New CDC Guidance to Base State COVID-19 Vaccine Supply on Administration Rates

Starting in 2 weeks, allocation of coronavirus disease 2019 (COVID-19) vaccines will be based on the percentage of doses each state has successfully administered thus far and the number of residents aged 65 or over, HHS Secretary Alex Azar said during a briefing Tuesday.

The new methodology is aimed at serving as an incentive for states to increase the speed and accessibility of available vaccines, as some states report significant roadblocks hindering rollout.

“In order to ensure doses are being put to use and put to use for the most vulnerable, we will be allocating them based on the pace of administration as reported by states,” Azar said. “We're giving states 2 weeks’ notice of this shift to give them the time necessary to plan and to improve their reporting if they think their data is faulty.”

As older Americans and those with comorbidities, in addition to health care and front-line workers, are at a higher risk of contracting COVID-19 and suffering severe complications, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended these populations be the first to receive immunizations.

However, many states have implemented their own, more stringent guidelines which have resulted in millions of vaccine doses piling up in freezers and some in the trash, Politico reports. Currently, some jurisdictions have reported they administered less than 15% of vaccines allocated while others report over 80% administration.

Although the new guidance aims to reduce challenges faced by states such as increasing vaccination sites and widening the population eligible for vaccination, states have just 2 weeks to work out any data or reporting kinks before their allocation is potentially cut.

When asked whether some states will receive less doses of the vaccine under the new guidance than they would have previously, Azar stated “if you’re not using vaccine that you have the right to, then we should be rebalancing to states that are using that vaccine… This ends up being, at least in the interim, a redistribution between and among the states, that should not necessarily hurt many states, but it will enhance the benefits,” for those adequately administering vaccines.

The secretary also drew a comparison to the new approach to that used when allocating remdesivir to hospitals earlier in the pandemic, stating it worked “exceptionally well” in that context.

Data reporting has been a prominent issue for health systems faced with influxes of COVID-19 patients since the beginning of the pandemic. In response to adjusted data protocols implemented in July, Carrie Williams, a spokesperson for the Texas Hospital Association, told The New York Times, “It has been an administrative hassle and confusing to constantly be shifting gears on reporting while hospitals are on the front lines during a pandemic.”

But recent daily records in COVID-19 cases throughout the country are prompting public health officials to vaccinate as many individuals as possible to prevent overwhelming health care systems.

“We have many jurisdictions now that are on the verge of going from linear growth [of COVID-19 cases] to basically exponential,” said CDC Director Robert Redfield, MD, during the briefing. “And we believe it's critically important at this time to get those most vulnerable people as quickly as we can into vaccination programs as a key strategy to maintain hospitals.”

Thus far, nearly 25 million first doses of either the Pfizer/BioNTech or Moderna vaccine have been made available for states to distribute. And 4 weeks into the rollout, “we have gained confidence in the integrity of our distribution system which has now successfully delivered to over 14,000 locations, essentially without a hitch,” Azar said, noting over 9 million first vaccinations have already been given.

Citing these milestones, Azar announced the next phase of allocation “reflects the urgency of the situation we face. Every vaccine dose that is sitting in a warehouse rather than going into an arm means one more life lost or one more hospital bed occupied.”

In addition to the new allocation guidelines, the next phase also expands groups getting vaccinated, as “state restrictions on eligibility have obstructed the speed and accessibility of administration.” To keep up with demand, the entire US supply of vaccines will be made available immediately, as opposed to reserving doses for second administrations. The approach does ensure there will be a second dose available for every person who receives a first dose, Azar said. "We are telling states today that they should open vaccinations to all of their most vulnerable people. That is the most effective way to save lives now.”

Specifically, states should open up vaccinations to all those age 65 and older and all individuals under age 65 with a comorbidity, according to the new guidance.

Apart from hospitals, additional vaccine administration sites will also be opened, including pharmacies and community health centers.

In a similar vein, both Azar and Redfield urged those who test positive for COVID-19 and are most vulnerable to severe complications to ask their health care providers why they are not receiving an FDA authorized antibody treatment “that are in ready supply.”

“We have products sitting on the shelves that can help keep people out of the hospital. That is just as unacceptable as vaccines sitting on shelves, unused,” Azar stressed.

As President-elect Joe Biden is set to take office next week, the officials said Biden's team will be briefed on the vaccine allocation changes.