Are There Enough COVID-19 Vaccines for America Without More Funding?

By1covidnews

Mar 25, 2022

With Congress having reached a funding stalemate regarding additional COVID-19 support, the White House has said that the federal government “does not have adequate resources to purchase enough booster vaccine doses for all Americans, if additional doses are needed.” We sought to assess this by estimating how far the current U.S. supply of COVID-19 vaccines could stretch under different scenarios. To do so, we looked at the number of COVID-19 vaccine doses the federal government has already purchased, and the number of people already vaccinated and boosted. We then estimated the number of additional doses that would be required to fill any gaps needed to reach vaccination targets, including to fully vaccinate those who still haven’t completed a primary series, under different assumptions about further booster coverage with 3^rd and 4^th doses. We assumed that vaccination will soon be authorized for all ages, and examined the future supply of mRNA vaccine doses only (i.e., Johnson and Johnson doses were not included). We assessed the following three scenarios:

Providing a 4^th dose to those ages 65 and older
Providing a 4^th dose to those ages 18 and older
Providing a 4^th dose to all ages

For each scenario, we looked at supply needed to purchase enough doses to reach two vaccine coverage targets: 70% and 100%. Data are as of March 20, 2022 (see methods for sources and additional details).

Findings

We find that the federal government does not have enough vaccine doses remaining in its current supply to fully cover the U.S. population with a 4^th dose under any of these scenarios.
The deficit between current supply and doses required is most acute (484 million doses) if a 4^th dose is authorized for all ages and enough doses are purchased to cover 100% of the population. However, a deficit still exists (162.5 million doses) even if 4^th doses are needed only for those ages 65 and older.
When a 70% population coverage target is used instead, there is still a supply deficit (118.3 million doses) if 4^th doses are purchased for those of all ages, and a modest deficit to reach 70% of those ages 18 and older with a 4^th dose (34 million). There are enough doses to cover 70% of those ages 65 and older with a 4^thdose.
Based on the lowest available prices paid per dose by the U.S. government for domestic vaccine supply ($15.00/dose for Moderna and $19.50 for Pfizer), we estimate that additional funding required ranges from $509.5 million (if all future doses were Moderna and enough were purchased to reach 70% coverage of those 18 and older with a 4^th dose) to $9.4 billion (if all future doses were Pfizer and enough were purchased to reach 100% of all ages with a 4^th dose).

It remains to be seen whether and when, and for which population groups, 4^th doses of a COVID-19 vaccine will be recommended in the U.S. While estimated U.S. COVID-19 vaccine supply needs vary widely depending on the assumptions used – as well as how many people choose to get vaccinated — this analysis indicates that under a plausible set of scenarios where 4^th doses are recommended, the federal government is unlikely to have enough doses already purchased to cover the U.S. population.

Scenario	70% Coverage	100% Coverage
4^th dose to 65+	196,460,245	465,723,410
4^th dose to 18+	337,162,096	666,726,055
4^th dose to all ages	421,517,894	787,234,338

Scenario	70% Coverage	100% Coverage
4^th dose to 65+	106,734,880	(162,528,285)
4^th dose to 18+	(33,966,971)	(363,530,930)
4^th dose to all ages	(118,322,769)	(484,039,213)

We calculated the number of people who would need to be vaccinated in the U.S. to reach 70% and 100% vaccine coverage by age group. We compared these levels to the number who had already completed a primary COVID-19 vaccine series (if they received two doses of the two-dose mRNA series or one dose of a single-dose vaccine), and the number who had received a 3^rd dose (booster) by age group. We then looked at the additional doses needed for three scenarios: 1) providing a 4th dose to those ages 65 and older; (2) providing a 4th dose to those ages 18 and older; and (3) providing a 4th dose to all ages. For each scenario, we assessed the number of doses needed to complete the primary vaccine series and, for scenarios 1 and 2, the number of doses needed to provide a third dose to all those ages 12 and older, as is currently recommended by CDC, before adding a 4^th dose. For scenario 3, we assumed a 3^rd dose would be recommended for all ages. For each of the 3 scenarios, we examined both 70% and 100% coverage targets, resulting in 6 distinct supply requirement outcomes. We then compared the number of additional doses needed in each supply outcome to the number of doses remaining in the current U.S. vaccine supply, and determined the amount of supply surplus or deficit. We assumed that any doses already delivered (whether administered yet or not) were no longer available for purposes of the remaining supply. We also did not include remaining J&J vaccines in the available future supply and we removed Moderna doses already provided for international use from the available supply. Finally, we estimated the potential cost of purchasing additional doses if more were needed. We used the estimated price paid per dose for Moderna and Pfizer vaccines using the lowest available price per dose estimate paid to date among supply contracts. Data on the size of the U.S. population by age group were obtained from the U.S. Census. Data on the number of U.S. vaccine doses purchased and estimated price per dose were obtained from official U.S. government, pharmaceutical company releases, and the UNICEF COVID-19 Vaccine Market Dashboard. Data on the number of vaccine doses delivered and number of people vaccinated were obtained from the CDC COVID Data Tracker and are current as of March 20, 2022.

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