Fauci: There’s No ‘Organized Approach’ to Tracking COVID Vaccine

·11 min read

The Biden administration is desperate to ramp up the distribution of COVID-19 vaccine. But officials working with the White House’s coronavirus task force are running into a major problem: The data they need to track the delivery of doses is incomplete, often late, and sometimes even contradictory.

Without a reliable accounting system, the administration is essentially flying blind, relying instead on hundreds of local anecdotes about issues with supply and low vaccination rates, according to three officials working with the White House’s COVID-19 task force. That makes it much more difficult to piece together a cohesive picture of a national problem with life-or-death consequences. Some vaccine vials lost in the system could hold as many as six or seven doses. And there are millions of doses unaccounted for, officials say.

“Right now, what we have is anecdotal stories, stories of people who are online and can't get it because there's not enough vaccine, places where you have vaccine in the refrigerator but you don't have enough people to administer it. We need to get an organized approach to find out exactly what is going on at the local level and try and fix it,” said Dr. Anthony Fauci, President Biden’s chief medical officer, in an interview with The Daily Beast.

In an interview earlier this week, CDC Director Dr. Rochelle Walensky told Fox News she did not know how many vaccine doses were available for use.

“I can’t tell you how much vaccine we have, and if I can’t tell it to you, then I can’t tell it to the governors, and I can’t tell it to the state health officials,” she said.

Fauci noted that Dr. Deborah Birx, the White House coronavirus task force coordinator under the Trump administration, spent the last several months of her tenure traveling across the country, meeting with local health officials in an attempt to bridge the communication gap between the federal government and states. It didn’t work.

“Deb knocked herself out trying to do that. And you're one person. You can't just be going around, you know, with their roller bag in their hand, trying to fix the problems. She should be totally commended for the effort. But you got to have a much more organized, multi-faceted approach rather than a single person,” Fauci said. “You need to try to figure out… what is going on at the local level. And how can we strengthen the interaction between the federal government and the locals to figure out what the issue is?”

Part of the problem, according to volunteers who have worked for New York City’s distribution hub, is that the state is relying on people with very little or no existing public health background to run massive vaccination centers. Volunteers, some of whom hail from various city agencies, said they’ve shown up for work only to receive little instruction on how to do their assigned jobs. One individual said they were handed a binder with hundreds of pages on how the team should run the show but that they didn’t have time to read it. Another volunteer said they had to figure out on the fly how to design the flow of patients streaming into the center, whether and how to check for identification, and how to account for the doses administered.

“We were given very few details of what we would be asked to do,” that volunteer said. “And then the next day a new team comes in and it’s like ‘Did you work yesterday? No? Do you know what we’re supposed to do? So every day people have to reinvent the wheel.”

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“If the New York City public health department had relatively the same resources as my hospital, we’d been in a much better position,” said Dr. Craig Spencer, an emergency medicine doctor at New York-Presbyterian Hospital, one of the country’s most prestigious academic medical centers. “Finances aren’t everything, but they are huge in terms of building capacity. We will find a way to brutishly push out the vaccine in these communities. But what we’re doing now isn’t working. This is not the best way to do this.”

Without a comprehensive data collection and analysis platform, officials said, they can’t fully understand whether the bottlenecks in one state, for example, are the result of the same issues as the bottlenecks in another. Second doses badly lag first jabs in several states that The Daily Beast reviewed, while others, such as California—which did not respond to requests for further information—have struggled to administer initial shots. The Biden team also doesn’t have a full grasp on how many vaccine doses are already available to states, whether some have either been set aside for second doses or for the federal long-term-care vaccination program or if some are simply sitting somewhere in the distribution system, perhaps in warehouses or distribution hub fridges.

The CDC’s vaccination tracker shows a wide gap between the number of doses distributed to states and the number states have administered. For example, in Kentucky, where Gov. Andy Beshear has said the state does not have enough supply to meet the demand for the vaccine, the CDC says the federal government has distributed 557,975 doses but that the state has administered just 312,192 of them. On the Kentucky government’s vaccination dashboard, however, the state says it’s only received 466,700 doses from the feds—representing nearly 90,000 fewer shots than what’s in the CDC tally. That could be because the state has not received and logged the latest shipment from the federal government, but both federal and state officials say they are not exactly sure why the gap exists.

Either way, the state appears to have more than 100,000 doses it has not administered, some of which are earmarked for the federally run long-term care vaccination program. Beshear has also said the state is holding back some of the doses it receives for second-dose shots. Although vaccination rates have improved in recent dates, several states are reporting similar situations to Kentucky's and are struggling to quickly get the vaccine out to those eligible.

“The most immediate impact to all of this is that this virus is going to keep infecting people. When you get to a critical mass vaccinated, you see a dramatic decline in new COVID cases,” said Dr. Megan Ranney, an emergency medicine doctor at Brown University in Rhode Island.

In a press conference with reporters Wednesday, Walensky attempted to explain the data discrepancies. She said her team is working to understand the divergence in the federal data vaccination tracker and the state vaccination distribution dashboards. In doing that, she said, the federal government is hoping to understand where in the distribution system vaccine is located and how many doses have been put into people’s arms.

“Not all vaccine that is allocated or delivered… is available for inserting into people’s arms. Where in the pipeline that is varies by the day of the week and whether it is available that singular day,” Walensky said. “We are working very hard in ensuring where exactly the vaccine is on any given day. The reporting of the data is actually also behind. We’re getting [information on] when vaccines are reported rather than when they are actually administered.”

According to the CDC’s vaccination tracker, the federal government has distributed about 44 million doses but only 23 million have been administered by states. State officials say the CDC tracker paints a misleading picture of the reality on the ground—that they are administering more doses than the federal government reflects in its data. Several officials who spoke with The Daily Beast said they fear the federal government, in viewing those numbers, will decide to curtail the number of doses their jurisdiction receives over the following weeks. Biden’s team has explicitly said they will not prioritize certain states over others and will instead distribute the vaccine equitably across the country.

On a call with the nation’s governors Tuesday—hosted by Walensky, Jeff Zients, the White House’s task force coordinator, and Gen. Gustave Perna, who oversees Operation Warp Speed—state leaders raised concern over the way the federal government tracks the vaccine, saying it was confusing an already chaotic distribution process, according to two individuals who were on the call.

Here’s Why It Will Be Hard to Ramp Up COVID Vaxx Production

“I can tell you that Missouri is not alone in our frustration on how vaccination data is being reported by the CDC," Missouri Gov. Michael Parson said in a statement after the call. "I and many other governors expressed concern that vaccination data from the CDC is being misrepresented and does not fully reflect the situations we are seeing at the state level."

At present, federal figures show Missouri has injected just 335,695 of 661,400 doses shipped to it. The state numbers show 374,742 inoculations in total, though only 84,000 people have gotten the crucial second dose.

New York Gov. Andrew Cuomo has been among the most vocal governors complaining about his state’s allotment of doses. An official in the Democrat’s office pointed to the drop-off in the federal allocation following the second week of the vaccine's availability. Albany's figures show the Empire State received 392,025 doses between Dec. 21 and 27, but only 201,500 between Dec. 28 and Jan. 3—and just 160,050 the week after that. That’s more than a 50 percent drop in two weeks. Based on calls with the Trump administration prior to the vaccine’s release, the Cuomo team said it had expected a slow rollout in the first week, but not such a decline in availability after the second. The ration has increased somewhat since then but has never approached the 392,025 level set in December.

Cuomo’s office has repeatedly said that New York now has a vaccine shortage, insisting the state could inoculate 100,000 people or more daily if given greater supply. As evidence, it noted New York has injected 93 percent of the first doses it has received.

However, the latest state figures show that less than than 30 percent of the second shots the feds have sent New York have made it into people’s arms. Cuomo defended this sore point on a call with the CDC Monday, according to individuals on the call who spoke with The Daily Beast. He asserted that some states have used second dose shipments to give the completely unvaccinated their initial prick, while New York is reserving the second doses for those who have already gotten the first shot—which is more logistically challenging.

Meanwhile, the CDC reports having shipped more than 2.4 million total doses to New York, even though the state’s dashboard only shows it receiving around 1.87 million—leaving more than half a million doses seemingly unaccounted for. But the source in Cuomo's office shared numbers with The Daily Beast showing that roughly 450,000 of those missing shots were in fact set aside for the federal program to vaccinate long-term care facilities, which come out of the state’s allocation but don’t show up on its tracker.

This, combined with different reporting schedules and structures, accounts for much of the divergence in state and federal figures, the official said.

Asked why there were widespread discrepancies between its federal tracker and state data, CDC officials said the agency has to pull data from several different places, which can take time to analyze and update. The CDC is sent vaccination data from pharmacies, federal agencies that receive the vaccine directly, and the Vaccine Administration Management System, which supports temporary, mobile, and satellite clinics, and state and local information systems.

The Biden administration plans on leaning more heavily on the Federal Emergency Management Agency (FEMA) to help streamline how counties, cities, and states track distribution and administration.

“What FEMA should be doing is integrating into the state emergency management departments,” said Juliette Kayyem, a former assistant secretary in the Department of Homeland Security. “They should be asking, ‘What are Pfizer and Moderna saying they have shipped? And for each state, FEMA should ask, ‘What do you have and where is the gap?’ Often in situations like this, you do a 50-state data call. You send an email out at night and you ask states to provide their numbers by the next day. You can do this every day. This is what you do in disasters.”

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