In medical centers and hospitals, in pharmacies, in schools and even on baseball fields, from Monday to Sunday and on holidays, the vaccination campaign in the United States has accelerated to the point of administering nearly three million injections a day. Since it began in December, 101.8 million people (30% of the population) have received at least one dose and, of these, almost 58 million are now fully vaccinated. News from states that are expanding the range of citizens eligible for inoculation has been frequent, reinforcing the sense that the tide is finally turning in this long and painful crisis: New York began with those in their thirties last week and will do so with those over 16 as of this Tuesday; Texas has already expanded coverage to any adult and most states will do so before the end of April.

The United States, which failed to contain the virus and has already exceeded the figure of 550,000 deaths, has demonstrated its scientific and economic power in the vaccine race. The keys to today’s success combine multiple and diverse factors, ranging from the multi-million dollar injection by the federal government, which dared to share the risks with the pharmaceutical industry, to a law that allows intervention in the production of factories dating from the Korean War, to unnatural alliances with rival companies. And including some individual contributions as made in USA as that of country star Dolly Parton and, incidentally, an “America First” cherry on top of trade policy.

The so-called Operation Warp Speed (whose name alludes to the fantasy, borrowed from science fiction, of traveling at speeds faster than the speed of light) has been, even for the most critical experts of Donald Trump, a success of the Republican Administration within an erratic management of the pandemic. It basically consisted of handing over more than 10 billion dollars to a group of pharmaceutical companies to research and develop these vaccines, with colossal pre-agreements for purchase without any guarantee of efficacy. For Amesh Adalja, an infectious disease expert at the Johns Hopkins Bloomberg School of Public Health, “that is probably the factor that has made the biggest difference between the United States and many other countries, even though the United Kingdom and Israel are vaccinating faster. The government secured doses of a vaccine when they didn’t yet know if they were going to work, and some are not even approved by the U.S. Food and Drug Administration (FDA).

In July, for example, the Executive announced an agreement to purchase 100 million doses of the vaccine developed by Pfizer-BioNTech for 1.95 billion dollars, with the option to buy an additional 500 million. Moderna’s is the one that has received the largest public funding. Promoted in collaboration with government researchers, it obtained $955 million for its development and $1.5 billion for the manufacture, distribution and delivery of 100 million doses. (It is in this that Dolly Parton also put her two cents). To Johnson & Johnson, the Administration gave more than $450 million for development and $1 billion for production and distribution, with an order for 100 million doses included in that amount. Astrazeneca and Oxford were injected with 1.2 billion for research, production and pre-orders for 300 million doses. Sanofi and GSK, 2 billion. Novavax, 1.6 billion. The latter two have yet to get their first vaccine to market.

“The whole thing could have been a scandal if the vaccines hadn’t worked, but it has worked out well,” notes Dr. Wachter.

A law of the Korean War

The first batches were manufactured with the help of the Production Defense Act, a rule dating back to the Korean War (1950) that gives the U.S. president the power to force companies to accept and prioritize contracts needed for national defense. The pandemic prompted the White House to invoke it, first to accelerate the production of masks and then to secure certain materials for vaccine production.

Even so, the first phase of distribution proceeded disappointingly slowly. The Trump Administration had pledged to end 2020 with 20 million citizens immunized and the number barely exceeded two and a half million. What experts call “the last mile of vaccination” – the stretch from vaccine to vaccinated person – failed. “There was a lot of emphasis on purchasing, but then the distribution to the states was not well planned, nor was the staffing or funding needed to administer it,” opines Johns Hopkins professor Adalja.

With the new Democratic administration, inaugurated on January 20, the United States stepped up the accelerator. On the one hand, it stepped up aid to the States and multiplied the number of federal vaccination centers and invested in the network of community pharmacies; on the other hand, the system as a whole and the authorities had learned to do better after the first few months. Soon after arriving at the White House, Moderna announced that he would be able to deliver 200 million doses by the end of May, a month ahead of schedule.

In addition, Biden’s team made two crucial decisions. It again used the Defense Production Act to make it easier for Pfizer to obtain the machinery needed to expand its Kalamazoo (Michigan) plant, and it pressured a J&J supplier to work against the clock to make up for the company’s backlog of product packaging bottlenecks. He has also sponsored a unique alliance between J&J and its rival, Merck, for the latter to help J&J manufacture the vaccine for the former. According to Merck, the government will help with 269 million dollars to adapt its facilities.

100 million doses

President Biden defined this agreement between competitors as “the kind of collaborations we saw in World War II. The 100 million doses he promised in his first 100 days in the White House, a calculatedly cautious forecast, were delivered into the arms of Americans weeks ago and he will probably fulfill his 100 days in office by getting double what he promised, 200 million doses. He believes there can be vaccines for everyone by the end of May and that next July 4 will be more than just a commemoration of America’s Independence Day, the birthday of the United States: he hopes it will serve as a celebration of independence from the virus.

In this optimistic scenario, pressure is growing for Washington to help countries with supply problems. The United States administers vaccines from Pfizer, Moderna and J&J, although it has millions of doses from AstraZeneca, which has not yet been approved by the FDA. Dr. Anthony Fauci, director of the Institute of Allergology and Infectious Diseases and a top advisor to Trump and Biden, estimates that the U.S. could meet its needs without relying on AstraZeneca units. For the time being, the government will export 2.5 million of them to Mexico and 1.5 million to Canada, its neighbors and partners in the North Atlantic Treaty trade agreement.

Biden has pledged to provide financial support to other companies, such as India’s Biological E, to manufacture more, in an agreement announced at the Quad Summit, a virtual meeting to address the issue involving the U.S., India, Japan and Australia.

Vaccine diplomacy has not, for the moment, gone much further. “If we have surpluses, we’re going to share them with the rest of the world,” Biden said last March. “First we’re going to make sure we can take care of Americans, but then we’re going to try to help the rest of the world,” he added.

At the current cruising speed, immunization of Americans could reach 90% by the end of July, although risks and challenges remain. “We’re still running into 20% to 25% of the population reluctant to get the vaccine, we’re also seeing occasional glitches in the system [such as J&J’s 15 million doses ruined this week by human error] and we’re delivering the vaccine on bench schedules, when we should be delivering it on 16- and 18-hour days. This is a race against the virus and its variants,” opines Mayo Clinic vaccine research group director Gregory Poland, also a consultant to several pharmaceutical companies. “The other problem,” he adds, “is that each state does it differently. In his view, “the idea of moving from phase to phase and group to group is intellectually appealing, but what you need is the more first doses in the arms, the better.”

Fatigue from this long year of pandemic and restrictions carries the ultimate danger. Vaccination is not progressing as fast as the desire for normalcy and infections have risen again – at a rate of 65,000 cases per day last week – close to last summer’s peak, while many states have begun to relax restrictions.

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