covid-19

[wiggin]

I have a suspicion that a factor in going to the 12 week max scheme rather than the 3 week one was getting rid of the hoarding issue as the same was happening here originally. Hospitals would hoard half the stock to give the second doses in 3 weeks time rather than use it now and using newer stock in 3 weeks time. Switching to 12 gets rid of that incentive at least for a couple of months.

This comes down to a failure of coordination by whoever is supplying the vaccines. If the central government provides clear guidance and commitments about when vaccines should be available and what kind of reserves, if any, are needed, then the local folks who are actually distributing the vaccines will know what to expect. The problem becomes when the central supplier (typically the federal/national government) becomes an unreliable predictor of future supply, in which case localities are left to fend for themselves.

The Israeli vaccination drive was reportedly going to slow down some in January because of lumpy supply; a pause itself is not unreasonable if you have clear forecasting for your supply (it's not clear if this is the case any longer, they were able to trade EMRs/phase IV trial data for increased supplies). In fact, it's a good thing if you're constrained by vaccine supplies rather than distribution/administration - there's no reason why the rate limiting factor should be distribution. So if supply is your limit, there needs to be clear communication and predictability in supplies. Without that forecasting and trust, you'll get hoarding.

I do not think that the solution to a hoarding problem is to change dosing schedules with little to no justification; the solution to hoarding is to address the actual problem, namely the trust local authorities have that promised doses will be delivered, on time.

[RandBlade]

This comes down to a failure of coordination by whoever is supplying the vaccines. If the central government provides clear guidance and commitments about when vaccines should be available and what kind of reserves, if any, are needed, then the local folks who are actually distributing the vaccines will know what to expect. The problem becomes when the central supplier (typically the federal/national government) becomes an unreliable predictor of future supply, in which case localities are left to fend for themselves.

The Israeli vaccination drive was reportedly going to slow down some in January because of lumpy supply; a pause itself is not unreasonable if you have clear forecasting for your supply (it's not clear if this is the case any longer, they were able to trade EMRs/phase IV trial data for increased supplies). In fact, it's a good thing if you're constrained by vaccine supplies rather than distribution/administration - there's no reason why the rate limiting factor should be distribution. So if supply is your limit, there needs to be clear communication and predictability in supplies. Without that forecasting and trust, you'll get hoarding.

I do not think that the solution to a hoarding problem is to change dosing schedules with little to no justification; the solution to hoarding is to address the actual problem, namely the trust local authorities have that promised doses will be delivered, on time.

You're right to say that supply is the limitation but to my understanding wrong to suggest that central government planning is the bottleneck. Supply itself from the manufacturers themselves is the bottleneck.

The only way for central government to know how much supply for certain it will have in 3 weeks time is if they are hoarding it today themselves, but they're not hoarding it - as soon as the vaccines are getting certified they're being rolled out.

Part of the restriction in Pfizer's vaccine to my understanding is that a batch failed certification and was thrown out. Good that it is being rigorously tested, bad for ensuring stable supply. Same could happen again in the future.

As far as I understand as part of the certification process (at least for AZ) the vaccine gets bottled up then left in a sterile environment for three weeks then the batch is tested to see if any mould has grown on it, if it has that batch needs throwing away. At the end of last year the situation was that there were a million doses certified, 4 million more bottled up awaiting certification, 15 million more manufactured awaiting bottling. So how many would there be available in 3 weeks time (now next week)? A proportion of that 4 million but how many would depend upon the certification process, it can't be guaranteed.

[wiggin]

You're right to say that supply is the limitation but to my understanding wrong to suggest that central government planning is the bottleneck. Supply itself from the manufacturers themselves is the bottleneck.

The only way for central government to know how much supply for certain it will have in 3 weeks time is if they are hoarding it today themselves, but they're not hoarding it - as soon as the vaccines are getting certified they're being rolled out.

Part of the restriction in Pfizer's vaccine to my understanding is that a batch failed certification and was thrown out. Good that it is being rigorously tested, bad for ensuring stable supply. Same could happen again in the future.

As far as I understand as part of the certification process (at least for AZ) the vaccine gets bottled up then left in a sterile environment for three weeks then the batch is tested to see if any mould has grown on it, if it has that batch needs throwing away. At the end of last year the situation was that there were a million doses certified, 4 million more bottled up awaiting certification, 15 million more manufactured awaiting bottling. So how many would there be available in 3 weeks time (now next week)? A proportion of that 4 million but how many would depend upon the certification process, it can't be guaranteed.

Yes, the central government should not be using their last dose to give someone dose 1 if they aren't sure they'll be able to provide dose 2. They absolutely should have a reserve in place based on their best estimates of future supply, scrap rates, extant second doses to be administered, etc.

I wasn't saying that the problem is the limited supply, that's just the circumstance. Appropriate management of distribution, crucially including excellent communication and transparency about their assumptions, is the way to address the hoarding problem. I mean, yes, obviously you could also fix it by magically having infinite supply. But in a constrained supply environment, you address hoarding by assuaging concerns about future supplies, not by either saying 'eh, forget about the dosing schedule' or commanding people to stop hoarding. It's even better if you can have a coordinated plan for managing the 'flow' of vaccinations, with agreed upon targets for first and second doses in each period of time in order to smooth the demand for fundamentally lumpy supply.