华盛顿——面对比预期慢的冠状病毒疫苗推出，特朗普政府周二突然改变策略，加快向更多人提供疫苗。此举出台之际，病例和死亡人数飙升至令人担忧的新高。
卫生和公共服务部部长亚历克斯·阿扎尔宣布了一系列重大变化，以增加疫苗，将资格扩大到更多老年人，并为人们提供更多拍摄场所。描述新政策的政府官员传达了一种明显的紧迫感。
一个变化会有一些牙齿。阿扎尔说，未来联邦政府将根据每个州的分配疫苗部分取决于各国在管理已经提供的服务方面取得了多大的成功。
阿扎尔在新闻发布会上说:“如果你没有使用你有权使用的疫苗，那么我们应该重新平衡到使用该疫苗的州。”
这不会在一夜之间发生，除非官员们试图理清报告滞后是否可能是表现不佳的原因。目前，政府根据州人口分配疫苗。
阿扎尔还表示，政府将停止控制辉瑞-生物技术公司和现代疫苗的第二剂所需剂量，实际上是供应量的两倍。这两次注射都需要两次剂量才能达到最佳保护效果。
此外，华盛顿敦促各州立即开始为其他低优先级人群接种疫苗，包括65岁以上的人群以及患有某些疾病的老年人和年轻人健康问题。
增加疫苗供应的举措使即将离任的政府与新的拜登-哈里斯团队更加一致。周五，当选总统乔·拜登表示，他将迅速释放最有效的疫苗剂量，以保护更多的人。他说他支持立即释放疫苗健康当局出于谨慎而退缩，以保证需要第二剂的人可以使用。
“下一阶段反映了形势的紧迫性，”阿扎尔说。“每一剂疫苗都放在仓库里，而不是放在手臂里，这可能意味着多一个本可以避免的死亡。”
最初，政府一直在抑制二次剂量，作为对潜在产量不足的安全预防措施。现在，官员们表示，他们有信心所需的供应将会到位。需要第二剂的人会优先。
副总统迈克·彭斯在白宫的一次电话中告诉州长们，“这不是一个供应问题。一段录音被提供给了美联社。
阿扎尔还给各州开了绿灯，以指定更多的地方让人们可以拍照。这些地方可以包括成千上万的药店，联邦政府支持的为低收入社区服务的社区卫生中心，以及已经在一些州建立的大规模疫苗接种点。
这一系列变化给一些地方官员提出了问题，他们仍在努力让疫苗接种运动全面展开。
截至周一上午，政府已向各州、美国各地区和主要城市分发了约2770万剂。但是根据疾病控制和预防中心的在线追踪，只有大约930万人接受了第一针。这意味着只有大约34%的可用疫苗被接种。
起初，镜头会医疗保健服务工人和养老院居民。排在第二位的是75岁以上的人。但是问题出现了，即使是在有限的人群中接种疫苗。一些医院和疗养院的工作人员对接种疫苗一直犹豫不决。日程安排问题造成了去疗养院打针的延误。
包括亚利桑那州在内的一些州已经或计划开设大规模疫苗接种中心，目标是在一个地方每天为成千上万的人接种疫苗。在佛罗里达州，州长罗恩·德桑蒂斯向65岁及以上的人开放疫苗接种。在其他州，地方卫生当局已经开始要求65岁及以上的居民进行登记，预计疫苗接种活动将会扩大。
尽管阿扎尔表示，战略的转变是特朗普政府努力的自然演变，但就在周五，他提出了拜登呼吁加快供应是否审慎的问题。
周二，他还试图将疫苗摄入缓慢归咎于各州。阿扎尔说，一些州“规定过多，试图微观管理每一剂疫苗”，导致瓶颈。
阿扎尔还批评了他所谓的“疫苗分发的住院治疗”，他说“我们在医院的冰箱里放了太多的疫苗。”
州和地方官员肯定会指出，是联邦政府建议将卫生保健工作者放在疫苗接种线的最前面。
特朗普政府指导了开发、制造和交付疫苗的紧急努力，希望避免冠状病毒测试早期失败的重演。被称为“扭曲速度行动”的它已经生产了两种高效疫苗，更多的疫苗即将问世。
根据疾控中心的建议，每个州都有自己的接种计划，优先考虑卫生保健人员和养老院居民。一些批评者说，政府的计划应该延伸到帮助各州在注射完成后进行管理。国会最近为此批准了80多亿美元。
在冠状病毒死亡人数继续上升的时候，疫苗推出的缓慢速度让许多美国人感到沮丧。根据约翰·霍普金斯数据库，美国已有超过37.6万人死亡。
阿扎尔说，疫苗接种的速度已经加快，有望在几周内达到每天100万次。但是美国医院协会估计，为了在今年年中实现广泛免疫，一周七天每天需要180万次疫苗接种。拜登设定了在头100天注射1亿次的目标。
全国县市卫生官员协会(National Association of County and City Health officers)的阿德里安娜·卡萨洛蒂(Adriane Casalotti)表示，当地公共卫生官员对周二的公告感到惊讶，并急于想出如何实施这些变化。
“各级政府的公共卫生系统确实需要站在同一战线上。惊喜对任何人都没有好处，”她说。
卡萨洛蒂补充说，让更多的群体排队“突然之间让更多的人有资格，当然也有兴趣，我们需要有适当的系统来给他们接种疫苗”。
但是政府官员迫切要求他们的案子。
疾控中心主任罗伯特·雷德菲尔德在电话中对州长们说:“我们认为，现在将疫苗接种到(更多的)个人身上，可能真的会给你们管辖区内的住院治疗带来巨大的变化，比如从现在起的4到6周内。”他补充说，这是他的强烈建议。
拜登一直高度批评特朗普政府的流行病应对措施，预计将于周四发表讲话，概述他的计划。他在他的头100天里寻找一个转折点。
阿扎尔说，他们将向拜登过渡团队简要介绍这些变化，但没有寻求他们的祝福。
US shifts to speed COVID shots as cases and deaths rise
WASHINGTON -- Facing a slower-than-hoped coronavirus vaccine rollout, the Trump administration abruptly shifted gears Tuesday to speed the delivery of shots to more people. The move came as cases and deaths surged to alarming new highs.
Health and Human Services Secretary Alex Azar announced a series of major changes to increase supply ofvaccines, extend eligibility to more seniors and provide more locations for people to get shots. Administration officials describing the new policies conveyed a notable sense of urgency.
One change will have some teeth to it. Azar said going forward the federal government will base each state's allocation ofvaccinespartly on how successful states have been in administering those already provided.
“If you are not using vaccines that you have the right to, then we should be rebalancing to states that are using that vaccine," Azar said at news conference.
That won't happen overnight, not until officials try to sort out whether lags in reporting could be the reason for what appears to be subpar performance. Currently, the government allocates vaccines based on state population.
Azar also said the government will stop holding back the required second doses of the Pfizer-BioNTech and Moderna vaccines, practically doubling supply. Both those shots require two doses to achieve optimum protection.
Additionally, Washington is urging states to immediately start vaccinating other groups lower down the priority scale, including people age 65 and older and younger people with certainhealthproblems.
The move to increase the supply of vaccines better aligns the outgoing administration with the new Biden-Harris team. On Friday, President-elect Joe Biden said he will rapidly release most available vaccine doses to protect more people. He said he supported immediately releasing vaccines thathealthauthorities were holding back out of caution, to guarantee they would be available for people needing their second dose.
“This next phase reflects the urgency of the situation,” said Azar. “Every vaccine dose sitting in a warehouse rather than going into an arm could mean one more death that could have been avoided."
Initially the government had been holding back second doses as a safety precaution against potential shortfalls in production. Now, officials say they are confident the needed supply will be there. And people needing a second dose will have priority.
“This is not a supply issue at this moment in time,” Vice President Mike Pence told governors on a White House call. A recording was provided to The Associated Press.
Azar also gave states the green light to designate more places where people can get shots. Those locations can include tens of thousands of pharmacies, federally supported community health centers that serve low-income communities, and mass vaccination sites already being set up in some states.
The flurry of changes raised questions for some local officials, still trying to get vaccination campaigns into full swing.
As of Monday morning, the government had distributed about 27.7 million doses to states, U.S. territories and major cities. But only about 9.3 million people had received their first shot, according to the Centers for Disease Control and Prevention's online tracker. That means only about 34% of the available vaccines had been administered.
Initially, the shots were going tohealth careworkers and nursing home residents. Those 75 and older were next in line. But problems arose even in vaccinating that limited pool of people. Some hospital and nursing home workers have been hesitant to get the vaccine. Scheduling issues created delays in getting shots to nursing homes.
Some states, including Arizona, have or are planning to open up mass vaccination centers, aiming to inoculate thousands of people a day in a single location. In Florida, Gov. Ron DeSantis opened up vaccinations to people 65 and older. In other states, local health authorities have started asking residents 65 and older to register, in anticipation the vaccination campaign would be expanded.
Although Azar said the shift in strategy was a natural evolution of the Trump administration's efforts, as recently as Friday he had raised questions about whether Biden's call to accelerate supplies was prudent.
On Tuesday, he also sought to deflect blame to the states for the slow uptake of vaccines. Azar said some states are being “overly prescriptive and trying to micromanage every single dose of vaccine,” leading to bottlenecks.
Azar also criticized what he called “the hospitalization of vaccine distribution,” saying “we have too much vaccine sitting in freezers in hospitals.”
State and local officials are sure to point out that it was the federal government that recommended putting health care workers at the front of the vaccination line.
The Trump administration directed a crash effort to develop, manufacture and deliver vaccines, hoping to avoid a repeat of earlier debacles with coronavirus testing. Dubbed “Operation Warp Speed,” it has produced two highly effective vaccines, with more on the way.
Each state has its own plan for who should be vaccinated, based on CDC recommendations that gave first priority to health care workers and nursing home residents. Some critics say the administration's planning should have extended into helping states administer the shots after they were delivered. Congress has recently approved more than $8 billion for that.
The slow pace of the vaccine rollout has frustrated many Americans at a time when the coronavirus death toll has continued to rise. More than 376,000 people in the U.S. have died, according to the Johns Hopkins database.
Azar said the pace of vaccinations has picked up, on track to reach 1 million daily within a couple of weeks. But the American Hospital Association estimates 1.8 million vaccinations a day are needed, seven days a week, to achieve widespread immunity by the middle of this year. Biden has set a goal of 100 million shots administered in his first 100 days.
Local public health officials were surprised by Tuesday’s announcement and scrambling to figure out how to implement the changes, said Adriane Casalotti of NACCHO, the National Association of County and City Health Officials.
“All levels of the governmental public health system really need to be on the same page. Surprises don’t benefit anyone,” she said.
Letting more groups in line “all of a sudden makes a lot more people potentially eligible and certainly interested and we need to have the systems in place to get them the vaccine,” Casalotti added.
But administration officials pressed their case urgently.
“We think right now getting the vaccine into (more) individuals, now, could really make a huge difference in the hospitalizations that you would see in your jurisdictions say four to six weeks from now,” CDC Director Robert Redfield told governors on the call, adding it was his strong recommendation.
Biden, who has been highly critical of the Trump administration's pandemic response, is expected to give a speech Thursday outlining his plans. He's looking for a turnabout in his first 100 days.
Azar said they'll brief the Biden transition team on the changes, but didn't seek their blessing.
