Nancy Messonnier, a top federal health official involved in the distribution of Covid-19 vaccines, predicted on Tuesday that delays in the administration of the shots would improve soon, even as public health experts have piled up complaints about the slow rollout and about the gap between the number of doses distributed versus those actually going into people’s arms.
“I really expect the pace of administration to go up pretty massively in the next couple weeks,” Messonnier, the director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, said in a conversation with STAT infectious disease reporter Helen Branswell.
Only a fraction of the Covid-19 vaccines distributed so far have been administered to health care workers and residents and staff of long-term care facilities, the first priority group for the immunizations. But Messonnier noted that the two vaccines regulators have so far authorized — one from Moderna and one from a partnership between Pfizer and BioNTech — are both based on an mRNA platform that’s never resulted in a successful vaccine before, and that both come with new distribution, storage, and administration protocols.
The vaccines also started arriving over the holidays, as health departments and hospitals were facing huge numbers of Covid-19 cases and hospitalizations. That also contributed to delays.
Now, Messonnier said, providers know what they’re dealing with, and the efficiency with which the shots are administered should improve.
“It’s the early stages of a really complicated task, but a task that we’re up for,” she said.
A CDC advisory group has issued recommendations for who should be prioritized for the shots given the limited supply, ranking groups based on their risk of exposure and who is at highest risk for more severe Covid-19. Local jurisdictions are adapting the recommendations to their own plans. But Messonnier encouraged providers to use their full supply of the vaccines, even if people wind up getting the shots ahead of their spot in line.
If, for example, one facility still has supply but no one left in a particular category to vaccinate, it should move to people in the next tier, Messonnier said.
“I really hope that articulating these phases … isn’t leading to unnecessary barriers,” she said. She added: “Don’t leave vaccine in the fridge. Don’t leave vaccine in the vial.”
But Messonnier said she didn’t support strategies the British authorities are taking to expand their vaccine supply, namely stretching out the interval between when the first and second doses are given, or potentially swapping different vaccines for people’s two doses. She noted that the clinical trial data that demonstrated the vaccines’ effectiveness came from using the same vaccine for the two doses given at specific intervals three or four weeks apart.
Her comments echoed a statement from top officials at the Food and Drug Administration Monday, who stressed the “importance of receiving Covid-19 vaccines according to how they’ve been authorized by the FDA in order to safely receive the level of protection observed in the large randomized trials supporting their effectiveness.”
Messonnier also said she didn’t think the two vaccines authorized so far could be deployed to certain communities to control particularly bad outbreaks given that the full protection wasn’t conferred until the second dose was administered. If a single-dose vaccine was shown to elicit protection quickly, she said, that could be a better tool.
“Diverting the vaccine to try to put out a forest fire probably isn’t the right strategy with these vaccines,” she said.
During the early days of what became the Covid-19 pandemic, Messonnier held regular press briefings about the spread of the coronavirus and famously warned in late February of potentially “severe” disruptions to daily life. Her comment, however, reportedly infuriated President Trump, and Messonnier receded from public view for months while continuing her work at the CDC.
More recently, however, Messonnier has returned to more frequent public appearances.
During the discussion Tuesday, Messonnier said she hoped the supply of vaccine would expand greatly in the spring, a time when the shots could be made more widely available to the general public, not just people with certain jobs or health conditions. But making the vaccine is only one step: successfully inoculating the vast majority of the population will require major efforts to educate the public, to build out accessible sites where people can easily get vaccinated, and to ensure individual people show up when it’s their turn to get the shot.
“It’s going to take some work from all of us working together to make the best use of the vaccine as quickly as possible,” she said.
Messonnier suggested that churches, schools, and stadiums could all become vaccine venues as a way to make it as easy as possible for people to get them — in addition to traditional sites like doctors’ offices or pharmacies. But Branswell noted that providers needed to be ready to treat side effects from the vaccines, including anaphylaxis, the severe allergic reaction that has been seen in a few people who have received the shots so far.
Messonnier noted that there have been more than a dozen cases of anaphylaxis so far associated with the vaccines, out of more than 4 million doses administered. Still, she said, sites need to be ready to treat anyone who might have a severe reaction with EpiPens and know what to do if they need more advanced care.
“Is that a complication? Certainly,” she said. “Can we work our way through it? Yes.”