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Photo illustration: Eniola Odetunde/Axios. Photos: the Washington Post, Pool/Getty Images

Despite the slow roll out of vaccines so far, NIAID director Anthony Fauci says the COVID-19 vaccination campaign will ramp up fast enough that Americans should see "a degree of normality in the fall."

Driving the news: President-elect Biden is planning a program that will have "much more interaction between the federal government and the states than there are right now" in order to reach his goal of 1 million vaccines a day for 100 days, Fauci tells Axios.

What's happening: Millions of available vaccine doses haven't been administered, raising questions about what went wrong with Operation Warp Speed.

  • Americans are "paying the consequences" of having a "program being run like a supply distribution program and not a vaccination program," says Carlos del Rio, distinguished professor of medicine at Emory University School of Medicine.
  • "Our approach in which public health is run by the states doesn't work in a pandemic. You cannot respond to a pandemic with 50 different plans," del Rio says. "The lack of federal leadership, in my mind, is one of the most important lessons going forward."
  • The U.S. needs to coordinate state sites and enough staffing to give people the shots, as well as logistics like freezer requirements, del Rio points out.

Yes, but: Fauci says he expects changes under the new administration and asks if it's "fair" to say there's a bottleneck in vaccinations, or if it's more about experiencing normal "bumps and hiccups" for a massive program launched during the holidays.

  • This week, the inoculation rate went up to half a million doses a day, he points out.
  • "Are we going to clear the bottleneck in a couple of weeks? I hope so. Are we going to get to 1 million a day in a couple of weeks? I doubt it. But I think by the time President-elect Biden gets in, he hopes to be able to have a system going that he can get 1 million a day for the first 100 days," Fauci says.

The problem right now in the U.S. is not lack of supply. But that may become an issue once the vaccination program ramps up and as urgency grows under the pressure of more transmissible variants that the CDC is monitoring closely.

  • Some nations are considering stretching out doses, giving people half doses or allowing a mix of vaccines — the latter is an option Fauci strongly opposes.
  • NIH is running a study to see how effective Moderna's vaccine is if the dose is halved.

What to watch: Public health scientists hope pandemic preparedness will become a top national priority.

  • "The first lesson learned is that pandemic preparedness is worth the investment. This pandemic and the inability to respond effectively has cost us not only lives, but the economy has taken an incredible hit," says Tara Kirk Sell, senior scholar at Johns Hopkins Center for Health Security.
  • Better diagnostics will be key to fighting future outbreaks, Sell says. Rapid antigen tests and other measures "can really change the game."

For now, though, Fauci says if herd immunity can be achieved by vaccinating 70%–85% of people by the end of this summer, "I think we'll start approaching a degree of normality in the fall and the winter, such that by this time next year, 2022, we will be very close to a return to normal."

Go deeper: Fauci sees greater China role in COVID-19 spread, one year on

Go deeper

14 hours ago - Health

One year of the coronavirus

One year ago today, a novel coronavirus was barely beginning to catch the public's eye. There were just over 2,000 confirmed cases worldwide, mostly in China, and five cases in the U.S.

The big picture: The sea of red says it all. Today, there have been over 100 million cases worldwide, led by the U.S. with 25 million.

Erica Pandey, author of @Work
14 hours ago - Economy & Business

Telework's tax mess

Illustration: Annelise Capossela/Axios

As teleworkers flit from city to city, they're creating a huge tax mess.

Why it matters: Our tax laws aren't built for telecommuting, and this new way of working could have dire implications for city and state budgets.

Caitlin Owens, author of Vitals
14 hours ago - Health

Vaccine hesitancy is decreasing in the U.S.

Reproduced from KFF ; Chart: Axios Visuals

An increasing number of Americans say they want to get the coronavirus vaccine as soon as possible, per new KFF polling.

Yes, but: Race, partisanship and geography still serve as major dividing lines for vaccine enthusiasm. And people of color are less likely than white Americans to say they have been vaccinated themselves or know someone who has.