How Joe Biden's team hopes to turn five vaccine doses into six

Low dead-space syringes and the importance of the supply chain

The Biden administration is “working on multiple fronts” to combat the Covid-19 pandemic according to Vivek Murthy, the administration’s designated choice for Surgeon General, including improved testing, investments in genomic surveillance, and of course a multi-pronged effort to improve the pace of vaccination.

In a call with journalists this afternoon, Murthy and Jeffrey Zients, the soon-to-be Covid Czar, talked about a wide range of plans but mentioned one specific idea that seems very promising to me and hasn’t been discussed very much in public.

The basic issue is that, as I first learned from Alex Tabarrok on Thursday, a standard five dose vial of vaccine in some cases actually holds six or even seven doses. The difference turns out to be whether or not you are using a “low dead-space syringe.” With such a syringe, there is less waste and you can stretch your supply by 20 percent or more.

This is quite remarkable. Increasing vaccine supply by 20% by building more factories could cost billions. We should do that, it would be worth it. But in this case, we managed to increase supply by at least 20% use a relatively inexpensive redesign of the syringe. What this indicates is the importance of thinking along the entire supply chain for opportunities for optimization.

The catch? Not all syringes provided by Operation Warp Speed and Pfizer are low dead-volume syringes so not every vaccine distribution site is getting the extra doses. We do need to invest more in the syringe supply chain.

On the call, Zients cited the need to invest in these more efficient syringes and posited that it’s an area where Biden will invoke the Defense Production Act to ensure that America’s production capacity of syringes is deployed to this purpose. It’s a small thing, obviously, and I don’t want to make it sound like it’s the whole Biden strategy for fighting the virus.

Rather, it’s an example of the potentially large gains that can be achieved by looking carefully at the whole playing fields and sweating the details.

Sweating the details is not really the Trump way, but it’s an example of how bringing on a team of competent, experienced, professionals can make a big difference in what is on some level a big logistics problems.


“The current administration has never had a federal or comprehensive strategy,” Zients said, noting that on a lot of these types of questions they simply haven’t received the kind of transition briefings that would let them get full visibility into example what the current situation is. But he says “this is a national emergency and we need to treat it like one. We’re going to throw the full weight and resources of the federal government behind ending the pandemic.”