The U.S. government announced major changes to vaccine distribution Tuesday, upending what’s been standard operating procedure for the past four weeks in an attempt to speed COVID-19 vaccinations and move closer to widespread immunity against the coronavirus.

In a media briefing, Health and Human Services Secretary Alex Azar asked states to expand vaccinations to people 65 and older, as well as others with comorbidities, provided they have some form of medical documentation. He said restrictions by states on who is eligible to get the vaccine “have obstructed speed and accessibility of administration.”

“There was never a reason that states needed to complete vaccinating all health care providers before opening vaccinations to older Americans and other vulnerable populations,” Azar said. “States should not be waiting to complete 1a priorities before proceeding to broader categories of eligibility.”

Azar also announced the government will release all available vaccine to states instead of holding back doses for scheduled second shots. Federal officials had been keeping vaccine in reserve to guarantee second doses but Azar said increased vaccine supply and the pace of manufacturing will ensure everyone who gets a first dose will get a second dose on schedule. .

Both vaccines authorized for use were studied in a two-dose regimen, with the Pfizer-BioNTech doses given 21 days apart and Moderna’s 28 days apart.

“Based on the science and evidence we have it is imperative that people receive their second dose on time,” Azar said. “That’s what the science says and ignoring that would be reckless.”

U.S. officials also are asking states to expand the locations where people can be vaccinated by adding community health centers, pharmacies and mass vaccination sites.

“Hospitals made sense as the early distribution sites when the focus was on health care workers, but they are not where most Americans go to get vaccines,” Azar said. “States should move on.”

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He said the federal government will deploy teams to support states doing mass vaccinations efforts. The government has partnered with 19 pharmacy chains and is ready to distribute vaccine to their locations, he added.

Criticizing some states for “heavy-handed micromanagement,” Azar also announced a change in dose allocation.

Instead of allocating vaccines based on the number of adults in each state, the HHS secretary said states will receive vaccines based on how quickly shots are administered, and their number of people 65 and older.

This new allocation system will go into effect in two weeks to give states time to prepare, Azar said.

“This new system gives states a strong incentive to ensure that all vaccinations are being promptly reported, which they’re currently not,” he said. “And it gives states a strong incentive to ensure doses are going to work protecting people rather than sitting on shelves or in freezers.”

So far, the vaccine rollout has been primarily to health care workers and nursing home residents. Of 27.6 million doses distributed, about 9.3 million have been administered as of Monday, according to the Centers for Disease Control and Prevention.

Dr. William Schaffner, a professor and infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee, said he was

“stunned” by the priority list change.

It has always been clear the Centers for Disease Control and Prevention’s vaccine allocation guidelines were designed to go in phases, he said, a process that was well-described in numerous documents, meetings and discussions.

When there is insufficient vaccine to provide it for everyone, a prioritization system is necessary, he said.

“This was called ‘phased’ because they were indeed to be implemented sequentially. Not rigidly so, there was always going to be overlap. But it was a sequential plan,” Schaffner said.

While the federal government focused on making vaccines and shipping them, he said too little attention was paid to communication and the support necessary for states to actually get doses into American arms.

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“Until very recently, the Congress has not allocated money for the actual delivery of vaccines to individuals, which is of course the most difficult and the longest part of the whole operation,” he said.

Azar said states “have ample funding,” but it hasn’t gotten deposited into accounts yet. Although $8 billion was allocated for vaccine distribution under the COVID-19 relief package on Dec. 27, the first payment isn’t expected to get to states for another week or so, said Schaffner.

“It will take time for it to be incorporated into budgets and to hire people every state,” he said.

The American Hospital Association estimates the nation would need to vaccinate 1.8 million people a day, every day, from Jan. 1 to May 31, to reach the goal of having widespread immunity by the summer. That’s also called “herd immunity” and would involve vaccinating at least 75% of the population.

Azar said in Tuesday’s briefing states were vaccinating at a pace of about 700,000 people a day, but expected that to increase to at least one million people a day in the next week to 10 days.

The news comes after the incoming Biden administration announced Friday it plans to prioritize the first dose and release all the available COVID-19 vaccines. Transition officials said it didn’t make sense to hold back vaccines at a time when more Americans are dying than at any point in the pandemic.

As of Tuesday, the U.S. reported more than 22 million cases and 378,000 deaths related to COVID-19, according to Johns Hopkins data.

Biden is expected to give a speech Thursday outlining his plan to speed vaccines to more people in the first part of his administration. Azar said the incoming administration will be briefed on Operation Warp Speed strategies.

Contributing: Elizabeth Weise and Karen Weintraub, USA TODAY; Associated Press. Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: COVID-19 vaccine: Trump admin. asks states to not hold back 2nd dose



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