Handling Vaccine Stocks like Toilet Paper

The sky is not falling and Japan is not about to run out of vaccine any time soon. There is enough vaccine already in the country (either in national government freezers or in municipal/local clinic freezers) or scheduled to be delivered at regular intervals over the next 3-4 months that Japan will be able to vaccinate all of its residents age 12 and above by the end of November. Pfizer/BioNTech shipments run until October, Moderna shipments until September. Japan can maintain a rate of about 1.4 million doses a day (i.e. higher than now) until the final month, when mostly only second doses will be needed and the pace could drop by half from the peak. All this while not even tapping into its supplies of 120m doses of AstraZeneca, of which it is giving away millions to Taiwan (2x), Malaysia, Indonesia (both July 1), the Philippines (July 8) and Thailand (July 9) so far and undoubtedly will give away a lot more.

Nevertheless the media report about local governments cancelling or postponing reservations due to vaccine shortages, while the government blames some municipalities for hoarding vaccine instead of using it. What’s behind all this?

The Japanese government wants municipalities to use all Pfizer doses as soon as possible. They allocate doses for every city and prefecture for every two week period. Pfizer vaccination takes two doses at least three weeks apart. According to Minister Kono, second doses should be taken from later shipments than first doses, as he made clear in a June 1 interview. Instead, municipalities treat first and second doses like Siamese twins, allocating them from the same source and keeping the second in a freezer for 3 extra weeks. That causes artificial shortages down the road, just like back when everybody tried to keep three months worth of toilet paper in stock at home.

By the end of June the government had distributed 78 million doses, more than enough doses for all people aged 65 and above to be completely vaccinated, priming the pipeline. After the allocations in May and June, extra doses were to continue being shipped in allocations every two weeks.

In many places the 65+ group won’t finish vaccinations until the end of July, so first doses will have finished for them around July 10 after which second doses will continue for another three weeks. Once the number of first doses for 65+ has reached a peak and then decreases, first doses for the next groups (people with medical conditions, 60-64, 50-59 etc.) can take over the next vaccination slots using the supplies in stock at that time. This phase would start no later than July 10.

Where the problem arises is that municipalities have this fixed idea that second shots for 65+ in July should still come from the original May/June shipments, kept waiting in a freezer until then, instead of from July shipments.

For example, 65 year old person A gets his first shot in the 4th week of June. The second shot will be due in the 3rd week of July. 60 year old person B wants to get her first shot in the first week of July, after the city has finished first shots for the 65+ group, and her second shot in the 4th week of July. The smart thing would be to let person B go ahead since enough vaccine is still in stock from June. More will arrive in allocations in the first and second half of July and both A and B will get their second doses in the 3rd and 4th week from that fresh supply. Instead what the cities are doing is to reserve the June stocks exclusively for the 65+ group, letting it sit in a freezer for a month while keeping person B waiting to make her reservation only after sufficient July shipments have come in to cover both of her first and second shots. That’s what the 40 million unused doses cited by the government and the cancellation of vaccinations due to “insufficient supplies” as per the mayors is about.

It doesn’t really make sense to let vaccines sit idle while keeping unvaccinated people waiting for their shots. Vaccine should go into arms as soon as possible to protect people against sickness and death.

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