with Alexandra Ellerbeck

The federal government has now bought enough coronavirus vaccines to fully immunize 750 million people.

That’s three times the number of American adults — raising questions about where all those extra doses might go.

Prospects of a vaccine shortage giving way to a surplus seemed nearer than ever this week.

President Biden announced yesterday that he ordered 100 million more doses from Johnson & Johnson, as a safeguard against manufacturing disruptions or outbreaks of coronavirus variants.

“Biden announced the plan a week after vowing that the United States will have enough vaccine to administer to all American adults by the end of May,” Christopher Rowland and Isaac Stanley-Becker write.

“The new order, which Johnson & Johnson indicated has not been finalized, will bring total United States orders of Johnson & Johnson vaccine to 200 million. Because it’s a one-dose vaccine, the supply will represent enough for 200 million people,” they add. “It is not expected to be fulfilled until the second half of the year, administration officials said.”

The United States should have 1.3 billion vaccine doses – if all goes according to plan.

Before this week, the Trump and Biden administrations had already bought, or contracted to buy, 1.2 billion doses from six different vaccine manufacturers. They include:

  • 100 million doses from Johnson & Johnson
  • 300 million doses from Pfizer
  • 300 million doses from Moderna
  • 300 million doses from AstraZeneca
  • 100 million doses from Novovax
  • 100 million doses from Sanofi

Together, the doses from all six companies would be enough to vaccinate 750 million people, given that all the vaccines other than Johnson & Johnson require two shots. Considering there are 260 million adults in the United States, that puts the United States way over the threshold needed to immunize the entire population who is eligible for vaccination.

Of course, three of the companies — AstraZeneca, Novovax and Sanofi — haven’t yet had their vaccines approved in the United States. It’s possible there could be some hiccups or delays for those companies in gaining emergency use approval by the Food and Drug Administration, strengthening the Biden administration’s argument for buying so many vaccine doses. 

And, one reason why the total projection is so large is because the Trump administration ordered hundreds of millions of vaccine doses last year, before any of the vaccines were approved, partly as a way to encourage vaccine development – and to hedge bets about which would be delivered first. 

Biden insisted yesterday that he’s not viewing the additional shots from Johnson & Johnson as surplus supply.

“We need maximum flexibility,” the president said. “There is always a chance we will encounter unexpected challenges or there will be a new need for a vaccination effort.”

Yet it seems clear the United States will end up with many more doses than it actually needs.

At face, the massive spending on vaccines could seem like a bit of an excess. Buying more vaccine doses for the future isn’t going to solve the immediate problem of meeting demand right now.

“If there’s a way to get 100 million doses right now, it would be worth it,” said Eric Topol, director and founder of the Scripps Research Translational Institute. “But otherwise it doesn’t make any sense.”

But there are a variety of ways to put extra supply to use.

The most obvious is to share vaccine doses with the rest of the world — both for humanitarian and diplomatic reasons. 

On his first day in office, Biden signed directives to reengage with the World Health Organization and opt into Covax, a multilateral effort to distribute vaccines globally. A national security memo released by the White House called for the secretaries of state and health to send Biden “a framework for donating surplus vaccines, once there is sufficient supply in the United States, to countries in need.”

Biden pledged yesterday to “try to help the rest of the world” with vaccines, after “making sure Americans are taken care of first.”

“If we have a surplus, we’re going to share it with the rest of the world,” he said.

But it’s unclear how far along the agencies are in working on the framework, frustrating some humanitarian groups who say the administration should move faster in plans to administer vaccines around the world.

“We are encouraged by the number of vaccines they have been able to secure,” said Tom Hart, North America executive director at the One Campaign. “But now hedging is starting to look a little bit like hoarding.”

The United States could also strengthen diplomatic bridges with other countries by giving them vaccine doses.

It’s called vaccine diplomacy, and several countries are heavily engaged in it. China has pledged half a billion doses of its vaccines to more than 45 countries, according to a tally by the Associated Press. Latin American countries are relying heavily on China, Russia and India for vaccines.

It’s in the interest of the United States to start becoming a vaccine supplier to poorer countries, said Carlos Del Rio, professor of medicine and global health at Emory University. Other countries are seizing opportunities to build goodwill and influence globally, while the United States is still focusing internally on vaccinating its own citizens, he noted.

“The U.S. needs to be a leader in the global health arena,” he said. “The void is being filled by Russia, China and India.”

Excess vaccine doses could also be used on children, for adult booster shots or for additional research.

None of the vaccines have been approved for use in children, but that could eventually change once trials on kids have been completed. Those efforts are lower priority, considering children only rarely become seriously ill from covid-19, but there will need to be millions more doses available to vaccinate them if the Food and Drug Administration grants approval.

It’s also possible that adults will need booster shots of the coronavirus vaccines in the future or that researchers will want to explore additional questions, such as whether mixing vaccines or giving them at different intervals changes the effectiveness, noted Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

“I don’t know that they’ll go to waste,” Adalja said.

Correction: An earlier version of the article mistakenly said the government has purchased 1.5 billion vaccine doses. The correct number is 1.3 billion doses, enough to vaccine 750 million people.

Congress has approved the sweeping $1.9 trillion stimulus bill.

The bill, which passed the House by nine votes yesterday with not a single Republican voting in favor, sends one of the largest economic rescue packages in history to Biden’s desk, The Post’s Tony Romm reports

The bill, which Biden is expected to sign tomorrow, includes another round of $1,400 stimulus checks for most Americans and enhanced unemployment aid for people still out of work. It authorizes a temporary yet dramatic increase in anti-poverty programs, including changes to the child tax credit that Democrats say could cut child poverty by up to half.

Here are some other changes we expect to see:

  • Boosted Obamacare subsidies will soon be available on Healthcare.gov, and people with lower incomes will see more plans with zero premiums. The changes are expected to help provide coverage for 1.3 million previously uninsured people. The government will also temporarily slash premiums for laid off workers who opt to maintain their employer provided health insurance through COBRA.  But the expansion come with a hefty $34.2 billion price tag, representing a 29 percent spending hike in the subsidies and driving home how expensive it is to rely on the nation’s nonprofit insurance industry to get Americans covered.
  • The twelve states that have not expanded Medicaid will see even more incentives from the federal government to do so. At least 4 million Americans who would otherwise be eligible for expanded Medicaid live in those dozen holdout states, with nearly a third of them in Texas. Under the stimulus bill, the government would increase its Medicaid contribution by 5 percent to states that expand the program.
  • Ambulance providers may see some relief from a provision that allows Medicare to reimburse providers for services even if the patient is not transported to a hospital. Current rules only allow ambulances to be reimbursed if they take a patient to the closest hospital or clinic, but during the pandemic, some jurisdictions have instructed ambulances to deliver care in place whenever possible.

Ahh, oof and ouch

AHH: States are preparing for a flood of vaccine doses.

The dilemma of how to ration scarce vaccine supplies could soon give way to challenges that come from handling a flood of new doses. State and local officials have been advised to plan for between 22 million and 24 million shots a week by early April, an increase of as much as 50 percent from current allocations, The Post’s Isaac Stanley-Becker reports.

States and other jurisdictions will need to ensure that they have the space and staff to administer vaccines. Another challenge may come in addressing vaccine hesitancy, which could suppress demand and make it harder for the country to reach herd immunity.

More than 32 million people in the United States have been fully vaccinated, and the pace of doses administered now exceeds 2 million a day. The Post spoke with five health experts who have been vaccinated about how they are navigating risk and how their lives have changed since being inoculated.

And there are other reasons for optimism going into the spring: The seven-day average for new daily coronavirus cases in the United States fell below 58,000 for the first time since mid-October, and hospitalizations are also down dramatically. Federal health officials cited these statistics in a decision to relax government guidelines on nursing home visits. Still, experts urge caution as new variants of the virus spread, and health officials worry that spring break travel could spark new outbreaks.

OOF: The World Trade Organization is meeting this week to consider suspending coronavirus vaccine patents.

The international trade organization is considering a proposal from India and South Africa that would temporarily waive patent rights to facilitate technology transfer and speed up production of the vaccines, Reuters’s John Miller reports. 

Some 100 nations have expressed support for the proposal, but it faces opposition from wealthy Western countries with large domestic pharmaceutical industries, including the United States. Activist groups who support the measure, including Doctors Without Borders, say that it could allow more countries to produce vaccines and speed up vaccine delivery to poorer countries. 

There’s a precedent for this type of move: Two decades ago, several countries, including Mozambique, Zambia and Zimbabwe, issued compulsory licenses for HIV/AIDS drugs, which allowed governments to waive some intellectual property rights, and resulted in a dramatic increase in access to the drugs. 

But the coronavirus vaccines are more complex than the AIDS drugs decades ago, and some experts say that loosening up patent restrictions would do little to increase global supply. They argue that the vaccines require close cooperation between developers and manufacturers and that bottlenecks in raw materials are a bigger concern than intellectual property limits. 

OUCH: Stimulus money is unlikely to speed a reopening of California schools.

The state’s schools are set to receive $15 billion in the latest stimulus package, with most of the education funding going to help districts buy personal protective equipment, install better ventilation and take other measures to prevent the spread of the virus. But some districts haven't come up with a plan for returning kids to classrooms this academic year.

“For communities that have yet to come up with a plan to resume in-person instruction this school year, it is unlikely to make a difference. In many places, the major hurdle to reopening schools before fall — or even then — remains disagreement with employee unions over what level of local transmission of the coronavirus is safe for their return,” The San Francisco Chronicle’s Alexei Koseff reports.

Financial support from the federal legislation, as well as state efforts, may not be enough to reopen classrooms in districts where families have been reluctant to send their kids back to school or where administrators and employee unions have not been able to come to terms on safety measures. 

Troy Flint, a spokesperson for the California School Boards Association, told the San Francisco Chronicle that declining community transmission and increased availability of vaccines for educators have had a bigger impact on reopenings than any legislation.

Elsewhere in health care

Senate Democrats are pushing for more public health funding.

The chair of the Senate Health Committee is reintroducing a bill that could steer billions of dollars in additional annual funding to state, local and territorial public health departments, The Post’s Dan Diamond reports. 

Sen. Patty Murray (D-Wash.), who chairs the Senate Health, Education, Labor and Pensions Committee, told reporters that the pandemic has laid bare the need for more public health investment and that the United States must rebuild “stronger and fairer” in the wake of this crisis. The bill is co-sponsored by 19 Senate Democrats, including Sens. Amy Klobuchar (D-Minn.) and Elizabeth Warren (D-Mass.).

Murray’s bill was timed to the release of a new report from public health organization Trust for America’s Health, which claimed that underinvestment in public health led to failures in the country’s pandemic response. The bill has the backing of more than 120 health organizations, including the Association of American Medical Colleges, Association of State and Territorial Health Officials, Asian & Pacific Islander American Health Forum, and March of Dimes.

Arkansas’s governor signed a near-total ban on abortion into law.

Gov. Asa Hutchinson expressed some reservations about the bill, which only allows abortions to save the life of the mother and does not provide exceptions for those impregnated in an act of rape or incest. But the Republican governor said he signed the bill because of its “overwhelming legislative support,” as well as his long-held pro-life convictions, the Associated Press’s Andrew DeMillo reports.

Arkansas is one of at least 14 states where conservative legislators have proposed outright abortion bans, in an effort to force to the Supreme Court to revisit its 1973 Roe v. Wade decision, which legalized abortion nationwide.

Medical examiner findings will play a key role in Derek Chauvin’s trial.

A video of Minneapolis police officer Derek Chauvin kneeling on the neck of George Floyd for nine minutes, even as Floyd gasped for breath and eventually stopped responding, incited nationwide protests and demands for policing reforms. 

“But when Chauvin’s trial for his alleged role in Floyd’s death begins, much of the argument will center instead on the autopsy details, most specifically whether fentanyl and underlying health conditions — not the police officer’s actions — stopped Floyd’s heart and lungs,” The Post’s Lenny Bernstein and Holly Bailey report.

Hennepin County District Court Judge Peter A. Cahill spoke to potential jurors for the trial of former Minneapolis police officer Derek Chauvin on March 9. (The Washington Post)

Autopsy results show that Floyd had three severely narrowed coronary arteries and likely suffered from long-term high blood pressure. He also had a large amount of fentanyl, a small amount of methamphetamine and THC — the active ingredient in marijuana — in his blood at the time of his death.

“Combined with sickle cell trait [and] his preexisting heart conditions, Mr. Floyd’s use of fentanyl and methamphetamine most likely killed him,” Chauvin’s attorney, Eric J. Nelson, wrote in an Aug. 28 court filing.

But seven experts in toxicology, cardiology and illegal drug use who were consulted by The Washington Post largely disagreed with the idea that Chauvin’s death was the result of a drug overdose. Several argued that the chain of events that evening inconsistent with a fentanyl overdose, which would have caused Floyd to become quickly sluggish and unresponsive. Instead, video shows Floyd coherently speaking with police and struggling when they pinned him down.

Sugar rush