman for AstraZeneca declined to say whether that manufacturer would consider a similar arrangement.
But as he departed the Emergent plant, Hogan, when asked about Scott’s request, offered his own assessment of how likely Baltimore residents are to see any advantage in their access to the vaccines being made in their city.
“I think it’s a nice try,” he said. “I mean, everybody would like to jump in the front of the line. But it’s not gonna happen.”
Erin Cox contributed to this report.