WASHINGTON -- The federal government will rush resources to support vaccinations, testing and treatments, but not vaccines, to Michigan in an effort to control the state's worst-in-the-nation coronavirus outbreak, the White House said Friday.
The announcement was made as Gov. Gretchen Whitmer strongly recommended, but did not order, a two-week pause on face-to-face high school instruction, indoor restaurant dining and youth sports. She cited more contagious coronavirus variants and pandemic fatigue as factors in the surge, which has led some hospitals to postpone nonemergency procedures.
Statewide hospitalizations have quadrupled in a month and are nearing peak levels from last spring and fall.
"Policy alone won't change the tide. We need everyone to step up and to take personal responsibility," Whitmer said Friday. Michigan's seven-day case rate was 492 per 100,000 people, well above second-worst New Jersey, with 328 per 100,000, according to the Centers for Disease Control and Prevention.
President Joe Biden outlined the federal actions late Thursday in a call with Whitmer to discuss the dire situation in the state, according to senior administration officials. The response will not include a "surge" of vaccine doses, a move Whitmer has advocated and which is backed by Michigan legislators and members of Congress.
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Instead, Biden talked about how the federal government was planning to help Michigan better utilize the doses already allocated to the state, as well as to increase testing capacity and provide more medications for the sick.
Whitmer, a Democrat, confirmed that she asked Biden to send more vaccine doses to Michigan, particularly the single-dose Johnson & Johnson shot.
"I made the case for a surge strategy," she said. "At this point, that's not being deployed, but I am not giving up.
"Today it's Michigan and the Midwest," she added. "Tomorrow, it could be another section of our country. I really believe that the most important thing we can do is put our efforts into squelching where the hot spots are."
Doses are allocated to states proportionally by population, but Whitmer has called for extra doses to be shifted to states that are experiencing a sharp rise in cases. The Biden administration isn't ready to make such a change.
"We're going to stick with the allocation system of allocating by state adult population," said White House covid-19 coordinator Jeff Zients, calling it "the fair and equitable way." He said the administration was looking to help Michigan administer more of its vaccine efficiently.
When Whitmer began calling for more doses from Washington, the state had not maxed out its orders for vaccines from the federal government, according to a person familiar with the matter, who spoke on condition of anonymity to discuss the situation.
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Gen. Gustave Perna, the top federal official overseeing distribution, raised the issue of gaps between states' allotments and their orders Tuesday in a White House call with the nation's governors. And on Thursday, Biden administration officials huddled directly with the Michigan health department to discuss the state's ordering strategy and ensure that it uses its entire allotment.
"We actually met with the White House team yesterday and walked through our entire ordering strategy, and when we ordered what and when," Dr. Joneigh Khaldun, a top state health official, said Friday.
She said the state was now "ordering all of the vaccines that are available to us."
DROP IN ORDERS
Other states have delayed ordering hundreds of thousands of vaccine doses available to them even as outbreaks escalate -- a sign the nation faces challenges related to demand, staffing and inoculation of hard-to-reach populations.
Four months into the effort, what's most mystifying is the number of states waiting to order all the doses they've been allotted.
At one point last week, 13 states had more than 100,000 doses apiece available and unordered, according to a federal official familiar with the figures who, like others, spoke on condition of anonymity because of the matter's sensitivity.
Indiana had pulled down only 90% of doses available to the state, leaving 306,000 on the shelves. Texas had ordered 95% of its share, leaving 673,000 doses temporarily untouched.
The delays have gained notice in the federal government, where officials have discussed whether performance metrics, including how quickly states are ordering and using their vaccines, and getting them to vulnerable groups, should be part of allocation decisions, according to three people familiar with the issue. Any new approach, however, would need sign-off from the White House, which has been at pains to avoid the appearance of penalizing some states while boosting others.
Experts argue that four months into the campaign, and with more transmissible variants of the virus spreading throughout the country, states should no longer be encountering bottlenecks preventing them from making use of their full vaccine allotments.
"States and their health care providers need to have the capacity at this point to deliver the vaccines available to them each week," said Jason Schwartz, an assistant professor of health policy at Yale University and a member of Connecticut's vaccine advisory committee. "We shouldn't be leaving vaccine doses on the table during this time."
State and county officials offered different explanations for not ordering their full allocations each week. Many cited the difficulty of matching first and second doses. "We don't always order all second doses, as they may not be needed that week, based on when first doses were used," said Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services.
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Others pointed to reduced demand, staffing challenges and inadequate communication between state and local officials. Mouhanad Hammami, director of the Wayne County Health Department in Michigan, said a sharp and unexplained drop-off in the county's share of Moderna doses meant it couldn't operate one of its clinics.
Sarah Verschoor, a spokeswoman for the Indiana Department of Health, said unordered doses had been "earmarked for businesses, higher education and local health department clinics that are set to start vaccinating in the coming days."
In North Carolina, Lisa Macon Harrison, health director for Granville-Vance Public Health in the northern part of the state, said orders dipped last week because of spring break.
DOSE SPACING DEBATED
The prospect of a fourth wave of the coronavirus has reignited a debate among vaccine experts over how long to wait between the first and second doses. Extending that period would swiftly increase the number of people with the partial protection of a single shot, but some experts fear it also could give rise to dangerous new variants.
In the United States, two-dose vaccines are spaced three to four weeks apart, matching what was tested in clinical trials. But in Britain, health authorities have delayed doses by up to 12 weeks in order to reach more people more quickly. And in Canada, which has precious few vaccine doses to go around, a government advisory committee recommended Wednesday that second doses be delayed even longer, up to four months.
Some health experts think the United States should follow suit. Dr. Ezekiel Emanuel, a co-director of the Healthcare Transformation Institute at the University of Pennsylvania, has proposed that for the next few weeks, all U.S. vaccines should go to people receiving the first dose.
"That should be enough to quell the fourth surge, especially in places like Michigan, like Minnesota," Emanuel said.
But opponents, including health advisers to the Biden administration, argue that delaying doses is a bad idea. They warn it will leave the country vulnerable to variants -- those already circulating and new ones that could evolve in the bodies of partially vaccinated people who are not able to swiftly fight off an infection.
"It's a very dangerous proposal to leave the second dose to a later date," said Dr. Luciana Borio, former acting chief scientist of the Food and Drug Administration.
Dr. Anthony Fauci, the nation's top infectious-disease expert, agreed. "Let's go with what we know is the optimal degree of protection," he said.
PRODUCTION TROUBLE
Johnson & Johnson has abandoned a pledge to deliver 24 million additional doses of its one-shot vaccine by the end of April after the continued failure of its troubled contract manufacturer in Baltimore to win government manufacturing certification.
The government slashed its national allocation of the vaccine to states by 86% to just 700,000 doses next week, down from nearly 5 million, a cut that Maryland Gov. Larry Hogan, a Republican, called "very concerning."
The cuts will make it harder to find the Johnson & Johnson shot across the country for much of April.
Washington, D.C., is in line to receive just 1,300 doses of the vaccine next week, down from 10,800 this week, according to data tracked by the CDC. California will receive 67,000, down from 572,000.
The Biden administration put Johnson & Johnson in control of manufacturing at the Emergent BioSolutions plant in Baltimore last week after 15 million doses were contaminated by another vaccine being made at the plant by AstraZeneca.
The rollout of Johnson & Johnson shots has been so slow that it is not yet a significant factor in the U.S. vaccination surge, which has been fueled by the Pfizer-BioNTech and Moderna two-shot vaccines.
Only 5 million Johnson & Johnson shots have been administered, according to CDC data, compared with 170 million shots of the other two vaccines.
JOHNSON & JOHNSON CLEARED
Federal health officials say it's safe to continue administering Johnson & Johnson shots at three vaccination sites in North Carolina that had an increase in reports of adverse reactions Thursday.
Four of the more than 2,300 people who received a Johnson & Johnson shot at PNC Arena in Raleigh on Thursday were hospitalized, and all but one had been released by Thursday night. Fourteen people experienced minor reactions that could be treated on-site.
The CDC gave the all-clear. It performed vaccine lot analyses and did not find any reason for concern.
"Reactions are expected, but what's important is that our patients are here with us being monitored, and medical personnel are right here in our clinics to respond to these rare events," said Kim McDonald, Wake County's medical director.
David Wohl, who oversees vaccine operations at the Friday Center in Chapel Hill and Hillsborough Hospital, said between eight and 14 of roughly 1,250 Johnson & Johnson vaccine recipients it served Thursday fainted after receiving the shot, though nobody was taken to a hospital.
The medical system said Friday that those who get the Johnson & Johnson vaccine tend to be younger and have an aversion to needles, which is why they prefer the single-dose shot.
"This may also be why there have been more reactions in those vaccinated with J&J," wrote UNC Health spokesman Alan Wolf. "We believe that the J&J vaccine is safe," he said. "Very few people (less than 1%) who have received this vaccine at our clinics have reported lightheadedness or fainting."
MISSISSIPPI RELUCTANCE
Mississippi residents have an abundance of vaccine options. On Thursday, there were more than 73,000 slots to be had on the state's scheduling website, up from 68,000 on Tuesday.
Public health experts say the pileup of unclaimed appointments exposes something worrisome: the large number of people who are reluctant to get inoculated.
"It's time to do the heavy lifting needed to overcome the hesitancy we're encountering," said Dr. Obie McNair, an internal medicine practitioner in Jackson, whose office has a plentiful supply of shots but not enough takers.
Although access remains a problem in rural Mississippi, experts say the state -- one of the first to open eligibility to all adults three weeks ago -- may be a harbinger of what much of the country will confront in the coming weeks, as increasing supplies enable most Americans who want vaccinations to easily make appointments.
The hesitancy has national implications. Experts say between 70% and 90% of all Americans must be vaccinated for the country to reach herd immunity, the point at which the virus can no longer spread through the population.
In Mississippi, just a quarter of all residents have received at least one dose compared with the nationwide average of 33%, according to state data. Other Southern states, among them Tennessee, Arkansas, Alabama and Georgia, have similarly low rates of vaccination.
Information for this article was contributed by Zeke Miller, David Eggert and Bryan Anderson of The Associated Press; by Isaac Stanley-Becker, Jacqueline Dupree, Lena H. Sun, Christopher Rowland and Erin Cox of The Washington Post; and by Carl Zimmer and Andrew Jacobs of The New York Times.
