Supply and demand and other things you need to know about the COVID-19 vaccine

It might be a respiratory illness, but it seems that optics are a huge part of COVID these days. 

“Again, this idea of ‘unused’ vaccine is just the wrong way to look at things,” said Danielle Scheurer, M.D., MUSC Health System chief quality officer. She’s afraid that’s exactly what people are focusing on at a state and federal level. According to Scheurer, there is an increased spotlight on rates of vaccination – that is, the amount of vaccine hospitals and long-term care facilities have on hand versus what has been injected into patients. 

 

“Naturally you can’t put 9,000 doses in people’s arms immediately, it takes several days to do that,” she said. As a result, there are almost certainly going to be doses in refrigerators that aren’t being administered. They will be, it just takes time. And because states want those rates to look better – as if they are being hyperefficient at administering everything they have – many state and federal organizations have started sending fewer doses of vaccine but increasing the number of times they are delivered. 

“The result is a really complex issue when it comes to scheduling,” Scheurer said. “How, in good conscience, do you schedule patients to get a vaccine when you’re not even sure if you’ll have it? We literally don’t know what we’re getting week to week until we open that box.”

Now, instead of getting 10,000 doses once a week, MUSC will be getting less – much less – somewhere on the order of 3,000 doses, as little as twice a week. Again, the actual numbers aren’t known until the shipments arrive. So in the case of vaccination at MUSC Health, it seems volume has become a casualty of appearance. 

With the vaccine landscape changing almost daily, each week we are checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. Are we running out of vaccine?

A. I wouldn’t say we’re running out, but we are certainly getting less these days. So for now, we’re pushing as many people as possible to later in the week and we’ve frozen all new appointments since last Wednesday. All we can administer is what we’re given and right now we’re just not getting a lot.

Q. Why do you think other countries have been more successful when it comes to sheer volume of vaccines administered?

A. I think a lot of other places have purely focused on shots in arms. Period. Here, in the United States, we seem to be more focused on fairness. It’s just too rule-based right now. People can’t stand the thought of the outlier, the jumping of the line, and I think it has driven a lot of this behavior. And sadly, it hasn’t built up people’s trust in hospitals, but rather it’s pitted us against each other.

Q. What phase are we currently in and who is eligible?

A. We’re still in Phase 1a, although it’s getting a bit confusing how we just keep adding groups but calling it the same phase. As of this week, state residents over the age of 65 are now eligible. That’s 309,000 more people. And right now, demand is grossly outweighing supply. 

Q. At what point are we going to have to make the hard decisions about who gets the second dose and who – largely from new groups of people being made eligible – gets a first? 

A. For now, the direction from the federal and state level has been to prioritize the second dose, but again we can look to other countries, like the United Kingdom, to see what works best. They’re focused on just getting them in arms, regardless of whether it’s the first or second dose. The truth is we’re all shooting in the dark a little bit, unless we are following the clinical trial protocols. All we can do is trust the process. If we see somebody else doing something that is working better, then we can make a change in strategy, such as focusing solely on first doses.

Q. Is there a difference in terms of what is administered in the first dose and second?

A. No. There’s no difference. The reason people tend to be feeling worse after the second dose isn’t because it’s a stronger version of the vaccine. It’s because their body already has an immune response prepared so it’s ready to fight. People always think that if we feel bad that means the virus is winning but that’s not the case. It just means our immune system is doing its job. It’s mounting a defense, and that’s a good thing. 

Q. Should people who might not qualify to be vaccinated for a while find a clinical trial to enroll in, in the hope they at least have a shot at getting a vaccine?

A. Absolutely. 100%. Especially if we know how well these vaccines are working and that they all seem to be made in a similar way. And worst-case scenario, if you become eligible while still in one of these trials, you can request to be unblinded. I am not necessarily encouraging that, but no matter your situation, they can still use your data and follow your course long term. And that still helps provide information on safety and efficacy to help those who haven’t been vaccinated yet.

Q. How encouraging is the Novavax vaccine, which is in clinical trials and could become available this summer?

A. That one is going to be a game changer, for sure. It only requires regular refrigeration, so for third world and less developed countries, that’s huge. And with transmissible illnesses like this, you’re only as strong as your weakest link. So it is in everybody’s interest – certainly those in developing countries, but to us as Americans as well – for more people to have access to a vaccination. The Johnson and Johnson vaccine is also very promising, it too only requires standard refrigeration, plus it’s just a single dose. For lower resource countries these will be much more appealing options.

**Have a question you'd like answered? Email it to donovanb@musc.edu with the subject line "Vaccine Q."