WASHINGTON -- The White House told states Tuesday that coronavirus vaccine doses they choose not to order will become available to other states -- the most significant shift in domestic vaccine distribution since President Joe Biden took office, and part of an effort to account for flagging demand in parts of the country.
The changes were unveiled to governors as Biden set a goal of providing at least one shot to 70% of adults by July 4, an increase that would account for about 40 million more people in the next two months. That level of coverage could drive down cases sharply, as it did in Britain and Israel. But achieving it, experts said, depends on efficiently delivering shots to places where people are still rolling up their sleeves -- or can be persuaded to do so.
Demand for vaccines has dropped off markedly nationwide, with some states leaving more than half their available doses unordered. Aiming to make it easier to get shots, Biden called for states to make vaccines available on a walk-in basis and he will direct many pharmacies to do likewise.
"You do need to get vaccinated," Biden said from the White House. "Even if your chance of getting seriously ill is low, why take the risk? It could save your life or the lives of somebody you love."
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Already more than 56% of American adults have received at least one dose of a covid-19 vaccine and nearly 105 million are fully vaccinated. The U.S. is currently administering first doses at a rate of about 965,000 per day -- half the rate of three weeks ago, but almost twice as fast as needed to meet Biden's target.
"I'd like to get it 100%, but I think realistically we can get to that place between now and July Fourth," Biden said of his new goal.
The strategy to shift doses from states with weaker demand to areas with stronger interest could transform how vaccine flows across the country. In recent weeks, numerous states have begun leaving significant quantities of doses unordered.
Oklahoma's deputy commissioner of health, Keith Reed, said Tuesday that the state is no longer accepting its full allocation of coronavirus vaccines as demand has dropped.
"The allocation would exceed 200,000 a week ... I don't have the exact numbers that we are accepting into the system right now, but it's more in the tens of thousands versus the hundreds of thousands," Reed said.
Earlier this week, Iowa turned down nearly three-quarters of the vaccine doses available to the state for next week because demand for the shots remains weak. Louisiana, meanwhile, hasn't drawn down its full vaccine allocation from the federal government for the past few weeks.
Last week, Arkansas declined the state's entire share. Gov. Asa Hutchinson said in his brief that he favored the allocation changes because doses that may be unneeded in Arkansas "can be used for the urgent needs across the country, where there's a higher acceptance rate, where there's a higher demand."
The scramble to use all available shots is intensifying as the pace of daily vaccinations decreases significantly -- and as health authorities pivot to inoculating hesitant and hard-to-reach populations. The seven-day average of daily shots administered dropped by 17% during the past week, according to data analyzed by The Washington Post, and by 33% since April 13.
Acknowledging that "the pace of vaccination is slowing," Biden predicted the inoculation effort is "going to be harder" when it comes to convincing "doubters" of the need to get their shots.
He said the most effective argument to those people would be to protect those they love. "This is your choice: It's life and death."
Biden's push is made as his administration has shifted away from setting a target for the U.S. to reach "herd immunity," instead focusing on delivering as many shots into arms as possible.
Officials said Biden's vaccination target would result in a significant reduction in covid-19 cases heading into the summer.
To that end, the Biden administration is shifting the government's focus toward expanding smaller and mobile vaccination clinics to deliver doses to harder-to-reach communities. It is also spending hundreds of millions of dollars to try to boost interest in vaccines through education campaigns and greater access to shots through community organizations that can help bring people to clinics.
Biden touted creative efforts to make it "easier and more fun" to get vaccinated, such as grocery stores offering discounts to shoppers who arrive to get shots and sports leagues that hold promotions to gets shots for their fans.
Ahead of the Food and Drug Administration's expected authorization of the Pfizer vaccine for kids aged 12-15, the White House is developing plans to speed vaccinations for that age group. Biden urged states to administer at least one dose to adolescents by July Fourth and work to deliver doses to pediatricians' offices and other trusted locations, with the aim of getting many of them fully vaccinated by the start of the next school year.
While younger people are at lower risk of serious complications from covid-19, they have made up a larger share of new virus cases as a majority of U.S. adults have been at least partially vaccinated and as higher-risk activities such as indoor dining and contact sports have resumed in most of the country.
Officials hope that extending vaccinations to teens -- who could get the first dose in one location and the second elsewhere, if necessary -- will further accelerate the nation's reduced virus caseload and allow schools to reopen with minimal disruptions this fall.
The urgency to expand the pool of those getting the shots is rooted in hopes of stamping out the development of new variants that could emerge from unchecked outbreaks and helping the country further reopen by the symbolic moment of Independence Day, exactly two months away. Though White House officials privately acknowledge the steep challenge, Biden sounded an optimistic note.
"The light at the end of the tunnel is actually growing brighter and brighter," Biden said.
Jeff Zients, coordinator of the White House coronavirus task force, said the changes reflect how quickly the government has been able to make shots available to everyone who wants them.
People willing to drive long distances have been covered, he said. More than 80% of people older than 65 have received at least one dose. In the next phase of the immunization campaign, defined by efforts to improve access and build confidence, "there is a need to add more flexibility to the current system," Zients said in an interview.
NO WINNERS OR LOSERS
The White House was at pains to avoid the perception of penalizing states -- or of picking winners and losers. Those deciding not to order their full allocation in a given week will not lose out permanently, instead ceding supply on a one-time basis. The changes are sensitive because governors have grown protective of vaccine supply, eager to tout expanding availability after a period of intense scarcity in the winter.
Freeing up unordered doses "accomplishes what we all want to accomplish," New York Gov. Andrew Cuomo, a Democrat who is chairman of the National Governors Association, said on Tuesday's White House call with governors, according to a recording of the conversation obtained by The Washington Post. "You have state control of your allocation. If a state isn't using it, then a state that can use it has access to it, which makes a lot of sense to all of us, I think."
Governors requested additional flexibility, including the option to take control of doses currently being directed to pharmacies in their states.
"I just think we can better use those doses," Delaware Gov. John Carney, a Democrat, said on the call, pointing to the state's efforts to achieve equity in access to immunization by "intentionally doing that kind of outreach."
As part of the changes announced Tuesday, pharmacies will have greater flexibility to redistribute doses to places where demand is greatest. Guidelines for the federal program made 80% of the pharmacy supply tethered to a state's population and the remaining 20% available for stores to reallocate. Going forward, only a majority of the supply will be dictated by a state's population, and pharmacies will have discretion over as much as 49% of the deliveries.
Federal officials had weighed other changes, including metrics that would account not only for unordered inventory but the pace of administering shots already distributed to states, according to people familiar with the discussions.
The White House previously resisted efforts to distribute vaccine by metrics other than population. Biden rebuffed Michigan Gov. Gretchen Whitmer last month when she requested more doses as her state was experiencing a surge in virus cases.
White House press secretary Jen Psaki said at the time nearly all states were ordering at or near their population allocations, which is no longer the case.
Days before leaving office in January, Trump administration officials had announced an incentive system that would have rewarded states with additional shots if they quickly used their supplies. Biden's team scrapped that idea and instead retained a population approach in most instances, even as it gradually directed more vaccine doses to retail pharmacies, community health centers and federally run mass-vaccination sites.
Information for this article was contributed by Isaac Stanley-Becker and Dan Keating of The Washington Post; and by Zeke Miller, Jonathan Lemire, Melinda Deslatte and staff members of The Associated Press.