Mira Irons, MD, discusses more efficient distribution of vaccines


Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.



In today’s COVID-19 Update, Mira Irons, MD, looks into delays in the distribution of vaccines, including issues with phone and vaccine registration systems and concerns about following different immunization regiments.

Learn more at the AMA COVID-19 resource center.


  • Mira Irons, MD, chief health and science officer, AMA

AMA COVID-19 Daily Video Update

AMA’s video collection features experts and physician leaders discussing the latest on the pandemic.

Unger: Hello, this is the American Medical Association's COVID-19 Update. We're back after what I hope was a healthy and happy New Year for you. We return with our regular COVID update and our weekly look at the numbers, trends and latest news about COVID-19 with AMA's chief health and science officer, Dr. Mira Irons in Chicago. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Irons, it's been almost two weeks since we last spoke. Can you give us an update, particularly, let's start with vaccine distribution efforts. What progress do we see over the holidays, and what's the outlook here in the near term?

Dr. Irons: Prior to the holiday break, we focused on the Pfizer vaccine and the Moderna vaccine getting emergency use authorization. And I think we were all hoping for more efficient distribution than what we've seen. It's taken much longer to gear up distribution of the vaccines. It seems as though 4.2 million shots have been given. But we're also hearing that 13 million doses have been delivered. And so the states, the hospitals, have a way to go to really scale their distribution. But the goal right now really should be shots in arms.

There are probably a lot of reasons for that. One of the reasons is that states, hospitals, were, because of the surge, had a lot of other things on their plate, dealing with the surge and then they had to mount a vaccination campaign. But I think that the first phase was really aimed at health care workers and residents of long-term care facilities. The problem is that some states are going into the next phase and that's where we're seeing chaos in states like Texas, where the phone lines, the phone system had timed out, and also in Florida where the online registration system for people over 65 crashed.

Unger: So that's not a positive start to this. And hopefully, that will correct in the next few weeks. Because of those kinds of delays, we're seeing some interest in or calls for different approaches to the administration of those shots. Some news from Dr. Fauci on that topic. Any perspective from you?

Dr. Irons: Well, I think that it's very concerning. So you look at the different approaches that are being taken in the UK. The UK, the health officials in Britain, last week announced that they're going to delay the second dose of vaccine made by Pfizer and also AstraZeneca to concentrate on getting as many people first injections as they can. As you know, they're dealing with a variant, a new variant, that is more contagious. And so they're really focusing on immunizing as many people as they can. They also updated their vaccination playbook to allow for a mix and match regimen. You could have dose one of one vaccine and then dose two of a second vaccine.

The thing we really have to remember is that there is no evidence to support that. What we know of the efficacies of the Pfizer and Moderna vaccines is really based on two doses in a short period of time between that first dose and second dose. Moving to different immunization regimens without having the evidence to support that is really concerning, especially when you have the supplies available in the United states. So the U.S. hasn't backed either of those strategies. And Dr. Fauci came out on Friday and said he would advise U.S. officials not to follow Britain's lead in accelerating the first injections at the expense of the second shots.

Unger: He also said that the president-elect Joe Biden's pledge to administer a hundred million shots of coronavirus vaccine within the first hundred days of his administration is a realistic goal. Is there any other information on that or really about kind of speeding this process up?

Dr. Irons: Well, I think that he can say that. I think what gives them the ability to say that is that the vaccines supply will be available. And obviously, our problems up till now have been distribution because the available supplies haven't been given. Now, I think if you talked to the states, one of the things you may hear is that they can't rely on a specific supply every week in order to make appointments for people to come in and get vaccinated. So I think that there are infrastructure or systemic issues that have to be fixed or have to be developed in order to make this go more smoothly.

Unger: Well, there's obviously a lot of urgency on multiple fronts for getting the vaccines rolled out faster. So let's talk a little bit more about the numbers that we're seeing, which have been pretty extraordinary over the past few weeks. What's happening across the country in terms of new cases and deaths?

Dr. Irons: So, the bad news continues. The current numbers today, 20,640,214 individuals have been diagnosed, confirmed to have COVID-19. And we passed another milestone over the holidays. Currently, as of this morning, 351,590 people have died in the United States of COVID-19. The data reporting over the last week has not been completely consistent. We saw at least 291,300 new cases reported on Saturday. That's a single day record, but that may actually be inflated because of decreased reporting over the holiday. So it's going to take the next few days to sort of get more consistent reporting out there. But if we just look at the last seven days, looking at a seven day average tends to smooth out some of these reporting issues. We're still looking at over 213,000 new cases per day, seven day average, and over 2,600 deaths per day.

Unger: We saw, particularly in terms of the Los Angeles area, having a huge surge right now, reading lots of information about expected kind of Christmas surge on surge. Any other kind of state by state perspective?

Dr. Irons: Well, when you look across the country, different states have different levels of activity. Some of the states that we worried about most the last few weeks in our discussions are actually seeing decreases in activity, but California is getting hit, especially hard. Their hospitals are full. Their emergency rooms are full. Some hospitals are starting to go to crisis standards of care. It's really a problem for the health care system there.

Unger: Well, globally, the big news coming out of the UK was this variant, which is now showing up across the world. Any other perspective on a global basis?

Dr. Irons: So as of Saturday, at least 34 countries have identified infections with the new variant, with Vietnam being the latest country to be added to the list. Parts of England might face harsher restrictions in the coming weeks to try to deal with this variant that is more contagious, more highly transmissible. It doesn't appear to cause more severe disease. But obviously if you can transmit it to more people, that's certainly going to be a problem, especially if they're of a demographic that would put them in that high-risk category. Canada is also now requiring passengers who are boarding international flights into the country to show their airline proof of a negative coronavirus test. This is in addition to the already existing 14-day quarantine that they're requiring of all people coming into the country.

Unger: Wow. So we talked just briefly before about trends that are driving this. Obviously, we saw a big spike coming out of Thanksgiving. Still expecting a spike to come out of the huge numbers of travelers over the Christmas holidays?

Dr. Irons: Well, I think that we're all waiting for it. I think that while a lot of people really did hear the messages to try not to travel and try not to celebrate with people outside of their immediate household, there still were hundreds of thousands of people traveling every day through the holidays. You might remember that what we saw for Thanksgiving was more a series of mini-surges rather than sort of a big surge. So as with everything we've learned with this virus, the next few weeks is going to tell the story. You can't really make a lot of predictions, but based on travel, based on a lot of the parties that we saw, the large gatherings that we saw around the country that were being shut down, I would imagine that we're going to see some surges in the numbers.

Unger: Well, the longer this pandemic goes on, the more we're learning about some of the side effects and long-term effects of a COVID-19. Can you talk to some of the things that we've learned recently?

Dr. Irons: I think it was last week, or just within the last week or two, there's been more information on this loss of the sense of smell and taste. I remember back early on in the pandemic, it seemed like a quirky sort of rare symptom that we were just learning about. The otolaryngologists were the first specialty to identify it, because people were being sent to them for evaluation. What we're learning now, as people are starting to study that particular symptom more, is that some people regain that sense of smell and taste within a few months and others don't. And so there's a lot of focus being put on studying individuals that don't, because it may actually help provide more information about how COVID, how the virus actually attacks the body and what the long-term side effects might be.

Unger: And including the risk of anxiety and depression associated with a loss of that particular sense, which is pretty serious. Finally, any key messages from the AMA that you want to make sure people know about?

Dr. Irons: So on Tuesday, December 29th, the Ad Council on the COVID collaborative announced that they developed a video series designed to address health care professionals' questions about COVID-19 vaccines. The video series was developed in collaboration with the AMA, the CDC, the U.S. Department of Health and Human Services, the National Institute of Allergy and Infectious Diseases and other top health and medical institutions. To reach health care workers, the content will be distributed via professional and community networks, including the American Public Health Association, the Association of State and Territorial Health Officials, the Infectious Disease Society of America, the National Association of County and City Health Officials, National Medical Fellowships and UnidosUS. the message is really that people should get vaccinated. We're still seeing some vaccine…we're hearing about some vaccine hesitancy in health care workers, I believe, in California, and also some staff in long-term care facilities. The best way to beat this is to vaccinate as many people as we can.

Unger: Absolutely. Well, thank you so much for being here. That's it for today's COVID-19 update. We'll be back tomorrow with another segment. For resources on COVID-19, visit ama-assn.org/covid-19. Thanks for joining us. Please take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.