Washington, DC—The supply of COVID-19 vaccine will increase dramatically in the next several weeks, as pharmacists play an even larger role in getting Americans immunized against the novel coronavirus.

The outgoing Trump administration announced a plan for the early launch of a federally arranged pharmacy partnership that ultimately will include more than 40,000 locations from 19 pharmacy chains and community-pharmacy groups across the country. The new program would be an expansion of the Pharmacy Partnership Program for Long-Term Care, which is in the process of vaccinating residents of long-term care facilities.

“This partnership allows states to allocate vaccines directly to these partners, and these partners can then administer vaccines to particular groups, like those over a certain age and in certain occupations, and eventually to the general public,” Health and Human Services Secretary Alex Azar said during a Wednesday media briefing. 

The push to increase vaccinations will become even more intense after the inauguration of Joseph R. Biden, Jr. as president on January 20. The upcoming administration has announced that it has a plan to release nearly all available coronavirus-vaccine doses.

“The president-elect believes we must accelerate distribution of the vaccine while continuing to ensure the Americans who need it most get it as soon as possible,” T.J. Ducklo, a spokesman for the transition team, said in a statement.

“He supports releasing available doses immediately and believes the government should stop holding back vaccine supply so we can get more shots in Americans’ arms now. He will share additional details next week on how his Administration will begin releasing available doses when he assumes office on January 20th.”

The Trump administration had shipped more than 21 million vaccine doses by the end of the first week in January, with millions more received by the federal government, but only 5.9 million people had received them. 

The debate has been heated on the issue of delaying the second dose of the two COVID-19 vaccines being provided under emergency-use authorization from the FDA.

An article published recently in Annals of Internal Medicine notes that efficacy for prevention of COVID-19 after a single dose but before the second dose of the Pfizer-BioNTech mRNA vaccine was reported at 52% (95% CI, 30%-68%) based on a small number of cases and 51% (95% CI, −53.6%-86.6%) for the Moderna mRNA vaccine. At the same time, according to University of Washington–led authors in an opinion piece, “a single dose of the Moderna vaccine decreased asymptomatic SARS-CoV-2 infections by two thirds. This substantial efficacy—above the 50th percentile threshold put forth by the U.S. Food and Drug Administration (FDA) as the minimum threshold for efficacy—was noted in the initial 2 to 3 weeks after the first injection.”

The commentators went on to point out, “Because we do not expect a protective immune response in the initial 14 days after immunization, this suggests that once immune response is more mature, the efficacy of a single dose may be higher than 51%. In fact, the survival curves for the cumulative incidence of COVID-19 in the trial separate at about 10 days, consistent with high efficacy once immunity to the first dose is induced.”

The authors propose that priority should be given to providing a single dose to as many people as possible, instead of emphasizing the 2-dose vaccination. In a list of pros and cons of the two-dose versus single-dose vaccination strategy, they advise that while the dual vaccine has very high efficacy, closely mirrors the clinical trial, and prevents severe disease, the requirement of 2 doses doubles time required for a critical proportion of the population to be vaccinated. The single-dose vaccine, on the other hand, gets a higher proportion of the population vaccine and has the potential to accelerate pandemic control.

A clinical study evaluating delaying the second dose reports, “Under a steady vaccine supply of 6 million doses per week, the flexible strategy would result in an additional 23% to 29% of COVID-19 cases averted compared with the fixed strategy.”

Comparing the current strategy with the now-proposed one, the report in the same issue of Annals of Internal Medicine adds, “In both scenarios, 24 million people received at least 1 dose by the eighth week, whereas 2.4 million additional people received 2 doses of vaccine in the flexible strategy because millions more received an initial dose during the first 3 weeks; all second doses were administered on schedule (within 3 weeks of first dose) in both strategies.”

On the other hand, those researchers explain, “If vaccine supply dropped to 3 million doses per week starting in week 4, overall benefits were reduced in both strategies, and the numbers of people receiving at least 1 dose by 8 weeks, 2 doses by 8 weeks, and 2 on-schedule doses by 8 weeks were 16.5, 12, and 12 million in the fixed strategy, respectively, and 20.1, 12.9, and 6.3 million in the flexible strategy, respectively.”

Yet, they conclude, “Overall, the flexible strategy averted an additional 27% to 32% of COVID-19 cases compared with the fixed strategy in the context of this moderate supply reduction.”

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