The Trump administration also said Tuesday it would begin releasing all available vaccine supply, rather than holding back second doses, as the incoming administration said last week it intended to do.
Biden’s team similarly wants states to expand eligibility for elderly residents, as some are already doing, said two transition officials, who spoke on the condition of anonymity to describe ongoing deliberations. But the officials said immediately including people 64 and under with a high-risk condition — which can mean everything from diabetes to obesity — would stretch supply and saddle states desperately in need of additional resources to augment their workforce and stand up mass vaccination sites.
Biden’s team was awaiting more details about another part of the plan to redirect some vaccine away from states moving more slowly to inoculate residents, but advisers looked unfavorably on a system that “punishes states,” said two officials, who spoke on the condition of anonymity because they were not authorized to discuss the criticisms.
“We believe we have to be straight with people about where we are,” said a senior transition official. “We want states to have the flexibility to move forward, but unfortunately this places an extreme responsibility on states without necessarily giving them the support to execute.”
“We don’t want to unfairly create the expectation that someone can walk in and get a vaccine today when in reality we don’t have enough supply for nearly 200 million people,” the official said.
Under the original recommendations from the Centers for Disease Control and Prevention, about 74 million people are in the first two priority groups for vaccination: health-care workers and the staff and residents of long-term-care facilities, followed by front-line essential workers and adults 75 and older. Adults 65 and older and those 16 to 64 with a high-risk medical condition were to come next, in what is known as phase 1c.
The last-minute shift, announced by Health and Human Services Secretary Alex Azar with fewer than eight days left in the Trump administration, added new complications to an already difficult handoff of one of the most ambitious immunization campaign in American history. Azar, joined by other members of the administration at a Tuesday briefing, maintained the vaccination effort is proceeding apace, despite data showing that only a third of distributed doses had been administered. Federal and state officials say there is a lag in reporting.
A senior Trump administration official disputed the Biden team criticisms, saying Operation Warp Speed officials looked at the data and studied what states were reporting.
“It’s clear in many states that an overly prescriptive focus on the highest priority group was creating a bottleneck and slowing vaccination uptake,” said the official, who spoke on the condition of anonymity to discuss internal deliberations.
Given soaring cases and deaths, he added, it is critical that every shot be used as quickly as possible, especially in the most vulnerable populations. Ultimately, he said, the decisions will be up to governors.
Biden, meanwhile, has insisted that the Trump administration is “falling far behind” in immunizing the public, a critical step in allowing Americans to travel, return to work and restore the economy and social fabric. He has set a goal for the country to deliver a first shot to 100 million people within his first 100 days in office. The ambitious target would also require quickly accelerating the pace of immunization.
Members of Biden’s transition team have been participating in calls with state health officials — organized by the National Governors Association — and have been hearing about states’ need for greater flexibility in spending federal funds and more information about the program run by chain pharmacies in long-term-care facilities, according to state officials who have participated.
While the incoming administration supports states moving as quickly as possible to vaccinate additional priority groups, the transition team has been told by state and local authorities and immunization managers that many states don’t have enough supply of the vaccine or other resources to hire more vaccinators to staff large-scale clinics, the two Biden transition officials said.
Biden intends to join his call for accelerating vaccinations with a pitch for more congressional relief aimed at funding the effort, according to people familiar with his plans, who spoke on the condition of anonymity because they were not authorized to discuss the matter.
Only in the economic stimulus package lawmakers passed at year’s end did they equip states with $8 billion to train additional vaccinators, improve data systems and do outreach to priority populations. But it takes time to get the money out to the states, and health officials say they need more resources to scale up properly.