Thread by @friedberg

there isn't a lot of transparency or accountability in the vax rollout at federal/state/local level, but the US does have enough vax doses to effectively end the pandemic in 45-60 days. here's why, key metrics to observe, and a reminder on how we can do it...

today, pfizer CEO reported producing 70M vax doses as of 12/31 & another 33M doses since start of the year = 103M doses in total! they're making ~100M per month & have reportedly already handed over ~70M doses to Fed govt. finance.yahoo.com/news/pfizer-pr…

we have a lot of doses and we don't need to vaccinate everyone to end the pandemic...

fewer people able to transmit the virus (due to infection or vaccination) = fewer new cases/day = cases eventually go to 0 and pandemic ends. goal is reproductive rate (R) < 1.0 ASAP

to get R<1 you don't need to vax everyone, you just need to vax enough ppl. + don't need everyone to receive 2 doses. 1 dose reduces infection/transmission by 52%. thus, if enough ppl get 1 dose, pandemic can end. 1M ppl w one dose = ~500k ppl w 2 doses.
bmj.com/content/371/bm…

if we stop thinking about the individual benefit of vax and recognize the group benefit, it's clearer how this gets done. MORE PPL vaccinated FASTER = the pandemic ends faster.

less focus on tiering, more focus on speed

https://twitter.com/friedberg/status/1347811357278707713

so, how many doses are needed?

seroprevalence studies show 14% of US pop infected as of 11/15. 250k avg new reported cases/day since then, likely missing 2/3 cases, so ~45M new cases = likely 25-35% of US pop has been immunized through infection, as of today.

jamanetwork.com/journals/jaman…

some studies estimate we need 67% of US pop immune to achieve R<1 w back-to-normal behavior. thus, we need an add'l 100M ppl (~35% of US) fully vaccinated = ~200M doses

nature.com/articles/s4157…

Fed govt has already received 70M, Pfizer+Moderna delivering ~100M/mo. by feb 28, should have enough doses to immunize enough ppl to let America return to normal as pandemic winds down.

we have doses needed. issue is speed. how fast can we deliver?

given we don't currently have a functioning Federal govt, States are being asked to vaccinate. many are passing doses to local govt, who are asking local doctors/hospitals to administer. hospitals already overburdened. local govt not setup to do this work. it's a mess.

states should take responsibility for last mile delivery. alternative approach, which can be administered by states:

https://twitter.com/friedberg/status/1347811361120677888

if states took responsibility for delivery (through local sites), supply chain would look like this:
Pfizer->Fed Gov->State Gov->People

provided the delivery rate of State Gov->People is the same as delivery rate of Pfizer->Fed Gov, we can deploy 200M doses in 45-60 days

Pfizer->Fed Gov is 100M/mo or 3M/day

this dose rate, roughly 1% of US population per day, is what's needed to keep up w supply of vax. thus, each state needs to deliver doses to 1% of their population/day. ex. CA needs to be at 400k/day (CA currently targeting ~100k/day)

each state should publish their daily throughput + target, by state and site.

it's also critical that Fed Govt->State Govt achieves 3M doses/day delivered w inventory time <5 days. this should be reported daily, by state.

& states should report delivery to local sites, by day

this approach is a simple framework for top-level goals that can be used to get this done as fast as possible. we can start from these goals - 1% of the population vax/day - to back into how many sites needed + ppl vax'd/day/site.

in SF, for example, we need 8k ppl vax'd/day. assuming 20 vaccinations/hr/nurse, we only need 20-40 nurses (or trained volunteers) working rotating shifts 24/7 to get this done in SF.

residents deserve to know/see where and how this will be done. a specific plan for number of sites, # ppl injecting at each site, and how that allows turnaround times to get 1% of population vax'd/day

we know what we need to achieve. we have the supply to achieve it. with some planning and dedicated execution, we can end this miserable pandemic and return to normal in March. now is the time for govt leaders to step up, be transparent, and be accountable. let's go.