Physician Joel Zinberg joins Brian Anderson to discuss the slow rollout of coronavirus vaccines, why states like New York and West Virginia have widely different vaccination rates so far, and reasons for optimism that the pandemic’s days are numbered.

Audio Transcript

Brian Anderson: Welcome back to the 10 Blocks podcast. This is Brian Anderson, the editor of City Journal. Joining me on today's show is Joel Zinberg. Dr. Zinberg is a senior fellow at the Competitive Enterprise Institute and an Associate Clinical Professor of Surgery at Mount Sinai Hospital. He's a native New Yorker who served for two years as General Counsel and Senior Economist at Council of Economic Advisers in the Executive Office of the President, where he specialized in health policy. He's been a contributor to City Journal for several years now, and we're excited to have him back on the podcast. His latest piece for us, which just posted this week on the website, is called "End Covid Now." He also has a very nice sharp piece in our forthcoming issue of the magazine called "The Path to Better Days".

Joel was actually the last guest we were able to interview physically in our studio last March at the outset of the pandemic that has dominated our lives for many months now. Joel, thanks again for joining us.

Joel Zinberg: Great to be here.

Brian Anderson: As you write in this new piece, "End Covid Now," the United States has distributed more than 20 million doses of COVID-19 vaccine so far, the two approved vaccines, but as everyone knows, the rollout of getting these vaccines administered has been distressing to put it mildly. Can you give our listeners a broad idea of what's been going on? It's been reported today, for example, that the Trump Administration is looking to somehow expedite the process.

Joel Zinberg: So what's been going on is that there were two approved vaccines, the Moderna vaccine and the Pfizer vaccine. They have been purchased by the federal government, which is now distributing them to states, and the states are supposed to undertake the administration of the vaccines.

And as you referenced, there's been a huge disparity between the number of vaccines distributed and the number of vaccines administered. And so there are already over, as of today, about 25 and a half million doses distributed and only 9 million of those doses have been administered. And there's probably been more than 9 million. There's always a bit of a lag in reporting, but it's nowhere close to the number that we had hoped would be administered. And I would remind your listeners that each of these vaccines requires two doses. So what we're talking about is just the first of their required two doses.

And the problem has been really that the states have done a particularly inefficient job of distributing the vaccines. Interestingly, the best in the nation have been the Dakotas, North and South Dakota, and West Virginia. Worst in the nation have been in terms of vaccines administered per 100,000 population have been Georgia and Arkansas. And New York is kind of right in the middle there.

And the problem that a lot of local officials are complaining of, particularly here in New York State, is that the states have been micromanaging the distribution efforts and haven't allowed the local entities to undertake long-standing plans that they have to do mass vaccination. And as I argue in my piece, unfortunately what's happened is that we are not relying on private vaccination channels that are well-established, that we use every year, for example, for influenza vaccination. And they tried to reinvent the wheel by setting up, belatedly, all sorts of new mechanisms to distribute a vaccine when they could be relying on the private channels and probably do a much better job.

Brian Anderson: New York here, Governor Cuomo, who has really tried to elevate himself as the hero of the COVID story, he's actually now getting a lot of criticism, including from the mainstream press for this vaccine distribution problem. What has been the record of New York here? Is it really just this kind of centralization problem that you're describing in this piece?

Joel Zinberg: Well, New York has administered about 36% of the 1.2 million doses that it's received. And the county executives are pretty unanimous in complaining that the state administration has ignored their pleas to utilize the plans they've had set up for a long time. So, the administration really has taken a relatively high-handed approach. And if you listen to the Cuomo State of the State Address from yesterday, he is now talking about setting up a public health corps with a thousand fellows to assist in vaccinations.

Vaccines have been in the public eye for months. Why is he first talking about setting this off now? If this was something he thought the state could do, it should have been done months ago. So I think what New York has done and in some ways is typical of what's going on in the country, is they're not relying on mechanisms that we have, and the government has decided it can do it better than the private entities that already exist to deliver healthcare.

Brian Anderson: Is the reverse the case with states like the Dakotas or West Virginia? Is that why? I think I read that West Virginia has almost 75% of its doses distributed. Are they just relying on local authorities more?

Joel Zinberg: Well, they're relying on local authorities. They're utilizing their private people. They've just done a better job of planning in advance and then New York has.

Brian Anderson: It's amazing. What's your view, if you have one, on this debate that's emerging about how to distribute the vaccine in terms of doses? Whether it makes sense to get more people vaccinated with the one dose or to hold on to some of the vaccine for the second dose, at the risk of, if you do vaccinate more people right now, of delaying the second dose somewhat.

Joel Zinberg: Well, there is some evidence that you do gain some immunity just from the single dose. So one would think that giving that single dose as widely as possible would be advantageous. And of course that relies on there being a continued supply of new vaccine manufactured that will then be shipped out and be available to deliver second doses.

And thus far, the production has gone pretty smoothly. There've been occasional hiccups, but by and large, the production's gone smoothly. And between Pfizer and Moderna, they have guaranteed that they will have produced and distributed about 200 million doses by the end of the first quarter of this year. In other words, by the end of March 31st. So if that's indeed the case, we probably will have enough supply that we can assure that everyone who gets the first dose, gets the second dose. So if it could be distributed more widely, giving that first dose more widely without holding large numbers of doses in reserve to assure a supply for the second dose, that would make sense.

The problem, of course, with that is that you need the capability of giving the first dose as period. What has been going on has not been a problem of withholding second doses, and that's why people aren't getting the first dose. The problem is that states that have already gotten their supply are not utilizing them to administer the first dose. So the federal government has been withholding a large amount of doses, so that they will then be available as the second dose. But that's not the problem. The problem has been at the local level. The first doses that have been made available have not been administered.

Brian Anderson: This achievement of inventing and approving two seemingly effective vaccines in such a short period has something to do certainly with the Trump Administration's Operation Warp Speed. That would be your view, right? This is kind of unprecedented to have vaccines so quickly.

Joel Zinberg: Absolutely. I mean, I wrote an article about this a few months ago now in the Wall Street Journal that outlined what the administration had done. And I was involved in writing a report back in September of 2019 by the Council of Economic Advisers that dealt with improving vaccination innovation and manufacturing for the use in pandemic influenza. And what we recommended in that report was that there be public-private partnerships to speed innovation and to speed the development and manufacturing of vaccines. And that's precisely what Operation Warp Speed did. It allied with multiple private pharmaceutical companies. We mentioned Pfizer, we mentioned Moderna, but there are several others, to help fund their development of the vaccine.

And it also went ahead and pre-purchased the vaccines so that the companies knew that if their vaccine was authorized or approved, that they would have a market. And in many cases, it went ahead and provided money to those companies so that they could start manufacturing the vaccines in advance of approval. So that once approval was granted by the FDA, that there would be a ready supply instead of then having to ramp up production facilities.

So these were all mechanisms that we dealt within that report dealing with a potential influenza pandemic and what could be done to improve vaccine production. Those were lessons that were applied in Operation Warp Speed. And as you made reference to it, it's a remarkable achievement. It normally takes five to 10 years to develop a new vaccine for a novel virus. And here it was done in about 10 months. Just completely unprecedented.

Brian Anderson: The distribution not withstanding, people are getting now. What's your view on how many Americans are going to need to be vaccinated before we reach maybe not full herd immunity, but a safe enough condition where we can start really returning to a more open lifestyle?

Joel Zinberg: Well, so a pandemic will end, or at least abate when there's a high enough number of people in the population who are immune. And they can become immune either through what one would call natural immunity, in other words, they've been infected with the virus and they've recovered from the disease. Or they can become immune because they've been vaccinated.

So when that total number of people who have immunity reaches a certain level, which we call herd immunity, then the virus will stop transmitting from person to person so easily. And the pandemic will peter out. And estimates are varied for COVID-19. And a lot depends on what we think is how transmissible the virus is, how easily it is to transmit from one person to other persons. So we're roughly in the range of about 70% would be needed to get herd immunity.

That number may go up by the way, if these new variants become widespread and if they are as easily transmissible, as people from the UK and South Africa seem to think. But at any rate, let's start with 70%. So you have to figure out before you decide how many people will need to be vaccinated to reach it. How many people already have natural immunity? We know there are over 22 million confirmed cases, and many observers, including the CDC, think that there are actually many more people who have been infected and recovered than are in confirmed cases. The CDC estimated it could be as high as eight times as many. So if you take 22 million confirmed cases and multiply that by eight, well, you're up over 160 million people.

So if we say conservatively that 150 million people have some degree of natural immunity, then you may only need to vaccinate about 100 million or so additional people who have not been exposed and recovered to the virus. You may need to only vaccinate those folks to reach that 70% threshold.

I've written in another piece that the CDC recommendations that everyone be vaccinated, whether they've had or not, and whether they've had a test to determine how many antibodies they have, or do not have, really doesn't make much sense. They're not utilizing the fact that we probably have a large number of people with natural immunity that don't need to get vaccinated.

Brian Anderson: What do you think about the criteria of order of vaccination? Should we really be concentrating, I guess, on the elderly first? That makes the most sense because they've proven the most vulnerable, but part of me thinks, well, maybe we should just vaccinate as many people as we can. First come first served, maybe even, and that that would just accelerate things.

Joel Zinberg: This disease, COVID-19, has a very clear predilection for the elderly and for people with underlying medical conditions. And somewhere between 80%, 85% of the deaths in this disease and of the severe cases, have been in people 65 and older. And among younger people, it is practically unheard of for someone to get a severe case and, I know, die, if they don't have some other underlying medical condition.

So in the initial phases of vaccine distribution, when you had severely constricted supplies, it made sense to concentrate on the people who are most likely to benefit, the people who are most vulnerable. And they've decided to focus on the people in long-term care facilities. And that made a lot of sense because the reality is they are only 1% of the US population, actually a little less than 1%, yet they account for 40% of the deaths in this country.

So you have a convergence of the elderly and unwell who are living in long-term care facilities, who could benefit. So that was the initial traunch of people for distribution. And the federal government made arrangements with private companies to distribute and administer the vaccines in that setting. But once we move beyond that severely constricted supply, and now we're hopefully entering that in this first quarter of this year, I think it makes sense to broaden things out. And in my article, I discussed a cutoff of 45 years of age, and I chose that particularly because, while more than the majority of the population are under 45, a little less than 2% of the deaths from COVID are in the under 45 age group. So that would be a very simple, easily-applied cutoff that people could utilize moving forward.

Then as supplies become even more ample, they could move to relax those age restrictions. But utilizing that 45-year-old cutoff with some exceptions made for people who are younger, but have dangerous underlying medical conditions, would accomplish most of what we need to do.

Brian Anderson: And presumably there'll be more vaccines approved as we move forward into 2021.

Joel Zinberg: That's correct. I mean, initially it looked like the AstraZeneca vaccine was going to be approved very soon here. It has been approved in the United Kingdom. Has not been approved here because there were some issues in their trials in terms of administering the dosage. And basically, in manufacturing, they messed up some of the labeling. And as a result, many of the people in the trials received only half a dose for that first dose, rather than a full dose. And then they went on to receive the full dose as the second dose. And interestingly, and no one can quite explain it, the people who got the half dose followed by the full dose did better than the people who got the full dose followed by the full dose. And so the people who got the half dose got over 90% effectiveness and the people who got the full dose on the initial dose were only in the 60% effectiveness range.

So overall the AstraZeneca vaccine is reported as 70% effective and that's on that basis. That's what the UK approved it as, but the FDA has been a little skeptical and wants to see additional studying and some sort of clarification before they move forward. But there's also a Johnson & Johnson vaccine in the works, which will have a tremendous advantage because it requires just a single dose rather than two doses. So, those are things we can hope we'll see some data on in the next few months and get approval on perhaps early in the second quarter of the year.

Brian Anderson: Well, that's very helpful, Joel. Thank you so much for coming on again. Don't forget, listeners, to check out Joel Zinberg's work on our website. That's We'll link to his author page and his recent work in the podcast description. You can follow City Journal on Twitter @cityjournal and on Instagram @cityjournal_mi. And as always, if you like what you've heard on the podcast, please leave us a ratings on YouTube, iTunes. Thanks very much for listening and thanks very much Dr. Zinberg again for joining us.

Joel Zinberg: You're quite welcome.

Photo by zoranm/iStock

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