Where Does Our Vaccine Supply Stand as Booster Shots Are Approved?

Boosters will reduce the number of doses that we can send to other countries.

By and
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The Biden administration announced last week that it will recommend a third “booster” shot for Americans who have received either of the mRNA COVID-19 vaccines currently authorized for emergency use. (A recommendation for the viral vector shot developed by Johnson & Johnson, which is also available on an emergency basis in the U.S. market, will be provided at a later time, after data from its ongoing two-dose trial is assessed.) The prospect of hundreds of millions of third mRNA doses going into the arms of Americans before much of the world gets a first inoculation always was a possibility, but the recommendation to move forward came more quickly, and is broader in its reach, than many had expected. Its speed and breadth also are altering previous assumptions about the availability of excess U.S. supply for international donations.

A brief update on U.S. domestic needs and available inventory over the coming months, with the booster campaign fully included in the assessment, can clarify the options now available for further U.S. donations to the international vaccination effort. The U.S. still will be able to make a meaningful contribution to the global campaign—likely just more than 1 billion doses—but its contribution will remain far below what is required to vaccinate the worldwide population, and thus also falls well short of what would be required to substantially reduce the risk of more dangerous (and possibly vaccine-evading) variants emerging somewhere around the world.

The Current Status of Expected U.S. Consumption and Available Supply

The original Operation Warp Speed portfolio included a diversified mix of vaccine types, sponsored by six developers: the Pfizer/BioNTech collaboration, Moderna, Johnson & Johnson, Oxford/AstraZeneca, Novavax, and Sanofi/GlaxoSmithKline. 

When the Phase III trials for the two mRNA candidates, from Pfizer/BioNTech and Moderna, showed them to be highly effective and very safe, the U.S. government moved quickly to make them the central pillars of its domestic vaccination campaign. To date, more than 345 million doses of the two mRNA candidates have been administered. Realistically, with the supply of the Pfizer/BioNTech and Moderna vaccines being sufficient to keep up with domestic demand, there is little prospect that any of the other candidates will get used in the U.S. market, at least during the current phase of the pandemic. A small exception is the J&J inoculation, which has been given to approximately 14 million people to date.

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  1. Avatar photo
    Ben Connelly

    So I agree that we need to send doses to other countries and that it’s a shame when they go to waste here instead of going into an arm of someone in a foreign country who wanted a dose. But my main contention with this article is similar to what other commenters have pointed out.

    Doses are going to waste in parts of the United States due to low demand. By the time a dose is close to expiration, it’s impossible to ship it off to South America or Africa. What if all the pharmacies had something for nearly-expired doses similar to the big discounts on food that is close to expiration date? Meaning there would be an afternoon or evening (or every day) advertised in advance, as a “hey we have these doses we don’t want to waste and anyone who wants a third dose can come and get it.” That seems to me to be fairly reasonable. Better than letting them expire. Nothing wrong with someone taking a dose that would have gone to waste had they not taken it.

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    Taylor B.

    A behind the scenes issue right now is wasted doses. Current vials (Pfizer or Moderna) have 6, 10, or 14 doses in them, but must be discarded soon after removing the first dose. With demand reduced over the past several weeks, many pharmacies are reporting most of their doses “wasted”. Many locations are also having trouble using all of their unopened vaccines before expiring simply because low demand. The 3rd dose recommendation will most likely increase demand to use up what would be wasted doses and then a bit more. There is ample supply. I expect the 3rd dose demand to follow very closely with regular flu shot demand. Increasing quickly through September, spiking mid-late October, and then gradually falling off through the holidays. Pray for your pharmacists (and any health care workers) this fall!

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  3. Shaybult

    The assumption made for the calculations - that every eligible person in the US will get 3 shots - is just silly. (The authors do admit this, but use these numbers in their calculations anyway.) Additionally, as Nick and Natty note in their comments, the calculations only account for the US government's current contracts - not potential future contracts and not contracts with other countries. And no "evidence" was presented that if we didn't give boosters we could immediately turn around and donate more vaccines, or that we can't just keep buying more vaccines to "make up" for the booster doses.

    I realize TD - or, more accurately in this case, AEI - is not alone in this "We're so selfish for doing boosters when there are countries that haven't yet been vaccinated at all" stance. And I give them credit for being a lot less histrionic about it than many outlets. But it's still, in my view, an inaccrurate reading of the situation.

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      Aylene Wright

      There's definitely a "eat your vegetables because kids are starving in Africa" vibe to some of this. Except in this case it's "don't eat your vegetables because kids are starving in Africa". And both statements are fallacious. There are also people using "it's selfish for me to get vaccinated before the developing world" as an excuse not to get vaccinated.

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        DougCLE

        Yes, except in this case, your “mom” has access to planes, ships, trucks, communications, logistics... the full industrial might of the US of A. We’ve overcome much worse obstacles.

        If you’ve been paying attention the last week, it might occur to you that the U.S. may be in dire need of some international good will. Well, here’s the opportunity to buy as much as we want, and cheap at the price. Let’s jump on it.

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          Aylene Wright

          I would actually totally support a US vaccine diplomacy effort. But the framing of this article was a zero-sum "either we give people in the US the 3rd shot OR we distribute more shots internationally". We should ideally be doing both.

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            Aylene Wright

            PS: And yes this would involve the production of more vaccines, but why not?

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  4. Ben Bobbitt

    Seems like herd immunity will be reached by large portions of the global population before they will have access to vaccines. I haven't seen any covid reports about countries like Nigeria, which is one of the most populated countries on earth. Seems like the virus would rampage through places like that.

    Something I’ve wondered about in relationship to the manufacture of so many vaccines is the reliance on the blood from horseshoe crabs. That seems like a finite resource. I believe it is used to check for contaminants in the vaccine. Perhaps it is not used for these mRNA types.

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      L Bernard

      Unfortunately, the Delta variant demonstrated that herd immunity through natural exposure is an optimistic take. The more likely scenario is, as COVID continues to spread unchecked, new variants will pop up, leading to a new wave of unchecked spread, leading to new variants, leading to... You get the idea.

      As for Nigeria, well, there hasn't been many COVID reports about China, either...

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      1. Ben Bobbitt

        I get what you're saying, but there’s only so many times this thing can go around. Even Spanish flu petered out eventually. Either it mutates into a less deadly form or it hits the herd immunity wall. I’m not suggesting that that wouldn’t still be potentially pretty catastrophic but humans have been through epidemics and pandemics before. They eventually end.

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    Jason Gibson

    The prospects of getting the world back fade :(

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  6. Natty Bumpo

    Frankly I doubt that half of the doses outstanding for initial inoculations in the US and a third of the booster shots will ever be used here, so about 300 million of the doses can go elsewhere if needed. I am also not clear as to whether these tallies include vaccines to be manufactured abroad by Pfizer, Moderna and other firms. As Nick notes, the bigger challenge will not be ccost but production speed and distribution. It would be interesting to know how worldwide production of all of the vaccines is ramping up (I believe Pfizer was going to license production in Italy and I recall hearing early on about production plans in India).

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    Nick H

    If I'm understanding this article correctly, the authors are only looking at the excess from the existing vaccine purchase contracts. Yes, adding a third dose to the recommendations does deplete the excess supply for donations, there's nothing preventing the US from purchasing more to give away. It's been proposed that the U.S. spend something like $50 billion (which is almost a trivial amount compared to the trillions spent thus far) to buy vaccinations to donate worldwide. The real bottleneck is production speed.

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    1. Shaybult

      There's also a bottleneck/barrier in terms of the ability of many countries in the developing world to accept the mRNA vaccines (at least at a high volume), given the temperatures at which they must be stored.

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