COVID-19 vaccination in the United States

The COVID-19 vaccination campaign in the United States is an ongoing mass immunization campaign for the COVID-19 pandemic in the United States. The Food and Drug Administration (FDA) first granted emergency use authorization to the Pfizer–BioNTech vaccine on December 10, 2020,[7] and mass vaccinations began four days later. The Moderna vaccine was granted emergency use authorization on December 17, 2020,[8] and the Janssen (Johnson & Johnson) vaccine was granted emergency use authorization on February 27, 2021.[9] By April 19, 2021, all U.S. states had opened vaccine eligibility to residents aged 16 and over.[10] On May 10, 2021, the FDA approved the Pfizer-BioNTech vaccine for adolescents aged 12 to 15.[11] On August 23, 2021, the FDA granted full approval to the Pfizer–BioNTech vaccine for individuals aged 16 and over.[12]

COVID-19 vaccination in the United States
Percent of the total population who are up to date with COVID-19 vaccines. Hover on the states on the map at the source page for exact numbers. Right-click on the source map, and then click "Show as a table" to get all the numbers.[1]
DateDecember 14, 2020 (2020-12-14) – present
Location United States
Compact of Free Association:[2][3]
 Palau
 Marshall Islands
 Micronesia
CauseCOVID-19 pandemic in the United States
Organized byCenters for Disease Control and Prevention
Participants262,323,837 people have received at least one dose administered of PfizerBioNTech, Moderna or Janssen
(August 17, 2022)
223,684,995 people have been fully vaccinated (both doses of Pfizer–BioNTech or Moderna, or one dose of Janssen)[4]
Outcome79% of the United States population has received at least one dose of a vaccine
67% of the United States population is fully vaccinated
WebsiteCDC
Weekly confirmed COVID-19 deaths
Map of cumulative COVID-19 death rates by US state.[5]
The US map below is for the percent of the total population of all ages by state or territory who completed the COVID-19 vaccination primary series. Booster doses are recommended too.
See Commons source for changing sourcing info.
Percentage with at least one vaccination dose.
US territories: GU = Guam. AS = American Samoa. MP = Northern Mariana Islands. VI = Virgin Islands. Associated states: PW = Republic of Palau. FM = Federated States of Micronesia. MH = Marshall Islands.[6]

The U.S. government first began the campaign under the presidency of Donald Trump with Operation Warp Speed, a public–private partnership to expedite the development and manufacturing of COVID-19 vaccines. Joe Biden became the new President of the United States on January 20, 2021. Biden began his term with an immediate goal of administering 100 million vaccine doses within his first hundred days in office, signing an executive order which included increasing supplies for vaccination.[13][14][15] This goal was met on March 19, 2021.[16] On March 25, 2021, he announced he would increase the goal to 200 million within his first 100 days in office.[17] This goal was eventually reached on April 21, 2021.[18]

By July 4, 2021, 67% of the United States' adult population had received at least one dose, just short of a goal of 70%. This goal was eventually met on August 2, 2021. While vaccines have helped significantly reduce the number of new COVID-19 infections nationwide, states with below-average vaccination rates began to see increasing numbers of cases credited to the highly infectious Delta variant by July 2021, which led to an increased push by organizations and companies to begin imposing de facto mandates for their employees be vaccinated for COVID-19.

On September 9, 2021, President Biden announced plans by the federal government to use executive orders and emergency temporary standards enforced by OSHA to mandate the vaccination of all federal branch employees, and require that all companies with more than 100 employees regularly test all employees who are not yet fully vaccinated for COVID-19.[19] On January 26, 2022, OSHA completely withdrew the vaccine mandate for companies with more than 100 employees due to a ruling from the Supreme Court of the United States that blocked the mandate.[20][21]

As of November 2022, according to The Commonwealth Fund, COVID-19 vaccination in the United States has prevented an additional 3.2 million deaths, an additional 18.5 million hospitalizations, and an additional 120 million infections from COVID-19. Vaccination has also prevented an additional $899.4 billion in healthcare costs.[22] According to a June 2022 study published in The Lancet, COVID-19 vaccination in the United States prevented an additional 1.9 million deaths from December 8, 2020, to December 8, 2021.[23][24] According to a July 2022 study published in JAMA Network Open, COVID-19 vaccination in the United States prevented an additional 235,000 deaths, an additional 1.6 million hospitalizations, and an additional 27 million infections from December 1, 2020, to September 30, 2021.[25]

Vaccination program

Timeline of daily COVID-19 vaccine doses administered in the US.[26] See the latest date on the timeline at the bottom.

Vaccines administered per pharmaceutical company as of October 19, 2022

  Pfizer–BioNTech (381,978,824) (59.43%)
  Moderna (241,011,491) (37.50%)
  Johnson & Johnson (18,916,447) (2.94%)
  Novavax (35,302) (0.006%)
  Not Identified (690,663) (0.107%)

Vaccines were distributed to states on a population basis, with the vaccine rollouts being administered by each individual U.S. state. The Centers for Disease Control and Prevention suggested that hospital workers and nursing home personnel be the first individuals vaccinated.[27] The subsequent phases of the rollout are determined by each individual state agency.

The CDC has issued cards that can be used to track vaccine progress and serve as a proof of vaccination when requested (such as during international travel).[28] States such as California and New York have offered a digital immunity passport accessible via a mobile app.[29][30]

Eligibility of non-citizens

On February 1, 2021, the Department of Homeland Security said it "fully support[s] equal access to the COVID-19 vaccines and vaccine distribution sites for undocumented immigrants" and that related federal agencies "will not conduct enforcement operations at or near vaccine distribution sites or clinics".[31]

States may have intended that vaccines be prioritized for their residents ahead of tourists, but there was some difficulty communicating and enforcing this. Some American adults have no driver's license,[32] and the United States does not automatically provide each citizen with identity documentation in a centralized system. Furthermore, when people did not show up for their vaccine appointments, many clinics vaccinated anyone else who happened to show up so that the doses would not be wasted. As a result, some tourists as well as undocumented immigrants were vaccinated.[33]

As of early February 2021, states including Florida, California, New York, and Texas were specifically trying to restrict "vaccine tourism": brief visits to the U.S. with the primary intention of obtaining a vaccine.[34] However, contrary to rumors that spread on social media, the United States did not have a policy of cancelling visas or imposing fines on tourists who sought vaccination. Diplomats pointed out that the B1/B2 tourist visa allows people to seek medical treatment while within the United States, even if they do not turn out to be eligible for the COVID-19 vaccine.[35]

As of May 13, 2021, according to the Colombian newspaper El Tiempo, the following U.S. states were not requiring foreigners to present proof of residency to receive the vaccine: Alabama, Arizona, California, Colorado, Florida, Iowa, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wyoming.[36] Thousands of Latin Americans were booking travel to the United States and being vaccinated in the country. Vaccination centers in some U.S. states were accepting foreign passports as valid identification. Travel agencies were advertising "vaccination tourism," and the U.S. embassy in Peru, for example, advised that travelers to the United States could seek vaccination.[37][38] The governor of Alaska announced that, as of June 1, any international visitor over age 12 could be vaccinated in Alaska and vaccines would be available at airports for convenience.[39]

Background

From early 2020, more than seventy companies worldwide (with five or six operating primarily in the U.S.) began vaccine research.[40][41] 28 different vaccines are being worked on and developed using the research provided by those companies.[42] The global competition had national security implications for various countries.[43]

In preparation for large-scale production, Congress set aside more than $3.5 billion for this purpose as part of the CARES Act.[44][41] Among the labs working on a vaccine is the Walter Reed Army Institute of Research, which has previously studied other infectious diseases, such as HIV/AIDS, ebola, and MERS. By March 18, tests had begun with dozens of volunteers in Seattle, sponsored by the U.S. government, and similar safety trials were planned for other potential vaccines.[45] Bill Gates, whose foundation shifted its focus nearly entirely to the pandemic, anticipated in early 2020 that a vaccine could be ready by early 2021.[46]

On August 5, 2020, the United States agreed to pay Johnson & Johnson more than $1 billion to create a hundred million doses of COVID-19 vaccine. The deal gave the U.S. an option to order an additional two hundred million. The doses were supposed to be provided for free to Americans if they are used in a COVID-19 vaccination campaign.[47]

On August 31, 2020, the Centers for Disease Control and Prevention (CDC) released their outline for how the COVID-19 vaccine would be administered and distributed across the entire country.

Senior citizens await COVID-19 vaccine at a Maryland pharmacy in January 2021.

BIO, a trade group of all COVID-19 vaccine makers except AstraZeneca, tried to persuade Secretary Azar to publish strict FDA guidelines that would help ensure the safety and public uptake of the vaccine. Politics impacted scientific practice, however, when chief of staff Mark Meadows blocked the FDA when it was realized that the timing of the provisions would make it impossible for a vaccine to be authorized before the November election.[48][49] Ultimately, the guidelines emerged[50] from the Office of Management and Budget and were published on the FDA website.[51]

As of October 2020, 44 were in clinical trials on humans, and 91 pre-clinical vaccines were being tested on animals.[52] Most of these trials were underway.[53]

On November 20, 2020, the Pfizer–BioNTech partnership submitted a request for emergency use authorization (EUA) to the Food and Drug Administration (FDA),[54][55] and the FDA announced that its Vaccines and Related Biological Products Advisory Committee (VRBPAC) would review the request.[56][57] An EUA is a mechanism under the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 that permits products not yet fully approved by the FDA to be used as part of an existing state of emergency.[58]

On December 11, the FDA granted emergency use authorization for the Pfizer–BioNTech vaccine.[59][60] An initial shipment of 2.9 million doses were scheduled to be distributed rapidly, and Pfizer promised to continue supplying the rest of the hundred million doses through March 2021.[61][62] Pfizer had adequate stocks available and began this distribution on December 17, 2020, but the federal government reduced the amount Pfizer was allowed to distribute.[63][64]

On December 18, 2020, the FDA granted the Moderna vaccine emergency use authorization,[65][66] which Moderna had requested on November 30, 2020.[67][68] The U.S. planned to rapidly distribute 5.9 million doses with more to come later.[69][70]

Despite his involvement in spurring their development via Operation Warp Speed, Trump largely downplayed vaccines during his final months in office, and both Trump and First Lady Melania Trump received the vaccine in private before Joe Biden took office as the new president in January 2021.[71][72][73]

On February 27, 2021, the Janssen COVID-19 vaccine was granted emergency use authorization by the FDA for use. However, this vaccine has faced backlash from some government officials, believing it to be not as effective as Pfizer or Moderna. On March 5, the mayor of Detroit, Mike Duggan, rejected a shipment of the Janssen vaccine, saying, "Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the city of Detroit get the best."[74] After backlash, Duggan declared he would no longer decline the vaccine.[75]

On March 11, 2021, President Biden announced that he would direct all states to make vaccines available to all adults no later than May 1.[76] On April 6 he said he would direct states to make all adults eligible for vaccination by April 19.[77] This deadline was met after several states opened up vaccination to everyone 16 and above the same day.[78]

On March 26, 2021, Ocugen submitted its master file for Covaxin a conventional inactivated vaccine to the FDA. In June the FDA suggested that the company go the longer route to gain full FDA approval instead of emergency use authorization.[79]

As of May 2021, most experts thought the United States would be unable to achieve herd immunity, at least in the near term, given insufficient demand for the vaccines.[80] On that note, many sources are saying the new variants last longer than 14 days, such as those found at home and abroad.[81]

On July 6, Biden announced plans for more targeted outreach in order to reach under-vaccinated populations, such as shifting from larger mass clinics to having wider availability at community locations and events, and going "neighborhood by neighborhood, and oftentimes, door to door—literally knocking on doors—to get help to the remaining people protected from the virus" [82][83][84]

On July 16, the FDA approved a request by Pfizer to give its vaccine a priority review designation, meaning that final approval of the vaccine would be pursued on an expedited timetable. While priority review processes usually take up to six months, it was expected that the Pfizer vaccine may be approved within weeks.[85][86][87] On August 23, the FDA announced that it had formally approved the Pfizer vaccine for individuals 16 and over. It remains subject to EUA for individuals aged 12 to 15.[12][88]

Incentives

Efforts have been made by private businesses and civic entities to help encourage vaccination. Incentives were promoted via local news,[89] ads,[90] government outreach, and apps.[91] Incentives included time off from work,[92] providing childcare and similar services,[93] ridesharing services offering free transport to vaccine clinic sites, and promotional incentives and discounts being offered to those who present proof of a recent vaccination.

Free items included beer, pizza, crawfish, donuts, and french fries.[94][95][96] Some sports teams established partnerships to offer vaccine clinics at their venues on game days, with free tickets to games offered to those who use the clinics.[97][98] Free cannabis was available in Washington State when getting a vaccine at a dispensary.[99]

Massachusetts ran a free lottery for fully vaccinated people, and gave out $6.5 million to ten people in the form of cash and scholarships.[100] Ohio ran a similar lottery, Maine gave away hunting licenses, and West Virginia gave away $100 savings bonds.[96]

Vaccines in order

Vaccine Submitted (EUA) Emergency use Authorization Deployment Submitted (Full) Full Approval
Pfizer–BioNTech November 20, 2020 December 11, 2020 December 14, 2020 May 7, 2021 August 23, 2021
Moderna November 30, 2020 December 17, 2020 December 21, 2020 June 1, 2021 January 31, 2022
Janssen February 4, 2021 February 27, 2021 March 1, 2021 No No
Novavax January 31, 2022 July 19, 2022 (ages 18+)[101] August 1, 2022 No No
Covaxin March 26, 2021 (ages 18+)[79]
November 5, 2021 (ages 2–18)[102]
Pending No No No
Astrazeneca No No No
Sanofi–GSK No No No No No
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