The US has entered a tricky phase of the COVID-19 vaccination effort as health care providers seek to increase the number of people getting the first shot while ensuring that a growing number of others receive a second dose by the time millions Americans are eligible for vaccines.
The need to give each person two doses a few weeks apart makes the country’s largest ever vaccination campaign enormously complicated. And persistent uncertainty about future vaccine supplies is fueling concern that some people will not be able to get their second injection on time.
In some cases, local health departments and healthcare providers have said they should temporarily curb or even cancel first-dose appointments to make sure there are enough second doses for people who need them.
Nola Rudolph said she struggled to make arrangements for her 71-year-old father and 68-year-old mother, who live in rural New York State. Everywhere she looked within driving distance was booked.
“When I saw that they were eligible, I was delighted,” she said. “When I saw that they were in a dead zone, I went from very hopeful to hopeless again.”
She has been able to arrange a second dose for her father, but has not yet been able to find a place for her mother. “It’s like walking around in a circle.”
For about the past month, the US delivered an average of 900,000 first doses daily, according to data from the Centers for Disease Control and Prevention analyzed by The Associated Press. Now many of those people are ready for a second dose, and the average number of Americans getting a second injection hit a record high on Tuesday – 539,000 a day in the past week.
The increasing demand for second doses comes as Biden’s administration is taking steps to boost dose supply.
White House COVID-19 coordinator Jeff Zients announced on Tuesday that states will see their dose allocations rise to 11 million a week from next week, more than 2 million weekly doses since President Joe Biden took office.
Since the vaccine was approved in late December, approximately 33 million people in the US have received an injection.
“It is very important and crucial to recognize that there are still not enough doses to get around,” said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention.
So far, about 10% of the US population has received at least one dose of the vaccine. About 3% received both doses, the AP analysis showed.
Throughout Los Angeles County, health officials say limited supplies mean most vaccinations this week will be for second doses. In the state of Napa County, some first-dose appointments were canceled last week to make sure there would be enough for second doses.
“We get a lot of questions from members of the community asking, ‘Is my second dose at risk?’ And at the moment we don’t have an answer because it all depends on the inventory coming in from the state, ”said Alfredo Pedroza, a provincial supervisor.
Both COVID-19 vaccines distributed in the US require two injections a few weeks apart to maximize protection. For Pfizer, the doses should be three weeks apart. For Moderna it is four weeks. But if necessary, the booster can be delayed for up to six weeks, according to the CDC, which updated its guidelines late last month.
State and local health officials are now emphasizing that extended timeframe in public posts to mitigate concerns that people will not get their second photo in time.
Federal officials have said they are confident that there will be enough doses to ensure that people get their second injection.
In some places, concern is fueled by the difficulty in booking the second dose. While many places schedule the booster when the first shot is given, others ask people to schedule it later due to logistical issues.
Tanny O’Haley is 64 and has Parkinson’s, but he is not eligible for the COVID-19 vaccine in Los Angeles County, where he lives. He received a first dose when he accompanied his 69-year-old wife to her vaccination, because the site had a leftover injection.
O’Haley has failed to schedule his second dose, despite numerous phone calls to local officials and the county’s health department. He plans to try again when he takes his wife to her second appointment on Wednesday.
“The whole experience was pretty awful,” said O’Haley.
In New Hampshire, officials are abandoning the current planning system after thousands of people struggled to book their boosters within the recommended time – and some get an appointment for two months later. People now get appointments for their second admission when they get their first.
New Hampshire is one of several local jurisdictions that have applied to use the CDC’s Vaccine Administration Management System, or VAMS.
At the Las Vegas Convention Center in Nevada, a different kind of scheduling problem surfaced last week when the site opened as a clinic dedicated to second doses only. When appointments were made available online, people eager for their first doses took up slots.
“We had enough vaccine – we just have to control the crowd somehow,” said JoAnn Rupiper of the Southern Nevada health district.
People who scheduled a first dose on the site had canceled their appointments, Rupiper said. To ensure that eligible people who had trouble making appointments online get their second photo, the convention center allows walk-ins.
Despite the confusion over schedule, health officials and healthcare providers say their biggest challenge remains limited supplies and variability in the number of doses from week to week. Even with the increase in shipments announced by President Joe Biden’s administration, local officials and suppliers say they don’t have enough doses to meet demand.
The shortage is one of the reasons Dr. Anthony Fauci, the nation’s top infectious disease expert, has noted the potential value of Johnson & Johnson’s one-time vaccine, which recently filed for emergency authorization. That shot is also cheaper to manufacture and easier to ship.
Pedroza said the cancellations took place in Napa County, California last week after a spike in shipments a few weeks ago led the county to think it would continue to receive at least as many doses. But the spike turned out to be a one-off windfall, Pedroza said.
In Seattle, UW Medicine temporarily stopped taking new appointments in late January due to limited supplies, combined with the need to give others their second dose.
“If there was more supply, we would like to make more first-dose appointments,” said Cynthia Dold, associate vice president of clinical operations at UW Medicine.
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Associated Press journalists Paul J. Weber in Texas, Nicky Forster in New York, Olga R. Rodriguez in San Francisco, Michelle R. Smith in Providence, Rhode Island, and Holly Ramer in Concord, New Hampshire, contributed to this report.
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The Associated Press Department of Health and Science is supported by the Science Education Department of the Howard Hughes Medical Institute. The AP is solely responsible for all content.