May 26, 2022

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White House: U.S. doesn't have money for fourth doses

White House: U.S. doesn’t have money for fourth doses

The Biden administration lacks the funds to purchase a potential fourth coronavirus vaccine dose for everyone, even as other countries place their own orders and potentially move ahead of the United States in line, administration officials said Monday.

Federal officials have secured enough doses to cover a fourth shot for Americans age 65 and older as well as the initial regimen for children under age 5, should regulators determine those shots are necessary, said three officials, speaking on the condition of anonymity to detail funding decisions. But the officials say they cannot place advance orders for additional vaccines for those in other age groups, unless lawmakers pass a stalled $15 billion funding package.

“Right now, we don’t have enough money for fourth doses, if they’re called for,” White House coronavirus coordinator Jeff Zients said on a forthcoming episode of “In The Bubble with Andy Slavitt,” which was recorded Monday and shared with The Washington Post. “We don’t have the funding, if we were to need a variant-specific vaccine in the future.”

Federal regulators and health officials have not yet determined whether a fourth shot is needed, and some experts question whether the extra dose will be necessary to boost protection for the general population.

But administration officials said placing orders for additional doses ahead of time – rather than waiting for the United States to be swamped with another wave of the virus – was imperative and a key lesson from the pandemic’s past two years. They also noted that the fast-moving omicron variant evaded some immune protection conferred by existing vaccines, demonstrating the need to invest in more targeted shots that could better fend off omicron and potential future variants.

“Vaccines don’t just appear when you snap your fingers and say, ‘OK, I want the vaccine.’ We’ve got to make it,” said a senior administration official. “And this year, it’s going to be more complicated, because there’s a very significant chance – although we’re still waiting for data – that the vaccines are going to need to be tweaked to cover omicron.”

Analysts at Kaiser Family Foundation, a nonpartisan health research organization, independently confirmed that the United States would need to purchase hundreds of millions of additional doses to ensure that every American could receive four shots, if necessary, said Jen Kates, who leads global health policy for the organization and previewed the forthcoming analysis.

“If their policy goal is to have enough doses available to provide a fourth dose to everyone, there are not enough doses purchased. They will run out of supply,” said Kates, estimating that the White House needed to purchase about 750 million additional doses to reach that goal.

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Kates said her team reviewed several alternate scenarios, such as lowering its projection to 70% of Americans who would be vaccinated with four doses, rather than 100%. Even with that lower target, “there’s not enough” doses already purchased, Kates said, adding that the full analysis would be published later this week.

About 65% of Americans, or roughly 217 million people, are considered “fully vaccinated” by the Centers for Disease Control and Prevention, according to federal data, and about 200 million of those people have received two doses of the mRNA vaccines produced by Pfizer-BioNTech or Moderna. Meanwhile, roughly 97 million Americans have received a booster shot, which is about 29% of the entire U.S. population, according to federal data.

Pfizer, BioNTech and Moderna last week filed for emergency authorization of second booster shots of their coronavirus vaccines – with Pfizer and BioNTech targeting people 65 and older, while Moderna sought permission for all adults – saying the shots would bolster waning immunity that occurs several months after the first booster.

The companies also are pursuing coronavirus vaccines for children under age 5, although federal regulators have yet to authorize those shots, as they await additional data about their effectiveness.

Pfizer and Moderna did not respond to requests for comment about the status of the Biden administration’s vaccine orders.

White House officials said they have grown concerned that vaccine manufacturers will prioritize orders already being placed by other countries – such as Japan, Colombia, Vietnam and the Philippines, which collectively plan to buy, or have already bought, more than 200 million additional doses of mRNA vaccines from Pfizer-BioNTech and Moderna this year, according to an internal tracker kept by administration officials and shared with The Post. Some countries – such as Chile, which recently purchased 2 million Moderna doses – also are beginning to administer fourth doses, arguing that the additional shots are necessary to ensure sufficient protection against the still-circulating virus.

Public health experts agreed that waiting to place vaccine orders could delay shipments to the United States, citing a 2020 episode when Trump administration officials turned down an opportunity to buy an additional 100 million doses of the Pfizer-BioNTech vaccine. Although Trump officials later changed their minds, Pfizer CEO Albert Bourla warned them the United States would need to wait more than six months for the additional doses to be shipped, he wrote in his new memoir, “Moonshot: Inside Pfizer’s Nine-Month Race to Make the Impossible Possible.”

“[W]e would have had to take supplies from Canada, Japan, and Latin American countries, all of which had placed their orders earlier than the U.S.,” Bourla wrote in a book excerpt published by Forbes, adding that then-White House senior adviser Jared Kushner called him to insist that Pfizer should immediately prioritize the United States’ order. “I refused to do that, and the debate between the two of us became heated.”

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Bourla said manufacturing “miracles” allowed Pfizer to ultimately meet its commitments to other countries while accommodating the additional U.S. order.

While the omicron wave has been in retreat for two months in the United States – with confirmed cases plunging from more than 700,000 per day in mid-January to about 32,000 per day now, according to The Post’s rolling seven-day average – public health experts warn that cases are likely to rise again, citing a spike across Europe, caused by BA.2, a subvariant of omicron.

But those warnings have yet to move congressional leaders, who are still debating the size of a coronavirus funding package and how to pay for it. As of Monday evening, several top Republicans said they still wanted a fuller accounting of the trillions of dollars the administration has already spent on the coronavirus response – and are questioning the administration’s call to action last week.

“The basic thing we ought to figure out is, is there a need?” said Sen. Richard Shelby, R-Ala., the top Republican on the Senate Appropriations Committee. “Secondly, if there’s a need, where’s all the money we appropriated?”

Other Republicans said they were still waiting on detailed answers to questions around critical supplies.

“Before I know how many they own today – how many vaccines, how many tests, how many therapeutics – it’s hard for me to assess whether they need more,” said Sen. Richard Burr, R-N.C., the top Republican on the Senate Health, Education, Labor and Pensions Committee. Burr added that he doesn’t believe he’s received that information yet, unless it arrived over the weekend.

Burr said he’s talked with the administration “constantly,” particularly Zients, the White House coronavirus coordinator, who is among the senior officials pressing their funding case in private meetings on Capitol Hill and in public forums.

“Ninety-three percent of the money that was allocated for covid response – direct covid response – has been spent. So there’s very little left,” Zients said on the forthcoming podcast with Slavitt. “The remaining funds are for areas like . . . medical care for veterans, or FEMA disaster relief. So we don’t have good resources to draw on from the prior allocated funds, and we need to make sure that this gets funded. So it’s up to Congress to either pass it on an emergency basis without offsets, or find viable offsets.”

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Health and Human Services secretary Xavier Becerra and Biden’s chief medical adviser, Anthony Fauci, also attended the Democratic caucus meeting on Capitol Hill last week to make the case for the covid package, according to a senior administration official, who spoke on the condition of anonymity to describe the private meeting. Becerra and Fauci stressed the country is still in a pandemic and much of the response would come to a halt in the coming months without additional funding, the official said.

White House officials also have warned that they will soon be unable to purchase additional therapeutics, including monoclonal antibodies, a key tool to help those who become infected, especially the immunocompromised and others at high risk.

But there’s no sign of Congress’ stalemate ending soon, with House lawmakers in their home districts this week and unable to agree with Senate leaders on how to fully finance any package.

Senior administration officials point to Congress’ previous efforts to provide coronavirus relief without offsetting the new dollars. And they argue they’ve been engaging with lawmakers for weeks on what the administration believes is at stake, such as cuts to states’ allotments of monoclonal antibodies and canceling planned purchases of more antiviral treatments.

Top lawmakers had found a way to pay for more than $15 billion in new coronavirus aid as part of a long-term bill to fund the government, which would have been the most immediate route to get the dollars the administration is desperately seeking. But some House Democrats denounced one of the financing mechanisms, which would have clawed back funds set aside for state governments to address coronavirus-related needs.

The pushback ultimately forced House Democratic leaders to strip the coronavirus aid from the bill. A new financing mechanism hasn’t been settled on, as Democrats attempt to plot a path forward.

“I don’t know that those conversations have been held just yet,” Sen. John Thune, R-S.D., the Senate’s top GOP vote counter, said Monday. “But my assumption is, if something’s going to move, they’d have to figure that out.”

“The House is working to reach agreement with the Senate on acceptable offsets,” a senior Democratic aide said.

Kates, the Kaiser Family Foundation expert, said the challenge of preparing for the pandemic’s next phase is complicated by the virus’ unpredictability.

“It’s possible in three months, we’ll all be saying, ‘Hey, we weren’t prepared, but fortunately, we’re in good shape.’ Or we could really be staring down something quite ominous,” Kates said. “We just don’t know.”