The Washington PostDemocracy Dies in Darkness

White House officials say U.S. has exhausted funds to buy potential fourth vaccine dose for all Americans

As a congressional stalemate stretches into its third week, officials warn it will hurt pandemic readiness

White House officials say billions of dollars are needed to pay for additional vaccines, tests, treatments and other supplies to fight the pandemic. (Demetrius Freeman/The Washington Post)
9 min

The Biden administration lacks the funds to purchase a potential fourth coronavirus vaccine dose for everyone, even as other countries place their own orders and potentially move ahead of the United States in line, administration officials said Monday.

Federal officials have secured enough doses to cover a fourth shot for Americans age 65 and older as well as the initial regimen for children under 5, should regulators determine those shots are necessary, said three officials, speaking on the condition of anonymity to detail funding decisions. But the officials say they cannot place advance orders for additional vaccine doses for those in other age groups, unless Congress passes a stalled $15 billion funding package.

“Right now, we don’t have enough money for fourth doses, if they’re called for,” White House coronavirus coordinator Jeff Zients said on a forthcoming episode of “In The Bubble With Andy Slavitt,” which was recorded Monday and shared with The Washington Post. “We don’t have the funding, if we were to need a variant-specific vaccine in the future.”

Federal regulators and health officials have not yet determined whether a fourth shot is needed, and some experts question whether the extra dose will be necessary to boost protection for the entire population.

But administration officials said placing orders for additional doses ahead of time — rather than waiting for the United States to be swamped by another wave of the virus — was imperative and a key lesson from the pandemic’s past two years. They also noted that the fast-moving omicron variant evaded some immune protection conferred by existing vaccines, demonstrating the need to invest in more targeted shots that could better fend off omicron and potential future variants.

“Vaccines don’t just appear when you snap your fingers and say, ‘Okay, I want the vaccine.’ We’ve got to make it,” a senior administration official said. “And this year, it’s going to be more complicated because there’s a very significant chance — although we’re still waiting for data — that the vaccines are going to need to be tweaked to cover omicron.”

Analysts at Kaiser Family Foundation, a nonpartisan health research organization, independently confirmed that the United States would need to purchase hundreds of millions of additional doses to ensure that every American could receive four shots, if necessary, said Jen Kates, who leads global health policy for the organization and previewed the forthcoming analysis.

“If their policy goal is to have enough doses available to provide a fourth dose to everyone, there are not enough doses purchased. They will run out of supply,” Kates said.

Kates said her team reviewed several alternate scenarios, such as lowering its projection to 70 percent of Americans who would be vaccinated with four doses, rather than 100 percent. Even with that lower target, “there’s not enough” doses already purchased, Kates said, adding that the full analysis would be published later this week.

About 65 percent of Americans, or roughly 217 million people, are considered “fully vaccinated” by the Centers for Disease Control and Prevention, according to federal data, and about 200 million of those people have received two doses of the mRNA vaccines produced by Pfizer-BioNTech or Moderna. Meanwhile, roughly 97 million Americans have received a booster shot, which is about 29 percent of the entire U.S. population, according to federal data.

Pfizer, BioNTech and Moderna last week filed for emergency authorization of second booster shots of their coronavirus vaccines — with Pfizer and BioNTech targeting people 65 and older, while Moderna sought permission for all adults — saying the shots would bolster waning immunity that occurs several months after the first booster.

The companies also are pursuing coronavirus vaccines for children under 5, although federal regulators have yet to authorize those shots, as they await additional data about their effectiveness.

Pfizer and Moderna did not respond to requests for comment about the status of the Biden administration’s vaccine orders.

White House officials said they have grown concerned that vaccine manufacturers will prioritize orders already being placed by other countries — such as Japan, Colombia, Vietnam and the Philippines, which collectively plan to buy, or have already bought, more than 200 million additional doses of mRNA vaccines from Pfizer-BioNTech and Moderna this year, according to an internal tracker kept by administration officials and shared with The Post. Some countries — such as Chile, which recently purchased 2 million Moderna doses — also are beginning to administer fourth doses.

Public health experts agree that waiting to place vaccine orders could delay shipments to the United States, citing a 2020 episode when Trump administration officials turned down an opportunity to buy an additional 100 million doses of the Pfizer-BioNTech vaccine. Although Trump officials later changed their minds, Pfizer CEO Albert Bourla warned them the United States would have to wait more than six months for the additional doses to be shipped, he wrote in his new memoir, “Moonshot: Inside Pfizer’s Nine-Month Race to Make the Impossible Possible.”

“[W]e would have had to take supplies from Canada, Japan, and Latin American countries, all of which had placed their orders earlier than the U.S.,” Bourla wrote in a book excerpt published by Forbes, adding that then-White House senior adviser Jared Kushner called him to insist that Pfizer should immediately prioritize the United States’ order. “I refused to do that, and the debate between the two of us became heated.”

Bourla said manufacturing “miracles” allowed Pfizer to ultimately meet its commitments to other countries while accommodating the additional U.S. order.

While the omicron wave has been in retreat for two months in the United States — with confirmed cases plunging from more than 700,000 per day in mid-January to about 32,000 per day now, according to The Post’s rolling seven-day average — public health experts warn that cases are likely to go back up, citing a spike across Europe caused by BA.2, a subvariant of omicron.

But those warnings have yet to move congressional leaders, who are still debating the size of a coronavirus funding package and how to pay for it. Key Republicans said they still wanted a fuller accounting of the trillions of dollars the administration has already spent on the coronavirus response — and are questioning the administration’s call to action last week.

“The basic thing we ought to figure out is, is there a need?” said Sen. Richard C. Shelby (R-Ala.), the top Republican on the Senate Appropriations Committee. “Secondly, if there’s a need, where’s all the money we appropriated?”

“The administration needs to take the money that’s been appropriated and use that to prepare for what might be coming down the road, if there are new variants that affect a lot of Americans,” added Sen. Mitt Romney (R-Utah) on Tuesday, who has emerged as a top skeptic of the White House’s request for additional funds.

Other Republicans said they were still waiting on detailed answers to questions around critical supplies.

“Before I know how many they own today — how many vaccines, how many tests, how many therapeutics — it’s hard for me to assess whether they need more,” said Sen. Richard Burr (R-N.C.), the top Republican on the Senate Health, Education, Labor and Pensions Committee.

Burr said he’s talked with the administration “constantly,” particularly Zients, the White House coronavirus coordinator who is among the senior officials pressing their funding case on Capitol Hill, as well as in public forums.

“Ninety-three percent of the money that was allocated for covid response — direct covid response — has been spent. So there’s very little left,” Zients said on the forthcoming podcast with Slavitt, a former White House senior adviser on coronavirus response. “The remaining funds are for areas like … medical care for veterans, or FEMA disaster relief. So we don’t have good resources to draw on from the prior allocated funds, and we need to make sure that this gets funded. So it’s up to Congress to either pass it on an emergency basis without offsets, or find viable offsets.”

White House officials also have warned that they will soon be unable to purchase additional therapeutics, including monoclonal antibodies, a key tool to help those who become infected, especially the immunocompromised and others at high risk.

But with House lawmakers in their home districts this week and unable to agree with Senate leaders on how to finance any package, there is no sign the stalemate will end soon.

Top lawmakers had initially planned to pay for more than $15 billion in coronavirus aid as part of a long-term bill to fund the government. But some House Democrats rejected one of the financing mechanisms, which would have clawed back funds set aside for state governments to address coronavirus-related needs. The pushback ultimately forced House Democratic leaders to strip the coronavirus aid from the bill. A new financing mechanism hasn’t been settled on, as Democrats attempt to plot a path forward.

“I don’t know that those conversations have been held just yet,” Sen. John Thune (R-S.D.), the Senate’s top GOP vote counter, said Monday. “But my assumption is, if something’s going to move, they’d have to figure that out.”

“The House is working to reach agreement with the Senate on acceptable offsets,” a senior Democratic aide said.

Kates, the Kaiser Family Foundation expert, said the challenge of preparing for the pandemic’s next phase is complicated by the virus’s unpredictability. “It’s possible in three months, we’ll all be saying, ‘Hey, we weren’t prepared, but fortunately, we’re in good shape.’ Or we could really be staring down something quite ominous,” she said. “We just don’t know.”

Coronavirus: What you need to know

End of the public health emergency: The Biden administration ended the public health emergency for the coronavirus pandemic on May 11, just days after WHO said it would no longer classify the coronavirus pandemic as a public health emergency. Here’s what the end of the covid public health emergency means for you.

Tracking covid cases, deaths: Covid-19 was the fourth leading cause of death in the United States last year with covid deaths dropping 47 percent between 2021 and 2022. See the latest covid numbers in the U.S. and across the world.

The latest on coronavirus boosters: The FDA cleared the way for people who are at least 65 or immune-compromised to receive a second updated booster shot for the coronavirus. Here’s who should get the second covid booster and when.

New covid variant: A new coronavirus subvariant, XBB. 1.16, has been designated as a “variant under monitoring” by the World Health Organization. The latest omicron offshoot is particularly prevalent in India. Here’s what you need to know about Arcturus.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

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