When will you get a vaccine?

Public health and media reports are setting an unrealistic expectation for vaccine availability. Those age 65+ are probably in line in March to April time frame. The general public is probably out to summer of 2021 to start receiving vaccinations.

UPDATE FEBRUARY 19, 20201

Biden says general availability of vaccines should be by August of 2021. With at least 1/3d of the adult population then eligible, it would likely take up to 3 months s after that to reach everyone. Would not be surprised if, considering the timing, that priority then shifts to K-12 students before the rest of the adults under age 65.

UPDATE FEBRUARY 15, 2021

UK says general availability in “Autumn of 2021”.

Also, some indications the US might have to make vaccine appointments available to all in the spring of 2021, certainly by early summer. It becomes impossible to determine who is eligible and who is not – meaning it just becomes more effective to open this up to everyone once more dosages are available.

UPDATE JANUARY 27, 2021

Pfizer will delivery 200M additional doses (2-doses per person) by May 31st instead of July 31st.

UPDATE JANUARY 8, 2021

Oregon Health Authority Director Pat Allen said today that it will be fall of 2021 before vaccines are likely to be available to the general public.

UPDATE DEC 20, 2020

Based on Dec 20, CDC ACIP meeting recommendations, there is new information for Phase 1a, 1b and 1c. The new information implies no general vaccine availability until likely mid-summer (late July) of 2021.

Please go here for the full update, including numbers, dates and potential wild cards to this information.

UPDATE DEC 23, 2020

The US government announced it has reached an agreement to purchase doses for an additional 50M people by July 31, bringing the total to 200 M.

The US has a contract with Johnson and Johnson for 100 million doses of its single dose vaccine, but no date of delivery has been announced.

The US has a contract with AstraZeneca for doses for 150 million people, but no delivery date has been announced.

From Schwab’s daily update for Dec 23:

On the COVID-19 vaccine front, Pfizer Inc (PFE $38) said that it has struck a deal with the U.S. government to provide 100 million more doses of its inoculation co-developed with BioNTech SE (BNTX $98). The new order, which is expected to be delivered by the end of July, brings the total number of doses provided by the firms to 200 million.

At this time, the US has publicly announced contracted delivery of doses for 185M people by June 30th, and 200 M total by July 31st. The US has contracted also with J&J and AstraZeneca, but there are no delivery dates published. The US also contracted with NovaVax and Sanofi, but both are significantly delayed – probably until 2H 2021, even late 2021.

These numbers are confirmed by the Director of the NIH in this video clip. He is optimistic that the AstraZeneca and Johnson and Johnson vaccines can be manufactured rapidly “at scale” and that the US may have enough vaccine doses for everyone by early summer.

In fact, an early December news report confirms that plans for vaccinating everyone in the U.S. were dependent on AstraZeneca and Johnson and Johnson vaccine deliveries, which are delayed until the spring of 2021 at the soonest. There are hints that neither vaccine has achieved the same 94-95% efficacy of the first two – which also implies that those of us at the end of the line might receive less effective vaccines. But we will not know until official trail data is released in perhaps Q1 2021.

Here is the TL;DR Summary

  • Prioritized groups will be underway by the end of 2020.
  • The consensus of “expert opinion” is for vaccines to go first to health care workers and other prioritized groups, which may include very elderly in group homes.
  • The consensus of expert opinion is that those age 65+ might be able to begin receiving vaccinations in the February – March time frame (that means “start” tor receive as it will then take some time).
  • The consensus of expert opinion is that more people in the workforce will then begin to have access in March to April time frame.
  • Only after that will vaccines be available to the general public. The expert consensus is that is likely to be in the summer of 2021 (June to September) – updated January 8, 2021: Oregon says it will be FALL OF 2021 for general public access.
  • As trials have not yet been conducted on children, it is likely that vaccines will not be available for children until summer of 2021.
  • Wildcards: Perhaps demand for vaccines will be less than expected. The pandemic might mostly die out on its own during 1H 2021, and that may lower demand for vaccinations. Vaccines contracted for U.S. and other nations’ delivery might be redirected to other countries (see below) delaying availability to the general public.

As vaccine distribution is not yet predictable, there are a wide range of estimates from “experts” and from the available public data.

We can look at the different “expert opinion” projections and do a Delphi-like “crowd wisdom” estimate of when the vaccine is available to the general public (rather than prioritized groups only).

We can also look at limited public data on contracted vaccine deliveries.

Both lines of evidence point to general availability beginning in the summer of 2021, with up to a few months to reach everyone who may wish to be vaccinated.

Read on for the list of “expert opinions” and contracted delivery information.

Most states have vaccine access plans described in multiple phases or tiers. The phases are similar to this description that I’ve created:

  • The first phase is for health care workers interacting with Covid-19 patients and some elderly residents, typically in institutional group housing.
  • This gradually expands to all in-facility health care workers and more elderly, and then front line health care such as EMS/paramedics/firefighters and police officers.
  • Next is vaccinations for “essential” customer-facing workers – this includes grocery and drug store workers, but potentially all of retail. This seems to be about when they begin vaccinating those 65+ as well.
  • Then, after that, this goes to workers in higher risk areas – such as some food processing plants and manufacturing.
  • Then to everyone in the work force.
  • Finally, and in last place, are those who work at home, or by themselves, or are retired but under age 65. The consensus of expert opinions is this group will start in late spring at the earliest and extend through the summer months.

The first phase begins next week and may take until the end of January. Additional workers will be added by February and into March.

Review of Experts

“When will vaccines be available to the general public?” depend on how you define “general public”.

The “general public” means when anyone can go to a doctor’s office, pharmacy or public vaccination clinic and receive a vaccination. This is probably late spring/summertime frame.

A few “experts” seem to include prioritized groups such as those age 65+ as the “general public” and thereby say vaccines will be available to the “general public” in February or March. But that is not what we are after – we want to know when any of us can be vaccinated.

Here is what the experts say:

  • The CDC’s advisory committee suggests general availability before June.
  • Colorado says general availability in “summer” of 2021.
  • Utah says June/July.
  • Wisconsin says “mid 2021 – summer”
  • Dr. Fauci has said both “perhaps by April, May or June” and “mid-2021”. Says large crowd events not likely to be permitted until end of Summer 2021. He says up to 85% of population must be vaccinated before we could hold large sporting events. This means late fall. Update: In mid-December, Fauci said “late-March to April” although another report said he actually said public vaccinations would start sometime between late March and June – which would be consistent with his earlier comments and the actual availability of vaccines.
  • U.S. Surgeon General says to expect the public to be vaccinated between June to September of 2021.
  • A few states say first possible availability is sometime in the April-June timeframe.
  • Some states give a broad estimate that first possible date will be in the April-September time frame.
  • Pennsylvania believes restrictions and mask requirements will be in effect through December 2021.
  • Florida says first availability not until late spring or perhaps early summer of 2021.
  • Texas says first availability in July – and general availability not ramped up until mid-summer.
  • Idaho says first vaccine available to public in late spring or summer of 2021.
  • Washington “it could be more than six months before Covid-19 vaccine is available to Washingtonians
  • San Francisco Public Health department says general public not likely to have access until summer or fall of 2021 and says you should plan that summer events will be canceled.
  • Walgreens and CVS think could be available to “general public” in spring of 2021. Note that this does not actually mean “general public” – it means that these drug stores will be able to offer vaccinations to members of prioritized groups (such as age 65+) beginning in the spring. The media has failed to define “general public”. Other large pharmacy chains so they do not know when vaccines will be available to the general public.
  • The Oregon Health Authority said on Friday that they anticipate vaccinating 10,000 adults per day. At that rate, it will take until September to vaccinate just half of the adults in the state. Oregon appears to have the worst plan of action of any state in the country, and is the 49th (2nd to last) state to deliver its first vaccinations to health care workers.
  • Central Oregon health officials say it will be several months before high risk members of the general public will be able to get vaccinated. For Oregon – “We do not yet know when we will have enough vaccine supply in Central Oregon to begin vaccinating high-risk patients, but anticipate it could be several months.” and “At this point, officials expect the vaccines to be available to the general public by late spring or early summer.
  • The City of Los Alamitos, CA has said first availability to non-health care “essential” workers in March or April of 2021, then followed by those age 65 and older, and finally, the general public in summer of 2021. (Amusingly, the news story says not until “summer of 2921”!)
  • West Virginia says could start in “mid-March” but it will not ramp up until spring/summer of 2021.
  • City of Long Beach, CA says:
    Phase 1a will be the first group to have access to the vaccine. The number of people in this group is larger than the quantity of doses in the first shipment, therefore Phase 1a is divided into three tiers. The City expects everyone in Phase 1a to be vaccinated within the first three months of next year.
  • Tier 1 of Phase 1a includes acute care and skilled nursing facilities, paramedics and EMTs and dialysis centers.
  • Tier 2 includes intermediate and home health care, community/public health field staff and primary care clinics.
  • Most other healthcare settings including laboratories, dentist offices and pharmacies will be in Tier 3.

In Phase 1b, as more vaccine allotments are received, they will be offered to other essential workers which includes refuse workers, grocery workers and those who have been working during the pandemic in an essential job function. The City anticipates this phase will begin in March or April of 2021.

Phase 1c includes high-risk populations of adults over age 65 and adults with high-risk medical conditions.

During Phase 2, the vaccine will be available to the general public. Administration of the vaccine to the general public is expected in early summer.

As you can see, the expert opinions range from about April to September with most saying mid-2021 – June/July time frame for general first access to the public (those not in prioritized groups). The U.S. Surgeon General’s comments “June through September” reflect first availability and then the time need to administer shots to tens of millions of people.

A wild card in this is the supply of vaccine relative to demand. Suppose fewer people decide to get vaccinated? If that happens, then general public availability might become late March to May time frame. Still, you might then have to get in line.

Review of Contracts for Delivery

In addition to “expert opinion” we can look at public information on supply of vaccines. This too points to a mid-2021 time frame for public availability.

I reviewed public news reports or government press releases on vaccine suppliers and proposed delivery dates. Much of this information is not of good quality so I had to make some assumptions.

Pfizer

Moderna

  • Enough vaccine for 50 M people. UPDATE: Moderna has now agreed to deliver enough for 50M by March 31st and 50M by June 30th.

Sanofi/GlaxoSmithKline

  • Contracted to deliver 100 M doses by unspecified time frame.
  • Delayed to late 2021 as did not survive trials and they are restarting. Apparently did not meet effectiveness requirements in the elderly.

Johnson and Johnson

Oxford/AstraZeneca

  • Contracted for 300 M doses (2 dose vaccine) for up to 150 M people.
  • There is no information on delivery dates so assume half of that (75M) by June 30th.

Novavax

  • Has Phase 3 trial underway in the UK.
  • A Phase 3 trial in the U.S. is to start this month
  • Was contracted to deliver 100M doses by January 2021 but obviously this is out to late spring at earliest.

There are other vaccines – and treatments – in development but doesn’t sound like we will hear much about them until spring.

Adding those up, that comes to vaccine for 150M by June 30th, plus an unknown number potentially from J&H and AstraZeneca.

Update Dec 16, 2020

Pfizer and Moderna are each delivering doses for up to 50M people by March 31st, for a combined total of 100M people. Moderna will deliver an additional 50M by June 30th, for a cumulative total of 150M people. Pfizer is not currently contracted for additional deliveries.

  • March 31st: vaccinations for up to 100M in hand
  • June 30th: vaccinations for up to 150M in hand.

Unknown when and how much or even if J&J and AstraZeneca will deliver in Q2. My bottom line estimate of 200M people so appears to be supported by this additional news.

Predictions that the general public will have access to vaccines in February or March appear to be outright lies.

Some in public health (including Dr Fauci) are calling for 75-85% of US population to be vaccinated before calling the pandemic over with and removing restrictions. A few others have made noises that new cases and deaths should be at zero – but we are no where near that goal with annual influenza, so that makes no sense.

The vaccination percent seems to me (and I am an idiot) to be the wrong metric. The metric should be that R-0 is very low and the disease incidence is low. Some suggest this could happen by the time 30% are vaccinated, which would be perhaps by March or April of 2021.

Limits to Vaccinations

3 or 4 vaccines will likely be available by March, and perhaps 6 by June. Those may be Pfizer/BioNTech, Moderna, Johnson and Johnson, and Oxford/AstraZeneca. Several others are in test phases.

Unfortunately, from the Bloomberg report, the total contracted vaccines, assuming everything goes smoothly, are only enough for around 200 million people by end of June or July of 2021.

Government statements that there will be enough vaccine for 300M people by June 30th appear to be optimistic and based on an assumption that everything would go right. At this time, J&J and Oxford/AstraZeneca are not yet approved. Sanofi and Novavax are both delayed – explaining why we have a shortfall instead of the expected 300M.

We seem to be overpromising what can be delivered – this creates a false public perspective that anyone can be vaccinated by the spring of 2021.

All of the data above says general availability will start about the summer of 2021. Hopefully this is wrong and it will become available sooner. (Update – Pfizer will deliver 200M more doses by May 31. Johnson and Johnson is expected to seek an EUA in February and this should expand doses in the spring time.)

The logistics of injecting millions of people will be a limiting factor. If we get our vaccines delivered by June 30th, it will still take a few months to administer them to all who may want them.

Definition of “Available”

“Available” of course only means we can sign up for a vaccination. If there is great demand, there could be a month or two wait to get vaccinated after first public vaccinations are available.

Time Delay to Being “Vaccinated”

Most vaccines require two doses while the J&J vaccine is a single dose.

The 2nd dose of a 2-dose vaccine is likely to be given about 3 to 4 weeks after the first dose (up to a maximum of 6 weeks, although other reports says 2nd dose can occur much later, if needed). While immunity may come quickly (52% effective after dose 1), even after a first dose, published reports say to expect up to 4-6 weeks after the first dose before we can be considered “vaccinated”.

  • Up to 100M+ may receive vaccinations through the spring because they are members of “prioritized” groups.
  • Best case first dose vaccination availability is during April/May. Based on the above, this seems very unlikely for most of us.
  • Likely first dose availability may be late June or July or later.
  • Worst case is probably August/September or later.

Add up from 2 to 6 weeks to your first dose to be considered “vaccinated”. Let’s say you get our first dose on July 1 – you probably won’t be able to consider yourself “vaccinated” until mid-August.

This means if you were planning on being vaccinated and taking a trip in the spring, you may wish to cancel that travel.

We have canceled all travel through June and I am expecting a large outdoor event in late July will be postponed (or canceled). I have friends who have canceled all trips until October of 2021. By then, airlines, restaurants and hotels will have been decimated – and travel may be difficult due to strong demand and limited supply of passenger seats and hotel rooms.

Hopefully we will know much more about vaccine rollouts by perhaps March of 2021. Let’s hope they are now under promising and ultimately over deliver on vaccines.

Redirection of Contracted Deliveries

Wealthier nations funded billions of dollars to develop – and then begin manufacture of those vaccines before approval, knowing this investment may be thrown away. Their early and risky funding led to their “buying” a significant share of the world’s vaccine supply in 2021. This means many countries will see less vaccine availability in 2021 and their time frame for vaccination may extend in to 2022.

Some countries have ordered an excess supply – because they know that many vaccines in development will not work out or will be delayed. The U.S. ordered one vaccination round per person – but because of problems in some of those vaccines, may only get 200 M+ by June 30th. Canada, on the other hand, has ordered 4x to 5x doses per person. Taxpayers are the one’s funding the risky development and early manufacturing – if these fail, the costs are on the U.S. taxpayers.

Some are pushing to re-direct the contracted supply to other nations. The effect of this would be that those on the end of the line in the U.S. and other countries for late 2021 vaccination, might have to wait until 2022. Obviously, Canada might be in a better position than the U.S. to redirect contracted supply due to its significant over capacity position – the U.S., not so much.

In the past 24 hours (12/16/2020), there has been an obviously coordinated global media campaign to highlight this topic.

Several nations will be under significant media and political pressure to forgo some of their contracted vaccine supply. If supplies are redirected, given expected U.S. demand and a supply less than originally hoped for, this means those who have a low priority access to vaccine in the U.S. might have to wait to the end of 2021 or even into 2022 to be vaccinated. This is not an idle concern: President elect’s medical task force adviser Zeke Emanuel is advocating that the U.S. divert its supply after the elite and “essential” people are vaccinated (which would include his being vaccinated first, of course).

As with immunity passports and the numerous problems that concept presents, politicians will be under tremendous pressure to divert domestic vaccines to other countries.

Update: New Zealand has contracted for enough vaccines for their own population, plus several islands that are controlled by New Zealand, plus several independent nation islands in the South Pacific. Thee will be much pressure on the developed nations to address this issue – how it will be addressed is unknown, other than Biden’s adviser advocating for re-directing existing supplies before vaccinating one’s own nation.

My expectation on Vaccine Diversions

The pandemic, like all prior pandemics, will begin to fade out on its own. Several respectable scientists think this could occur between January and June of 2021. I am seeing a peak forming in the large quantities of data that I follow (but I am an idiot so please ignore me).

By about April, as President Biden’s “100 million vaccinated in first 100 day” promise is fulfilled, public health will move the goal posts. The current goal is we remain under restrictions until 75-85% of the U.S. population is vaccinated (according to Dr. Fauci). However, with R-0 then falling to a low level by spring, the new goal will be a low infection rate and a small number of fatalities. This will become the “cover” for President Biden to announce that U.S., out of generosity, will be diverting U.S. contracted vaccines to other countries.

Conveniently, this will occur after 100% of the elite have been vaccinated. The rest of us will likely have to put our lives on hold, refrain from travel, cover up our faces and generally remain in hiding until the end of 2021. We may even be prohibited from traveling due to the pressure to give “immunity passports” and a “freedom to travel” to the elite and “essential” people. (Labeling the rest of us as non-essential is incredibly demoralizing.)

New York Times Vaccine Calculator

The NY Times has a vaccine delivery estimator, based on CDC and other government guidelines. Enter some information and it suggests your position in line.

As an old but worthless, non-essential, non elite member of society, you can see where I rank in the vaccination schedule. First is at top and last is at the bottom. I am down near the point where hell freezes over 🙂

Like the news report typo said – probably out to the summer of 2921!

Related: The above analysis is similar to the same projection I made in early September. Only now we have more data.

Related: 15 days to flatten the curve becomes 18 to 21 months.

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