When will the U.S. get enough Covid-19 vaccine to stop the madness?

And why is there madness, anyway?

It seems like an easy enough question to answer: When will everyone in America who wants a vaccine be able to get one? That question implies another one: Why is our current vaccine distribution system such a cluster****?

I’ll begin with the end of this story, which is: Best as I can tell, just wait until May or June. Moderna and Pfizer will have given the U.S. enough shots to immunize 100 million Americans by the end of March, or roughly one-third of the country. Another one-third could get the vaccine by June or so. And the rest can get it by September.

That’s not bad, but here’s the stark truth: There are about 130 million Americans who are either over 65 or are essential workers, so very fragile populations will still be fighting over vaccines well into April. Moderna and Pfizer say they will sell the U.S. enough for another 100 million-ish by the end of June, and by then, Johnson & Johnson is supposed to have kicked in enough vaccines for another 100 million people. So somewhere between April and June, the pressure valve should be released.

NOTE: There are 130 million essential workers and people over 65 in the U.S. Edits welcome.

In other words, we’ve still got a long way to go. I’m not confident these harsh realities have been communicated to the American public just yet. There are a lot of numbers and percentages and pharmaceutical names being thrown around, but the simple problem we have right now is there is not enough vaccine, and there won’t be until sometime in the second quarter of this year — likely towards the end of the second quarter. Until then, I fear, there is good reason to believe this whole affair will continue to feel like the Hunger Games.

I spent a lot of time digging through vaccine availability numbers the past few days, and here’s the basics I’ve found. For starters, it’s not easy to find good numbers.

You’ll see a lot of grand predictions like “XX Company will make a billion doses by 2022.” But what you want to know is when your state…your doctor, really…can give you a vaccine. And that information is tantalizingly hard to find.

Also, I have found that “doses” and “people” are sometimes used interchangeably, which is really confusing, because 100 million doses of the Johnson & Johnson vaccine will supposedly help 100 million people, but 100 million of Moderna — which requires two doses — only helps 50 million people. So I’ll try to stick to “people” in this piece.

I’m going to try to avoid playing the blame game in this piece, because blaming people doesn’t protect anyone from Covid. But I think it helps to understand why we got here.

The U.S. is currently getting somewhere around 10 million doses total per week. That means roughly enough vaccine to immunize 20 million adults per month, which sounds about right. With a few enhancements to production, that gets us to 100 million by April 1.

Those 10 million doses are being split among the states using some Census formula, federal officials say, and then the states are divvying them up whatever way they chose. In some cases, they are tracking doses using a system that Uncle Sam paid Deloitte $43 million for. It’s so bad that many states and organizations are buying their own software or turning to off-the-shelf products like Eventbrite instead.

This is causing grand inefficiency, unfairness, predictable line-jumping by donors, and more than anything, emotional trauma to people who really, really need and deserve to get into our minimal vaccine lifeboats first.

But this local distribution mess — which better get fixed, quick — is only a sideshow to the real problem. And the real problem is there are not enough vaccines. Governments facing shortages often use red tape to create institutional overhead for citizens as a throttling tool. Sometimes, it’s intentional, sometimes it’s just muscle memory, but that’s the way we govern.

So onto the real problem: Remember, it’s a medical miracle that we are putting vaccines into arms one year after discovering a virus. Making billions of doses and shipping them to the right places might even be a bigger miracle. Logistics, boring as they are, matter. We have reached the logistics stage of the Covid problem, so let’s get into it.

The Trump administration smartly made bets on various vaccines last year, in case many of them didn’t pan out. We have been lucky: More than one has been a success. But we were a little unlucky, too. The U.S. made its biggest bet on the early front-runner, the Oxford/AstraZeneca vaccine. It paid $1.2 billion to secure enough for about 150 million Americans, at one point believing those doses might be here by right about now, helping roughly 60% of Americans. Instead, to date, we’ve received none. AstraZeneca’s trials ran into some controversy, and while it’s approved for use in the EU., it’s now unclear when the firm might even apply for use in the U.S. So that’s a big weapon off the table for some time, and that’s the biggest reason the U.S. is facing such a shortage of vaccines right now.

And while AstraZeneca is being used across the E.U. now, the U.S. won’t get help from that vaccine any time soon. EU governments have been warned that they will receive 60% less of the vaccine by March than initially planned, due to production issues.

While the U.S. was betting on Astra-Zeneca, it turned down a chance to buy more than the initial 50-million person allotment of Pfizer vaccine — which is all we’ll get through March. Those doses ended up being sold to other countries. That also contributed to the current situation, but again, it was reasonable to spread out vaccine bets among various makers.

Moderna has also promised to deliver 50-million people worth of vaccines by the end of March. The firm is churning out about 250,000 people-worth of doses daily at its Indiana plant… It has also suggested that between now and then, its weekly production should be able to increase. "Production and releases are not linear and we have explained that we have been successfully scaling up our production yields over time,” the firm told NPR.

The good news is that another 50-million-people worth of both Pfizer and Modera jabs are coming between April and the end of July, and the current administration thinks it will secure a third 50-million-person set of doses for the July-September time frame. Even without any other good news, that should mean plenty to vaccinate all Americans by the end of summer.

OK, maybe end of summer doesn’t sound like good news. But there is potential for more good news soon: release of additional vaccines into the marketplace. That’s why last week’s Johnson & Johnson news was so closely watched. The firm’s clinical trials went well enough that it might be able to start selling its doses into the marketplace during February. The U.S. has purchased enough J&J to innoculate another 100 million people. Still, J&J has until June to deliver those doses so they will likely not offer much help until well into spring. Since J&J is a single-dose vaccine, there *might* be enough to vaccinate the entire over 65 and essential worker population by the end of March.

Other vaccines might be on the way, too, though there is mixed news on that front. Lost in last week’s Johnson & Johnson headlines was good news from another vaccine maker, Novavax, which also proved effective at fighting Covid. It was paid $1.6 billion as part of Operation Warp Speed last year with the goal of delivering 100 million doses by the beginning of 2021. It’s unclear when Novavax might get authorization to sell into the U.S. market, however.

Meanwhile, results from trials of a sixth vaccine made by Sanofi and GlaxoSmithKline were disappointing. Sanofi is, for now, shifting to production of Pfizer’s vaccine, so that’s not likely to help any time soon.

I wish there were better news, but unless something fundamentally changes — like a decision to abandon two-dose regimens for Moderna and Pfizer —- there won’t be enough vaccine in the U.S. to create smooth distribution until well into the spring.

There are many other factors which might eat around the edges of this problem. At some point, we’ll burn through the early vaccine adopters in that first group of 130 million and we’ll reach the point where some percentage of them will decline the vaccine. That will open slots for others, and relieve pressure on the distribution system, perhaps making the “anyone who wants one can get one” moment feel closer to the beginning of spring than the end of spring. That’s a good news / bad news story, however. And even if one third of that 130 million group declines, the vaccine pipeline will still be backed up way into April and probably May.

While that reality sounds harsh, it’s also been predicted for quite some time. When I went looking for predictions of “When can every American who wants a vaccine get one?” here’s some of what I found.

“This new federal purchase can give Americans even more confidence that we will have enough supply to vaccinate every American who wants it by June 2021,” U.S. Department of Health and Human Services Secretary Alex Azar said in a statement.

“Assuming all of the close review of the J&J data all pans out, we’re going to have the capacity between Moderna, Pfizer, J&J, to have enough vaccines available by June for the entire U.S. adult population,”Dr. Mark McClellan, a former FDA commissioner, said on “The News with Shepard Smith.”

“Already with this portfolio, I feel confident that we can cover the U.S. population within the first half of 2021,” Moncef  Slaoui said at the Milken Institute’s Future of Health summit. Later at the White House meeting, Slaoui specified that every person who wanted a vaccine would get access by June.

The terrible unknown in this is the appearance of variants and how they might escape vaccine protection — or simply be so contagious that a renewed outbreak hits in the next 12 weeks, before the U.S. vaccination program can slow it down. Might the outbreak be so bad that U.S. authorities decide one dose is better than nothing for another 100 million Americans by March 31? Or might Moderna and Pfizer have to focus on a reformulation of its vaccines? Unfortunately, Mother Nature isn’t always kind to predictions.

In other words, keep wearing masks. Get out of the way so the most vulnerable people can get vaccinated. And someone make a ***ing website that’s easy enough for the elderly to use.