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Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day three seven

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Speaker 1: since coronavirus was declared a global pandemic. Today's main story.

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Speaker 1: The US vaccination effort has ramped up to a pace

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Speaker 1: of more than a million shots a day, but second

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Speaker 1: shots are coming to putting pressure on states and leaving

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Speaker 1: some people hanging as they wait to get fully immunized.

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Speaker 1: But first, here's what happened in virus news today. US

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Speaker 1: regulators called Johnson and Johnson's COVID nineteen vaccine safe and effective.

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Speaker 1: It's a key milestone on the path towards giving Americans

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Speaker 1: access to the first such shot to work in a

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Speaker 1: single dose. According to the Food and Drug Administration, which

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Speaker 1: reviewed the company's trial results, the vaccine was seventy two

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Speaker 1: effective in the US based trial arm of its global study.

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Speaker 1: The f d A found the vaccine to be effective

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Speaker 1: against severe disease and said it worked better against mutant

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Speaker 1: coronavirus strains then previously reported. New York City health officials

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Speaker 1: said six per cent of the city's coronavirus cases are

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Speaker 1: due to the UK variant, which is believed to be

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Speaker 1: more contagious. While that number is higher than officials liked.

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Speaker 1: They said the number has remained steady in recent weeks. Meanwhile,

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Speaker 1: the city's middle school students will return to the classroom

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Speaker 1: on Thursday, bringing New York one step close to a

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Speaker 1: semblance of normalcy. Since the pandemic shuttered many school buildings

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Speaker 1: for nearly a year. High school buildings will remain closed. Finally,

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Speaker 1: the Czech Republic is preparing to impose a stricter lockdown

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Speaker 1: to prevent the collapse of its medical system. So far,

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Speaker 1: the government's measures have failed to contain one of the

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Speaker 1: fastest spreading and deadliest outbreaks in Europe. Almost exactly a

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Speaker 1: year after the first COVID nineteen case appeared in the country,

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Speaker 1: the crisis is worse than ever and the situation requires

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Speaker 1: a tougher response, according to Prime Minister Andre Babish. And

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Speaker 1: now for today's main story. Almost a month after US

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Speaker 1: vaccination campaigns ramped up to give COVID nineteen shots to

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Speaker 1: more than a million bull of day, their second doses

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Speaker 1: are now coming. Do that's putting a strain unstated rollouts

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Speaker 1: and leaving some people without complete immunizations. I spoke to

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Speaker 1: John Tozzi, who told me that as President, Joe Biden

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Speaker 1: accelerates purchases and distribution, critical weaknesses in the system are

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Speaker 1: starting to show. With vaccine rollout firmly underway, many Americans

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Speaker 1: have begun to receive their first shot of a COVID

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Speaker 1: nineteen vaccine, which is certainly a success, but I want

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Speaker 1: to know has prioritizing getting that first shot too Americans

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Speaker 1: meant that the US is now in trouble of making

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Speaker 1: sure people get their second dose of the vaccine. Well,

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Speaker 1: I wouldn't say that we're necessarily in trouble, but there

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Speaker 1: have been some challenges, as everybody kind of knew there

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Speaker 1: would be with the two dose vaccine. You know what

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Speaker 1: we've seen in the last couple of weeks. I mean, really,

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Speaker 1: when you look at the vaccination campaign, the initial rollout

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Speaker 1: didn't really hit its stride until kind of the middle

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Speaker 1: of January, on the middle and end of January, when

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Speaker 1: we were sort of beginning to consistently deliver a million

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Speaker 1: doses or more a day. And what happened in February

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Speaker 1: is that now all those people who were who were

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Speaker 1: getting their first doses in January are due for their

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Speaker 1: second shots either three or four weeks after the initial vaccination.

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Speaker 1: So it's sort of created this um new pressure on

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Speaker 1: the supply while there are still many millions of people

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Speaker 1: who haven't gotten their first dose. So we've seen in

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Speaker 1: a couple of places that this has just led to

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Speaker 1: some complications and challenges. And so let's let's walk through

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Speaker 1: some of the science behind the two doors the two

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Speaker 1: dose vaccine here in terms of say the Fieser or

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Speaker 1: the Madarna vaccine. You know, what is the timetable that

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Speaker 1: is recommended between the first and second shot and why

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Speaker 1: is that timetable perhaps so important? So in the clinical

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Speaker 1: trials that the drugmakers used to study these vaccines, uh

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Speaker 1: last year, the Fiser shots were spaced three weeks apart

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Speaker 1: and the Madernal shots were spaced four weeks apart. And

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Speaker 1: I'm not an expert in the science, but my understanding

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Speaker 1: is that, you know, the sort of first dose kind

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Speaker 1: of prompts an initial immune reaction, and then the second

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Speaker 1: dose seals that it makes it more stronger and more

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Speaker 1: durable and more effective. That's that's our our understanding. Um.

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Speaker 1: So those are the timetables that were used in the trials,

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Speaker 1: and because they're what we're used in the trials, that's

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Speaker 1: what's recommended that doesn't mean that if you get your

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Speaker 1: second door, so the Fiser vaccine twenty two days later

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Speaker 1: rather than twenty one days later, it's not going to work. Right.

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Speaker 1: There's you know, there's flexibility, and the CDC has actually said,

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Speaker 1: I mean, the CDC has said people forget their doses

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Speaker 1: on the recommended time frame, but if not, up to

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Speaker 1: six weeks is sort of an acceptable range where things

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Speaker 1: should be okay. There's some other evidence from other research that,

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Speaker 1: particularly with the astra Zeneca vaccine in use in the UK,

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Speaker 1: that um, you know, longer time frames may be acceptable. So,

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Speaker 1: you know, we're kind of dealing with this situation where

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Speaker 1: what was studied in trials is now um you know,

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Speaker 1: which is a very controlled situation, is now in a

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Speaker 1: more um you know, in the real world. You can't

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Speaker 1: always reach people at the precise interval or the supply

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Speaker 1: may up be there. So I think the public health

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Speaker 1: world is trying to figure out kind of how how

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Speaker 1: to handle that. Yeah, and I mean, certainly the very

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Speaker 1: difficult logistics of administering a two dose vaccine are becoming evident,

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Speaker 1: and to what extent are we seeing the perhaps necessary

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Speaker 1: effects are necessary consequences of trying to make the decision

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Speaker 1: between whether to hold back some supply of vaccine to

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Speaker 1: guarantee people can get a second dose of a vaccine

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Speaker 1: versus prioritizing getting as many people a first dose as

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Speaker 1: possible and not worrying perhaps about supplies of the second

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Speaker 1: dose until later. Is that kind of what we're starting

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Speaker 1: to see in the real world the effects of that

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Speaker 1: that decision. Yeah, I think to some extent, if you

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Speaker 1: go back to the middle of December, when the vaccines

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Speaker 1: were first being delivered, UM, the government held back half

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Speaker 1: the supply, in fact, initially even more than half the

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Speaker 1: supply to make sure there would be uh second doses

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Speaker 1: available in time, because they were very concerned about, you know,

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Speaker 1: whether there was kind of manufacturing, reliable manufacturing to to

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Speaker 1: make the new supply. Then in January, Uh, that kind

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Speaker 1: of shifted. The US had more confidence in the manufacturer's

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Speaker 1: ability to kind of reliably make new supply of of

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Speaker 1: the vaccines UM, and there was a real urgency to

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Speaker 1: get the public vaccinated because cases were so high, um

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Speaker 1: and climbing so quickly. Uh, certainly in December and January,

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Speaker 1: so you know, we we move from holding back a

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Speaker 1: second dose reserve to now second doses are you know,

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Speaker 1: as as best as we can tell, being supplied more

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Speaker 1: or less out of uh, you know, newly manufactured vaccines.

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Speaker 1: And I think there were some states that have you know,

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Speaker 1: and and some facilities that have their own you know,

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Speaker 1: reserves that may kind of cover them for a certain

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Speaker 1: period out. But you know, it's no surprise that if

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Speaker 1: we if we are not holding reserves, that at some

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Speaker 1: point there are trouble getting enough doses to the right

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Speaker 1: place at the right time. You know. We talked to

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Speaker 1: a hospital system in Michigan where they actually had to

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Speaker 1: cancel appointments for second doses last week because they did

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Speaker 1: not get the allocation that they expected from the state UM.

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Speaker 1: And I think those situations are incredibly common. But you know,

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Speaker 1: if it's if it's your second dose that you're waiting

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Speaker 1: on UM and obviously matters matters to you. Yeah, And

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Speaker 1: I mean this brings up kind of a question of

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Speaker 1: maybe across the board numbers, you know, we're we're hearing

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Speaker 1: about how more and more Americans are able to be

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Speaker 1: vaccinated UM as we moved through February and into March.

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Speaker 1: But what kind of data is available thus far about say,

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Speaker 1: the number of Americans who have been able to get

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Speaker 1: their second dose and even more specifically, their second dose

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Speaker 1: within the recommended timetable for their vaccine so UM. As

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Speaker 1: of today Wednesday, according to the CDC website, about forty

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Speaker 1: four forty five million Americans have gotten at least one dose,

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Speaker 1: and about twenty million of them um have gotten both doses,

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Speaker 1: so a little less than half. Just to keep in mind,

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Speaker 1: you know, many of those people, you know, people who

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Speaker 1: just got their vaccine in the last three or four weeks,

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Speaker 1: they're not due for their second dose yet, right, so

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Speaker 1: you'd expect the number to be UM to be to

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Speaker 1: be a lower. We don't have a clear sense of

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Speaker 1: how many people are sort of overdue for their second dose.

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Speaker 1: The CDC has said that most people are getting it

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Speaker 1: in the recommended three or four week intervals, and that

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Speaker 1: only a small percentage is sort of beyond the six

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Speaker 1: week time frame that they've kind of identified as the

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Speaker 1: you know, the sort of upper or outer limit. You know,

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Speaker 1: we don't have hard numbers around that we know from

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Speaker 1: from Texas earlier this month, even before the storms, there

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Speaker 1: there were um several thousand people who were who were

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Speaker 1: overdue a lot of states don't seem to be tracking this.

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Speaker 1: I think it may be something that it will take

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Speaker 1: a few weeks or even months to sort of understand

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Speaker 1: with better data. You know, how many people got one

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Speaker 1: dose and then for whatever reason, did not get or

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Speaker 1: weren't able to get a second dose on time. We

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Speaker 1: have heard about whether a second shot of these two

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Speaker 1: dose vaccines, say fives or maderna, is actually necessary at all,

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Speaker 1: and and that you're you're good to go, You're protected

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Speaker 1: enough after receiving your first shot. What is what are

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Speaker 1: some of the arguments there, you know, I think the

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Speaker 1: argument against that, against stretching doses or or you know,

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Speaker 1: only going uh for one dose of the vaccine is

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Speaker 1: that the trials were done with two doses, and and

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Speaker 1: that is what the evidence shows offers protection. Now, we

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Speaker 1: do know from the trials that there is some protection

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Speaker 1: after the first dose, you know, because the people in

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Speaker 1: the trials um got two doses. We don't have good

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Speaker 1: evidence over how long that that immunity might last, you know,

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Speaker 1: how durable it is. You know. So in the US, certainly,

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Speaker 1: UM the authorities are not recommending skipping the second dose

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Speaker 1: or stretching out the interval beyond you know what's indicated.

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Speaker 1: You know, we know that other countries have been experimenting

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Speaker 1: with that and doing that the UK. I think we're

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Speaker 1: beginning to get some evidence from some of those situations.

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Speaker 1: But in the US, the decision has been not to

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Speaker 1: try and stretch the supply by only giving people one dose.

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Speaker 1: And you know, I heard the CDC director UM Rochelle

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Speaker 1: Lensky yesterday on a congressional panel. She got a similar question,

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Speaker 1: and she said, if the if the drug makers had found,

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Speaker 1: you know, a durable immunity after one dose, they would

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Speaker 1: have much preferred to have a single dose vaccine is easier,

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Speaker 1: it increases the supply. UM. You know, so there's a

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Speaker 1: reason that that two doses were used in the trials. UM.

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Speaker 1: You know, for people who are we're trying to reach

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Speaker 1: and UM protect against the virus, particularly priority populations like

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Speaker 1: healthcare workers and you know, elderly folks, people in nursing homes. UM.

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Speaker 1: You know, the idea of UM stretching the doses. Uh,

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Speaker 1: it's not what the US authorities are recommending. Right now.

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Speaker 1: As we move forward through the vaccine rollout in the States,

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Speaker 1: you know, we are seeing kind of an ever changing eligibility. UM.

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Speaker 1: More and more states are opening up restriction is to

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Speaker 1: allow more of their populations to get their first dose.

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Speaker 1: I mean, to what extent are you expecting that the

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Speaker 1: logistical hurdles of making sure not only people can get

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Speaker 1: their first shot, but their second shot on time? I mean,

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Speaker 1: how much are you expecting that this is going to

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Speaker 1: just become more complicated and potentially more problematic as we

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Speaker 1: continue through the vaccine rollout. Um, It's hard to say.

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Speaker 1: I think, you know, one really good news item on

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Speaker 1: the horizon is that the Johnson and Johnson vaccine, which

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Speaker 1: is being you know, considered by the FDA this week

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Speaker 1: for emergency authorization, is a single dose. You know, if

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Speaker 1: that is authorized as as it's expected to be, you know,

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Speaker 1: that is a much simpler and much faster way to

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Speaker 1: immunize people. You Know. The other thing is, I think

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Speaker 1: the systems and just the sort of infrastructure around vaccination

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Speaker 1: has been improving. You more people are getting vaccinated. UM,

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Speaker 1: I think some of the you know, I T systems

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Speaker 1: and you know, booking websites like that's still pretty chaotic

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Speaker 1: in some places. And you know, we certainly heard from

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Speaker 1: people who went in for their first dose and then

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Speaker 1: we're not given an appointment for their second dose and

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Speaker 1: had trouble booking it a little bit. I think that's

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Speaker 1: still going on, but I don't think it's hard to

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Speaker 1: say whether it's going to get worse or whether it's

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Speaker 1: gonna get better. I think, you know, as we increase

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Speaker 1: the volume of vaccinations and increase the supply, you know,

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Speaker 1: hopefully some of these things will will become smoother in time.

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Speaker 1: That was John Tozzi, and that's it for our show today.

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Speaker 1: For coverage of the outbreak from one bureaus around the world,

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Speaker 1: visit Bloomberg dot com slash coronavirus and if you like

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Speaker 1: the show, please leave us a review and a rate

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Speaker 1: it on Apple Podcasts or Spotify. It's the best way

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Speaker 1: to help more listeners find our global reporting. The Prognosis

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Speaker 1: Daily edition is produced by Tophur foreheads Magnus Hendrickson and

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Speaker 1: me Laura Carlson. Today's main story was reported by John Tozzi.

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Speaker 1: Original music by Leo Sidrin. Our editors are Rick Shine

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Speaker 1: and Francesca Levi. Francesco Levi is Bloomberg's head of Podcasts.

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Speaker 1: Thanks for listening.