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Biden sets nation on seven-week sprint to near-universal vaccine access

Accelerating pace of inoculations puts the president’s target within reach, consistent with his strategy of underpromising and overperforming

President Biden speaks about returning to normalcy by July Fourth in his prime-time address. (Andrew Harnik/AP)
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President Biden asserted full command of the nation’s vaccination campaign in his prime time address Thursday, framing his first 100 days around a series of new promises that build on the program’s momentum and appear within reach.

Most notably, he directed states and other jurisdictions to make all adults eligible by May 1, setting off a seven-week sprint throughout the country consistent with the accelerating pace of inoculations. Benefiting from manufacturing improvements now boosting the store of doses after months of scarcity, his team has seized the opportunity to mobilize federal resources to rush those doses to Americans whom he promised a semblance of normalcy by July Fourth.

“If the president is saying it can all get done by May 1, I’m all in,” said Michael Fraser, chief executive of the Association of State and Territorial Health Officials.

The main constraint is still supply, Fraser said, cautioning states against opening the floodgates before taking care of their most vulnerable residents, which is the reason many have hewed to a strict priority system. Those moving quickly to open up eligibility are doing so largely because many people are hesitant to get the shots, he said, which may foreshadow difficulty reaching the level of immunity needed to corral the virus.

Biden recognized the likelihood of additional obstacles when he said opening eligibility to all adults by May 1 does not mean everyone will be able to get a shot on that date. Appointments may still prove elusive in some places, given the patchwork nature of the rollout and the gradual increases in supply. The unpredictable march of the virus, meanwhile, means the president’s expectations about Independence Day celebrations were hedged with the need for some limitations.

But as with his previous goals, which were achievable because they reflected progress already in motion, his promises about vaccine availability square with what’s happening inside factories and on the ground.

Alaska, for instance, became the first state to remove virtually all eligibility requirements, as the governor, Republican Mike Dunleavy, said this week that anyone 16 and over could sign up for a vaccine. Michigan is throwing open appointments to the general public beginning April 5, while Wisconsin health officials announced the state would do so May 1. Other states are also expanding eligibility more gradually: Ohio, Indiana and West Virginia have opened appointments to those 50 and older. The same age cohort will become eligible next week in Texas. In Georgia, availability will expand next week to those 55 and older.

The Biden administration is sticking with May 31 as its target for having enough supply to cover the entire adult population, while stressing it may take longer to fully immunize everyone who comes forward, especially using the two-dose protocols developed by Pfizer-BioNTech and Moderna. Johnson & Johnson’s vaccine is a single shot. Only the Pfizer-BioNTech product has been authorized in the United States for people as young as 16.

The approach of expanding vaccine eligibility before everyone can get inoculated parallels earlier phases of the rollout. Health-care workers gained access to the shots at the program’s outset in December, though many states did not finish immunizing those who were willing until well into the new year.

Biden’s strategy is not without risks, from manufacturing setbacks and logistical breakdowns as states seek to scale their programs, to the rapid spread of new and more transmissible variants of the virus that could sicken people before they get vaccinated.

But he paired the updated timeline with a suite of initiatives aimed at expanding the number of vaccinators and the places where people can get shots, buttressing existing federal support for what his aides have repeatedly described as a “wartime effort.”

New website for vaccine appointments

The newest element is the president’s plan for a federally supported website, slated to go up by May 1, to help people find vaccine appointments. The site will be an expansion of VaccineFinder.org, which launched in February as a partnership between the Centers for Disease Control and Prevention and Boston Children’s Hospital.

The site will shift to a .gov domain, but details were otherwise sparse, and it was not immediately clear how such a website might sync with a jumble of state and commercial platforms.

Such plans carry risks given frustrations with some existing sites, as well as the failure of HealthCare.gov, which crashed within two hours of its launch in October 2013. Jeff Zients, the coordinator of the White House’s coronavirus task force, was tapped at the time to salvage the website.

A new online portal risks creating additional hurdles for people already straining to understand when it’s their turn in line, especially if the site gives rise to unrealistic expectations, said Ramesh Raskar, an associate professor at the MIT Media Lab and the founder of the PathCheck Foundation, a nonprofit developing public-health technology.

If a solution seamlessly matching supply to demand, akin to Uber, is not possible, Raskar said, a better option might be to remove technology from the process. The government could simply assign time slots, while also creating opportunities for people to show up and be immunized without an appointment.

Biden’s plan builds on technology created during a previous pandemic. The VaccineFinder site was started by Google during the H1N1 influenza outbreak in 2009 and subsequently taken over by John Brownstein, chief innovation officer at Boston Children’s, to help with distribution of flu and other routine vaccines, such as shingles and hepatitis.

The site has limitations Brownstein said he hopes to address in coming weeks, including directing users to external websites, rather than allowing them to schedule appointments directly. Also, it does not currently send out follow-up reminders for the second shots.

“This is going to be like building layers to the cake. And what you have with VaccineFinder.org is a great foundation,” said Ryan Panchadsaram, who served as deputy chief technology officer of the United States during the Obama administration. “What they need to do next, is ‘does this CVS have an appointment?' And that’s a bit harder.”

Panchadsaram, who worked on the rescue effort for the broken HealthCare.gov website in 2013, said the new digital undertaking could prove even more critical. “HealthCare.gov helped enroll 20 million,” he said. “There will be 200 million people looking for vaccines.”

Zients said Friday the website would be paired with a call center geared toward those without access to the Internet. He said the administration would also deploy “technology teams” to help improve state and local systems to schedule vaccine appointments.

New places, people to administer shots

Officials expect that signing up for vaccine appointments will become simpler once there are more slots to go around. But more slots also require more staff and more space.

The administration is making dentists, paramedics and midwives, among others, eligible to administer vaccine, building on state initiatives to surge the workforce. An additional 4,000 active duty troops will support vaccination efforts, bringing the total military deployment to more than 6,000, the White House said.

Shots will soon be accessible at many more locations: The administration plans to double the number of pharmacies offering vaccine, bringing the total to more than 20,000. It will also direct more supply to community health centers, involving nearly 1,000 such sites throughout the country.

The number of mass vaccination centers supported by the Federal Emergency Management Agency will also double, according to senior administration officials. Currently the federal government has opened or plans to open 21 such centers, in states ranging from California to Florida. The latest addition is a site at Detroit’s Ford Field.

“The Biden administration is paying close attention to the steps that are necessary to get the vaccine from a vaccine depot into the arms of members of the public,” said John Auerbach, president and chief executive of Trust for America’s Health and a former Massachusetts public health commissioner.

The nation is now averaging more than 2 million shots a day, and about 65 percent of adults 65 and older have received at least one dose.

“Each week in February and March, we have seen our vaccine grow, and even more vaccine is anticipated as we move into April and May,” Julie Willems Van Dijk, Wisconsin’s deputy health secretary, said in a Thursday briefing, explaining why everyone 16 and over would become eligible in May.

She said 80 percent of the state could be vaccinated by June, but hesitancy about the shots may lead as much as 40 or 50 percent of the population to pass on immunization — a significant hurdle for health officials, beyond supply of shots and the capacity to administer them.

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