June 28, 2022

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COVID-19: Efforts to Increase Vaccine Availability and Perspectives on Initial Implementation

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<div>What GAO Found The federal government has taken several actions to increase the availability of COVID-19 vaccine doses and indicated it expects to have enough doses available for all adults in the United States by the end of May. As of April 1, 2021, the government had purchased 1.2 billion doses of one- and two-dose regimen vaccines. Also, vaccine companies reported making additional manufacturing sites operational, among other actions to expand capacity and mitigate challenges. Federal officials said projecting future availability of vaccine doses can be difficult, in part because of uncertainty surrounding complex manufacturing processes. Given this uncertainty, coupled with the significant manufacturing and distribution increases needed to have enough vaccine doses available for all adults, managing public expectations is critical. GAO's prior work has found that timely, clear, and consistent communication about vaccine availability is essential to ensure public confidence and trust, especially as initial vaccine implementation did not match expectations. COVID-19 Vaccination Site Stakeholders GAO interviewed identified challenges with initial COVID-19 vaccine implementation. For example, some stakeholders said states often did not have information critical to distribution at the local level, such as how many doses they would receive and when. The federal government has begun initiatives—outlined in a national response strategy—to improve implementation, such as creating new vaccination sites. In its March 2021 distribution strategy, CDC provided a high-level description of its activities and noted that more details would be included in future reports to Congress. To meet the expectations set by recent announcements, such as the planned expansion of vaccine eligibility to all adults and the introduction of tools to help individuals find vaccines, it will be imperative that the federal government effectively coordinate and communicate its plans, as GAO recommended in September 2020. Why GAO Did This Study Providing the public with safe and effective vaccines to prevent COVID-19 is crucial to mitigating the public health and economic impacts of the disease. The U.S. had almost 30 million reported cases and over 545,000 reported deaths as of March 27, 2021. The federal government took a critical step in December 2020 in authorizing the first two COVID-19 vaccines and beginning distribution of doses across the nation. The government had distributed about 180.6 million vaccine doses, and about 147.8 million doses had been administered, as of March 27, 2021, according to Centers for Disease Control and Prevention (CDC) data. The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines, among other issues, actions the federal government has taken to increase the availability of COVID-19 vaccine doses, and challenges with initial vaccine implementation—that is, prioritizing, allocating, distributing, and administering vaccine doses—identified by stakeholders and steps the federal government has taken to improve vaccine implementation. GAO reviewed documents from the Departments of Defense and Health and Human Services, transcripts of public briefings, data from CDC, and interviewed or received written responses from federal officials, vaccine company representatives, and select public health stakeholders. GAO incorporated technical comments from the Department of Defense, the Department of Health and Human Services, and the Federal Emergency Management Agency as appropriate. For more information, contact Alyssa M. Hundrup at (202) 512-7114 or hundrupa@gao.gov.</div>

What GAO Found

The federal government has taken several actions to increase the availability of COVID-19 vaccine doses and indicated it expects to have enough doses available for all adults in the United States by the end of May. As of April 1, 2021, the government had purchased 1.2 billion doses of one- and two-dose regimen vaccines. Also, vaccine companies reported making additional manufacturing sites operational, among other actions to expand capacity and mitigate challenges.

Federal officials said projecting future availability of vaccine doses can be difficult, in part because of uncertainty surrounding complex manufacturing processes. Given this uncertainty, coupled with the significant manufacturing and distribution increases needed to have enough vaccine doses available for all adults, managing public expectations is critical. GAO’s prior work has found that timely, clear, and consistent communication about vaccine availability is essential to ensure public confidence and trust, especially as initial vaccine implementation did not match expectations.

COVID-19 Vaccination Site

Stakeholders GAO interviewed identified challenges with initial COVID-19 vaccine implementation. For example, some stakeholders said states often did not have information critical to distribution at the local level, such as how many doses they would receive and when. The federal government has begun initiatives—outlined in a national response strategy—to improve implementation, such as creating new vaccination sites. In its March 2021 distribution strategy, CDC provided a high-level description of its activities and noted that more details would be included in future reports to Congress. To meet the expectations set by recent announcements, such as the planned expansion of vaccine eligibility to all adults and the introduction of tools to help individuals find vaccines, it will be imperative that the federal government effectively coordinate and communicate its plans, as GAO recommended in September 2020.

Why GAO Did This Study

Providing the public with safe and effective vaccines to prevent COVID-19 is crucial to mitigating the public health and economic impacts of the disease. The U.S. had almost 30 million reported cases and over 545,000 reported deaths as of March 27, 2021. The federal government took a critical step in December 2020 in authorizing the first two COVID-19 vaccines and beginning distribution of doses across the nation. The government had distributed about 180.6 million vaccine doses, and about 147.8 million doses had been administered, as of March 27, 2021, according to Centers for Disease Control and Prevention (CDC) data.

The CARES Act includes a provision for GAO to report on its ongoing monitoring and oversight efforts related to the COVID-19 pandemic. This report examines, among other issues, actions the federal government has taken to increase the availability of COVID-19 vaccine doses, and challenges with initial vaccine implementation—that is, prioritizing, allocating, distributing, and administering vaccine doses—identified by stakeholders and steps the federal government has taken to improve vaccine implementation.

GAO reviewed documents from the Departments of Defense and Health and Human Services, transcripts of public briefings, data from CDC, and interviewed or received written responses from federal officials, vaccine company representatives, and select public health stakeholders. GAO incorporated technical comments from the Department of Defense, the Department of Health and Human Services, and the Federal Emergency Management Agency as appropriate.

For more information, contact Alyssa M. Hundrup at (202) 512-7114 or hundrupa@gao.gov.

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