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Illustration: Sarah Grillo/Axios

Some of the same problems that have plagued the coronavirus vaccine rollout could also make it harder for people to get the second dose of the vaccines.

Why it matters: The two vaccines authorized so far both require two shots to reach the full potential of their protection, and those second shots need to happen within a specific window of time —putting extra pressure on a system that’s already struggling to work out its kinks.

What's next: This week will be “when we’re really starting to scale up to the second dose..the challenge is going to be about the availability of inventory and scheduling,” Louisville Mayor Greg Fischer said in an interview.

  • “Unlike the first dose, you’ve gotta get the second dose within that time window, so there’s a little more criticality to it,” he added.

The problem: Some states say they don’t have enough visibility into how many doses of vaccine they are getting from the federal government, and when.

  • “You need to have information on that entire supply chain,” said Celine Gounder, a professor at NYU Grossman School of Medicine. “Forget second doses, we just don’t know where doses are.”
  • “You need to have visibility three to four weeks in advance to make sure you have that dose in hand, on time, for those patients who are coming back for a second dose,” said Jessica Daley, a vice president at Premier Inc., which works with health systems across the country.

Between the lines: When vaccinating health system employees, “we know them, we can account for them, and it’s a finite number. But when it gets to the community, its magnitude is multiple, multiple times” that, said Scott Evans, CEO of Sharp Grossmont Hospital.

Where it stands: Nationally, about 8% of the population has received at least one dose of the vaccine, and less 2% have received both shots, per Bloomberg.

  • The Biden administration isn't holding doses in reserve for people's second shots — it's shipping everything it can right away, trying to give as many people as possible at least some protection. Second doses will come from new supplies, although some providers and health departments are withholding second doses themselves.
  • Once someone receives the first dose of the vaccine, they have six weeks to get the second, per the Centers for Disease Control and Prevention’s recommendations.

Scheduling is also an issue. States and localities that used Eventbrite or other first-come, first-served systems may not have an easy way to guarantee appointments for second doses.

  • “Things as simple as making appointments and calling people to come back and remind them to take their second dose — we don’t have the infrastructure," Gounder said.

The other side: Some health officials and providers feel confident that they’ll be able to make the second dose process run smoothly.

  • This often comes down to being able to successfully pull off the little things, like differentiating online between first dose appointments and second dose appointments or scheduling second dose appointments at the same time patients receive their first dose.

The bottom line: We don’t know what will happen if millions of Americans fail to receive their second shot in a timely manner. But at this point in the pandemic, we can little afford to figure it out the hard way.

Go deeper

Feb 1, 2021 - Health

Chilling trend: A longer, deadlier pandemic

Illustration: Eniola Odetunde/Axios

Mutated versions of the coronavirus threaten to prolong the pandemic, perhaps for years — killing more people and deepening the global economic crisis in the process.

The big picture: The U.S. and the world are in a race to control the virus before these variants can gain a bigger foothold. But many experts say they already expect things to get worse before they get better. And that also means an end to the pandemic may be getting further away.

Updated 5 hours ago - Politics & Policy

Omicron dashboard

Illustration: Brendan Lynch/Axios

  1. Health: Pfizer and Moderna boosters overwhelmingly prevent Omicron hospitalizations, CDC finds — Omicron pushes COVID deaths toward 2,000 per day — The pandemic-proof health care giant.
  2. Vaccines: The case for Operation Warp Speed 2.0 — Starbucks drops worker vaccine or test requirement after SCOTUS ruling — Kids' COVID vaccination rates are particularly low in rural America.
  3. Politics: Biden concedes U.S. should have done more testing — Arizona says it "will not be intimidated" by Biden on anti-mask school policies.
  4. World: American Airlines flight to London forced to turn around over mask dispute — WHO: COVID health emergency could end this year — Greece imposes vaccine mandate for people 60 and older — Austria approves COVID vaccine mandate for adults.
  5. Variant tracker

10 Senate Republicans propose compromise on COVID relief package

Sen. Susan Collins (R-Maine) Photo: Alex Wong/Getty Images

A group of 10 Senate Republicans, led by Sen. Susan Collins (Maine), sent a letter to President Biden Sunday requesting a meeting, saying they have developed a counterproposal to the president's COVID-19 relief plan.

The big picture: The proposal includes $160 billion in spending for vaccines, testing and tracing, treatment and medical equipment. The senators said the plan "could be approved quickly by Congress with bipartisan support," if it gained Biden's support.