WEBVTT - The Second Shot Squeeze 0:00:03.160 --> 0:00:08.840 Welcome to Prognosis. I'm Laura Carlson. It's day three seven 0:00:09.119 --> 0:00:14.360 since coronavirus was declared a global pandemic. Today's main story. 0:00:15.440 --> 0:00:18.840 The US vaccination effort has ramped up to a pace 0:00:18.920 --> 0:00:23.079 of more than a million shots a day, but second 0:00:23.079 --> 0:00:28.240 shots are coming to putting pressure on states and leaving 0:00:28.280 --> 0:00:31.920 some people hanging as they wait to get fully immunized. 0:00:33.840 --> 0:00:48.600 But first, here's what happened in virus news today. US 0:00:48.680 --> 0:00:54.640 regulators called Johnson and Johnson's COVID nineteen vaccine safe and effective. 0:00:55.240 --> 0:00:58.880 It's a key milestone on the path towards giving Americans 0:00:59.200 --> 0:01:02.960 access to the first such shot to work in a 0:01:03.040 --> 0:01:07.280 single dose. According to the Food and Drug Administration, which 0:01:07.319 --> 0:01:11.800 reviewed the company's trial results, the vaccine was seventy two 0:01:12.280 --> 0:01:17.119 effective in the US based trial arm of its global study. 0:01:17.640 --> 0:01:20.440 The f d A found the vaccine to be effective 0:01:20.480 --> 0:01:25.000 against severe disease and said it worked better against mutant 0:01:25.040 --> 0:01:32.360 coronavirus strains then previously reported. New York City health officials 0:01:32.360 --> 0:01:36.640 said six per cent of the city's coronavirus cases are 0:01:36.720 --> 0:01:40.319 due to the UK variant, which is believed to be 0:01:40.400 --> 0:01:45.280 more contagious. While that number is higher than officials liked. 0:01:45.680 --> 0:01:51.840 They said the number has remained steady in recent weeks. Meanwhile, 0:01:52.200 --> 0:01:55.960 the city's middle school students will return to the classroom 0:01:56.120 --> 0:02:00.440 on Thursday, bringing New York one step close to a 0:02:00.520 --> 0:02:05.080 semblance of normalcy. Since the pandemic shuttered many school buildings 0:02:05.320 --> 0:02:12.240 for nearly a year. High school buildings will remain closed. Finally, 0:02:12.639 --> 0:02:16.560 the Czech Republic is preparing to impose a stricter lockdown 0:02:16.800 --> 0:02:21.080 to prevent the collapse of its medical system. So far, 0:02:21.440 --> 0:02:24.720 the government's measures have failed to contain one of the 0:02:24.840 --> 0:02:30.560 fastest spreading and deadliest outbreaks in Europe. Almost exactly a 0:02:30.639 --> 0:02:34.639 year after the first COVID nineteen case appeared in the country, 0:02:34.840 --> 0:02:39.200 the crisis is worse than ever and the situation requires 0:02:39.240 --> 0:02:50.040 a tougher response, according to Prime Minister Andre Babish. And 0:02:50.160 --> 0:02:54.600 now for today's main story. Almost a month after US 0:02:54.680 --> 0:02:58.760 vaccination campaigns ramped up to give COVID nineteen shots to 0:02:58.880 --> 0:03:02.320 more than a million bull of day, their second doses 0:03:02.560 --> 0:03:07.720 are now coming. Do that's putting a strain unstated rollouts 0:03:07.760 --> 0:03:12.880 and leaving some people without complete immunizations. I spoke to 0:03:12.960 --> 0:03:16.720 John Tozzi, who told me that as President, Joe Biden 0:03:16.880 --> 0:03:22.119 accelerates purchases and distribution, critical weaknesses in the system are 0:03:22.240 --> 0:03:32.119 starting to show. With vaccine rollout firmly underway, many Americans 0:03:32.120 --> 0:03:34.120 have begun to receive their first shot of a COVID 0:03:34.200 --> 0:03:38.560 nineteen vaccine, which is certainly a success, but I want 0:03:38.600 --> 0:03:44.040 to know has prioritizing getting that first shot too Americans 0:03:44.200 --> 0:03:47.520 meant that the US is now in trouble of making 0:03:47.560 --> 0:03:52.080 sure people get their second dose of the vaccine. Well, 0:03:52.120 --> 0:03:54.720 I wouldn't say that we're necessarily in trouble, but there 0:03:54.760 --> 0:03:58.840 have been some challenges, as everybody kind of knew there 0:03:58.840 --> 0:04:02.640 would be with the two dose vaccine. You know what 0:04:02.680 --> 0:04:06.119 we've seen in the last couple of weeks. I mean, really, 0:04:06.160 --> 0:04:10.240 when you look at the vaccination campaign, the initial rollout 0:04:10.520 --> 0:04:13.520 didn't really hit its stride until kind of the middle 0:04:13.560 --> 0:04:16.720 of January, on the middle and end of January, when 0:04:16.760 --> 0:04:20.760 we were sort of beginning to consistently deliver a million 0:04:20.839 --> 0:04:25.600 doses or more a day. And what happened in February 0:04:25.720 --> 0:04:27.680 is that now all those people who were who were 0:04:27.680 --> 0:04:30.160 getting their first doses in January are due for their 0:04:30.200 --> 0:04:35.320 second shots either three or four weeks after the initial vaccination. 0:04:35.400 --> 0:04:39.600 So it's sort of created this um new pressure on 0:04:39.720 --> 0:04:42.760 the supply while there are still many millions of people 0:04:43.000 --> 0:04:46.479 who haven't gotten their first dose. So we've seen in 0:04:46.480 --> 0:04:48.560 a couple of places that this has just led to 0:04:48.640 --> 0:04:52.960 some complications and challenges. And so let's let's walk through 0:04:53.240 --> 0:04:56.440 some of the science behind the two doors the two 0:04:56.440 --> 0:04:59.440 dose vaccine here in terms of say the Fieser or 0:04:59.480 --> 0:05:03.720 the Madarna vaccine. You know, what is the timetable that 0:05:03.880 --> 0:05:06.960 is recommended between the first and second shot and why 0:05:07.120 --> 0:05:12.240 is that timetable perhaps so important? So in the clinical 0:05:12.279 --> 0:05:18.400 trials that the drugmakers used to study these vaccines, uh 0:05:18.720 --> 0:05:24.799 last year, the Fiser shots were spaced three weeks apart 0:05:25.200 --> 0:05:28.800 and the Madernal shots were spaced four weeks apart. And 0:05:28.880 --> 0:05:32.279 I'm not an expert in the science, but my understanding 0:05:32.360 --> 0:05:35.680 is that, you know, the sort of first dose kind 0:05:35.680 --> 0:05:40.120 of prompts an initial immune reaction, and then the second 0:05:40.200 --> 0:05:44.400 dose seals that it makes it more stronger and more 0:05:44.480 --> 0:05:49.800 durable and more effective. That's that's our our understanding. Um. 0:05:49.920 --> 0:05:52.760 So those are the timetables that were used in the trials, 0:05:53.080 --> 0:05:55.400 and because they're what we're used in the trials, that's 0:05:55.440 --> 0:05:59.440 what's recommended that doesn't mean that if you get your 0:05:59.480 --> 0:06:02.880 second door, so the Fiser vaccine twenty two days later 0:06:02.960 --> 0:06:05.880 rather than twenty one days later, it's not going to work. Right. 0:06:05.960 --> 0:06:09.680 There's you know, there's flexibility, and the CDC has actually said, 0:06:09.960 --> 0:06:11.960 I mean, the CDC has said people forget their doses 0:06:12.640 --> 0:06:15.640 on the recommended time frame, but if not, up to 0:06:15.720 --> 0:06:19.280 six weeks is sort of an acceptable range where things 0:06:19.320 --> 0:06:23.760 should be okay. There's some other evidence from other research that, 0:06:23.960 --> 0:06:28.479 particularly with the astra Zeneca vaccine in use in the UK, 0:06:29.279 --> 0:06:33.960 that um, you know, longer time frames may be acceptable. So, 0:06:34.120 --> 0:06:36.320 you know, we're kind of dealing with this situation where 0:06:36.360 --> 0:06:39.919 what was studied in trials is now um you know, 0:06:39.960 --> 0:06:42.680 which is a very controlled situation, is now in a 0:06:42.800 --> 0:06:45.800 more um you know, in the real world. You can't 0:06:45.839 --> 0:06:50.000 always reach people at the precise interval or the supply 0:06:50.040 --> 0:06:53.600 may up be there. So I think the public health 0:06:54.240 --> 0:06:56.400 world is trying to figure out kind of how how 0:06:56.440 --> 0:07:01.080 to handle that. Yeah, and I mean, certainly the very 0:07:01.120 --> 0:07:07.440 difficult logistics of administering a two dose vaccine are becoming evident, 0:07:07.720 --> 0:07:13.800 and to what extent are we seeing the perhaps necessary 0:07:13.880 --> 0:07:19.480 effects are necessary consequences of trying to make the decision 0:07:19.560 --> 0:07:23.960 between whether to hold back some supply of vaccine to 0:07:24.040 --> 0:07:27.400 guarantee people can get a second dose of a vaccine 0:07:27.960 --> 0:07:32.840 versus prioritizing getting as many people a first dose as 0:07:32.920 --> 0:07:36.440 possible and not worrying perhaps about supplies of the second 0:07:36.480 --> 0:07:40.240 dose until later. Is that kind of what we're starting 0:07:40.280 --> 0:07:43.520 to see in the real world the effects of that 0:07:43.520 --> 0:07:46.320 that decision. Yeah, I think to some extent, if you 0:07:46.360 --> 0:07:49.600 go back to the middle of December, when the vaccines 0:07:49.640 --> 0:07:54.640 were first being delivered, UM, the government held back half 0:07:54.760 --> 0:07:57.280 the supply, in fact, initially even more than half the 0:07:57.280 --> 0:08:01.440 supply to make sure there would be uh second doses 0:08:01.680 --> 0:08:06.640 available in time, because they were very concerned about, you know, 0:08:06.680 --> 0:08:10.960 whether there was kind of manufacturing, reliable manufacturing to to 0:08:11.080 --> 0:08:14.680 make the new supply. Then in January, Uh, that kind 0:08:14.720 --> 0:08:18.720 of shifted. The US had more confidence in the manufacturer's 0:08:18.760 --> 0:08:23.480 ability to kind of reliably make new supply of of 0:08:23.520 --> 0:08:27.080 the vaccines UM, and there was a real urgency to 0:08:27.880 --> 0:08:33.040 get the public vaccinated because cases were so high, um 0:08:33.080 --> 0:08:37.199 and climbing so quickly. Uh, certainly in December and January, 0:08:37.600 --> 0:08:41.960 so you know, we we move from holding back a 0:08:42.080 --> 0:08:45.880 second dose reserve to now second doses are you know, 0:08:46.000 --> 0:08:49.520 as as best as we can tell, being supplied more 0:08:49.640 --> 0:08:54.000 or less out of uh, you know, newly manufactured vaccines. 0:08:54.040 --> 0:08:56.680 And I think there were some states that have you know, 0:08:56.720 --> 0:09:00.400 and and some facilities that have their own you know, 0:09:00.679 --> 0:09:03.880 reserves that may kind of cover them for a certain 0:09:03.920 --> 0:09:06.880 period out. But you know, it's no surprise that if 0:09:06.920 --> 0:09:09.440 we if we are not holding reserves, that at some 0:09:09.520 --> 0:09:13.120 point there are trouble getting enough doses to the right 0:09:13.160 --> 0:09:15.840 place at the right time. You know. We talked to 0:09:15.880 --> 0:09:19.560 a hospital system in Michigan where they actually had to 0:09:19.720 --> 0:09:23.920 cancel appointments for second doses last week because they did 0:09:23.920 --> 0:09:27.560 not get the allocation that they expected from the state UM. 0:09:27.720 --> 0:09:31.959 And I think those situations are incredibly common. But you know, 0:09:32.640 --> 0:09:34.959 if it's if it's your second dose that you're waiting 0:09:34.960 --> 0:09:39.200 on UM and obviously matters matters to you. Yeah, And 0:09:39.240 --> 0:09:42.079 I mean this brings up kind of a question of 0:09:42.240 --> 0:09:44.960 maybe across the board numbers, you know, we're we're hearing 0:09:45.000 --> 0:09:49.000 about how more and more Americans are able to be 0:09:49.120 --> 0:09:52.120 vaccinated UM as we moved through February and into March. 0:09:52.400 --> 0:09:57.120 But what kind of data is available thus far about say, 0:09:57.160 --> 0:09:59.960 the number of Americans who have been able to get 0:10:00.040 --> 0:10:04.120 their second dose and even more specifically, their second dose 0:10:04.200 --> 0:10:10.120 within the recommended timetable for their vaccine so UM. As 0:10:10.280 --> 0:10:16.680 of today Wednesday, according to the CDC website, about forty 0:10:16.800 --> 0:10:21.319 four forty five million Americans have gotten at least one dose, 0:10:21.760 --> 0:10:26.199 and about twenty million of them um have gotten both doses, 0:10:26.240 --> 0:10:29.560 so a little less than half. Just to keep in mind, 0:10:29.640 --> 0:10:32.079 you know, many of those people, you know, people who 0:10:32.200 --> 0:10:34.600 just got their vaccine in the last three or four weeks, 0:10:34.600 --> 0:10:36.480 they're not due for their second dose yet, right, so 0:10:36.520 --> 0:10:39.440 you'd expect the number to be UM to be to 0:10:39.520 --> 0:10:42.200 be a lower. We don't have a clear sense of 0:10:42.240 --> 0:10:47.200 how many people are sort of overdue for their second dose. 0:10:47.360 --> 0:10:49.680 The CDC has said that most people are getting it 0:10:49.760 --> 0:10:53.600 in the recommended three or four week intervals, and that 0:10:54.360 --> 0:10:58.880 only a small percentage is sort of beyond the six 0:10:58.960 --> 0:11:01.800 week time frame that they've kind of identified as the 0:11:02.400 --> 0:11:06.160 you know, the sort of upper or outer limit. You know, 0:11:06.200 --> 0:11:08.520 we don't have hard numbers around that we know from 0:11:08.559 --> 0:11:13.040 from Texas earlier this month, even before the storms, there 0:11:13.080 --> 0:11:16.320 there were um several thousand people who were who were 0:11:16.360 --> 0:11:19.480 overdue a lot of states don't seem to be tracking this. 0:11:19.640 --> 0:11:21.760 I think it may be something that it will take 0:11:21.800 --> 0:11:25.959 a few weeks or even months to sort of understand 0:11:25.960 --> 0:11:28.520 with better data. You know, how many people got one 0:11:28.600 --> 0:11:31.160 dose and then for whatever reason, did not get or 0:11:31.200 --> 0:11:35.679 weren't able to get a second dose on time. We 0:11:35.760 --> 0:11:40.200 have heard about whether a second shot of these two 0:11:40.200 --> 0:11:45.079 dose vaccines, say fives or maderna, is actually necessary at all, 0:11:45.160 --> 0:11:47.840 and and that you're you're good to go, You're protected 0:11:48.000 --> 0:11:51.120 enough after receiving your first shot. What is what are 0:11:51.160 --> 0:11:54.800 some of the arguments there, you know, I think the 0:11:55.240 --> 0:12:00.560 argument against that, against stretching doses or or you know, 0:12:00.679 --> 0:12:06.480 only going uh for one dose of the vaccine is 0:12:06.520 --> 0:12:09.040 that the trials were done with two doses, and and 0:12:09.320 --> 0:12:13.240 that is what the evidence shows offers protection. Now, we 0:12:13.280 --> 0:12:16.600 do know from the trials that there is some protection 0:12:17.080 --> 0:12:21.599 after the first dose, you know, because the people in 0:12:21.640 --> 0:12:24.800 the trials um got two doses. We don't have good 0:12:24.800 --> 0:12:29.560 evidence over how long that that immunity might last, you know, 0:12:29.640 --> 0:12:33.360 how durable it is. You know. So in the US, certainly, 0:12:33.840 --> 0:12:39.040 UM the authorities are not recommending skipping the second dose 0:12:39.280 --> 0:12:42.720 or stretching out the interval beyond you know what's indicated. 0:12:43.200 --> 0:12:46.920 You know, we know that other countries have been experimenting 0:12:46.960 --> 0:12:49.600 with that and doing that the UK. I think we're 0:12:49.640 --> 0:12:52.959 beginning to get some evidence from some of those situations. 0:12:53.040 --> 0:12:55.720 But in the US, the decision has been not to 0:12:55.800 --> 0:12:59.880 try and stretch the supply by only giving people one dose. 0:13:00.120 --> 0:13:03.160 And you know, I heard the CDC director UM Rochelle 0:13:03.360 --> 0:13:07.800 Lensky yesterday on a congressional panel. She got a similar question, 0:13:07.840 --> 0:13:11.040 and she said, if the if the drug makers had found, 0:13:11.559 --> 0:13:15.440 you know, a durable immunity after one dose, they would 0:13:15.480 --> 0:13:19.800 have much preferred to have a single dose vaccine is easier, 0:13:19.800 --> 0:13:22.760 it increases the supply. UM. You know, so there's a 0:13:22.800 --> 0:13:26.960 reason that that two doses were used in the trials. UM. 0:13:27.000 --> 0:13:30.000 You know, for people who are we're trying to reach 0:13:30.080 --> 0:13:34.640 and UM protect against the virus, particularly priority populations like 0:13:34.679 --> 0:13:40.240 healthcare workers and you know, elderly folks, people in nursing homes. UM. 0:13:40.440 --> 0:13:44.760 You know, the idea of UM stretching the doses. Uh, 0:13:45.400 --> 0:13:47.760 it's not what the US authorities are recommending. Right now. 0:13:48.840 --> 0:13:52.560 As we move forward through the vaccine rollout in the States, 0:13:52.640 --> 0:13:57.600 you know, we are seeing kind of an ever changing eligibility. UM. 0:13:57.840 --> 0:14:00.280 More and more states are opening up restriction is to 0:14:00.280 --> 0:14:03.559 allow more of their populations to get their first dose. 0:14:04.400 --> 0:14:08.280 I mean, to what extent are you expecting that the 0:14:08.520 --> 0:14:13.600 logistical hurdles of making sure not only people can get 0:14:13.679 --> 0:14:18.080 their first shot, but their second shot on time? I mean, 0:14:18.120 --> 0:14:20.240 how much are you expecting that this is going to 0:14:20.400 --> 0:14:24.600 just become more complicated and potentially more problematic as we 0:14:24.680 --> 0:14:28.960 continue through the vaccine rollout. Um, It's hard to say. 0:14:29.040 --> 0:14:34.560 I think, you know, one really good news item on 0:14:34.600 --> 0:14:37.640 the horizon is that the Johnson and Johnson vaccine, which 0:14:37.680 --> 0:14:40.800 is being you know, considered by the FDA this week 0:14:40.840 --> 0:14:44.760 for emergency authorization, is a single dose. You know, if 0:14:44.800 --> 0:14:48.280 that is authorized as as it's expected to be, you know, 0:14:48.360 --> 0:14:51.720 that is a much simpler and much faster way to 0:14:51.760 --> 0:14:54.120 immunize people. You Know. The other thing is, I think 0:14:54.240 --> 0:14:58.800 the systems and just the sort of infrastructure around vaccination 0:14:58.880 --> 0:15:02.960 has been improving. You more people are getting vaccinated. UM, 0:15:03.000 --> 0:15:05.720 I think some of the you know, I T systems 0:15:05.800 --> 0:15:09.040 and you know, booking websites like that's still pretty chaotic 0:15:09.080 --> 0:15:11.120 in some places. And you know, we certainly heard from 0:15:11.160 --> 0:15:13.800 people who went in for their first dose and then 0:15:14.000 --> 0:15:16.360 we're not given an appointment for their second dose and 0:15:16.360 --> 0:15:18.840 had trouble booking it a little bit. I think that's 0:15:18.840 --> 0:15:21.600 still going on, but I don't think it's hard to 0:15:21.640 --> 0:15:24.880 say whether it's going to get worse or whether it's 0:15:24.880 --> 0:15:28.440 gonna get better. I think, you know, as we increase 0:15:28.520 --> 0:15:32.280 the volume of vaccinations and increase the supply, you know, 0:15:32.320 --> 0:15:35.240 hopefully some of these things will will become smoother in time. 0:15:40.760 --> 0:15:43.720 That was John Tozzi, and that's it for our show today. 0:15:44.200 --> 0:15:47.560 For coverage of the outbreak from one bureaus around the world, 0:15:47.920 --> 0:15:52.720 visit Bloomberg dot com slash coronavirus and if you like 0:15:52.840 --> 0:15:55.040 the show, please leave us a review and a rate 0:15:55.120 --> 0:15:58.680 it on Apple Podcasts or Spotify. It's the best way 0:15:58.680 --> 0:16:03.600 to help more listeners find our global reporting. The Prognosis 0:16:03.640 --> 0:16:07.640 Daily edition is produced by Tophur foreheads Magnus Hendrickson and 0:16:07.800 --> 0:16:12.760 me Laura Carlson. Today's main story was reported by John Tozzi. 0:16:13.560 --> 0:16:17.600 Original music by Leo Sidrin. Our editors are Rick Shine 0:16:17.600 --> 0:16:22.360 and Francesca Levi. Francesco Levi is Bloomberg's head of Podcasts. 0:16:23.000 --> 0:16:23.840 Thanks for listening.