Biden Shifts Vaccination Strategy in Drive to Reopen by July 4

WASHINGTON — President Biden, confronting lagging vaccinations that threaten his promise of near normalcy by July 4, on Tuesday overhauled the strategy to battle the pandemic, shifting from mass vaccination sites to more local settings to target younger Americans and those hesitant to get a shot.

In a speech at the White House, Mr. Biden said he was launching a new phase in the fight against the coronavirus, with a goal of at least partly vaccinating 70 percent of adults by Independence Day and with a personal plea to all of the unvaccinated: “This is your choice. It’s life and death.”

After three months of battling supply shortages and distribution bottlenecks, the Biden administration is confronting a problem that the president said was inevitable: Many of those who were most eager to get vaccinated have already done so. Vaccination sites at stadiums once filled with carloads of people seeking shots are closing, and states that once clamored for more vaccines are finding that they cannot use all of the doses that the federal government wants to ship to them.

Yet the administration’s own health experts say tens of millions more Americans must be vaccinated before the infection rate is low enough to return to what many people consider ordinary life.

The administration now wants tens of thousands of pharmacies to allow people to walk in for shots. It has also ordered up pop-up and mobile clinics, especially in rural areas, and it plans to devote tens of millions of dollars for community outreach workers to provide transport and help arrange child care for those in high-risk neighborhoods who want to be vaccinated.

To build up confidence in vaccines, federal officials plan to enlist the help of family doctors and other emissaries who are trusted voices in their communities.

In a new effort to match supply with demand, federal officials informed states on Tuesday that if they did not order their full allocation of doses in any given week, that vaccine would be considered part of a federal pool that is available to other states that want to order more. Until now, if states failed to order all of the doses allotted to them on the basis of population, they could carry over that supply to the next week.

Mr. Biden also announced a new federal website and phone number that will help people find the vaccination site closest to them. “We’re going to make it easier than ever to get vaccinated,” he promised.

The administration is hoping for an uptick in vaccinations if the Food and Drug Administration authorizes the use of the Pfizer-BioNTech vaccine for adolescents ages 12 to 15 by early next week, as expected. The president said adolescents were important in the fight against the virus because while they are not as susceptible to severe disease, they can still get sick and infect others.

Experts say the United States may never reach herd immunity, the point at which the virus dies out because of a lack of hosts to transmit it. And the president suggested that the nation was still far from beating the pandemic.

While the vast majority of seniors have been vaccinated, “We’re still losing hundreds of Americans under 65 years of age every week,” Mr. Biden said. “And many more are getting seriously ill from long stretches at a time.” He warned that the nation would be vaccinating people into the fall.

Still, the president said, if 70 percent of the nation’s adults have received at least one shot of vaccine by July 4, “Americans will have taken a serious step toward a return to normal.”

To get there, Mr. Biden said, the government must shift the focus from mass vaccination sites to doctors’ offices, pharmacies and other local settings, and mount a far more concerted effort to reach those who are reluctant to get shots or simply figure it is too much trouble.

“We’re going to keep at it,” the president said, expressing optimism that “most people will be convinced by the fact that their failure to get the vaccine may cause other people to get sick and maybe die.”

As of Tuesday, more than 106 million people in the United States were fully vaccinated and more than 56 percent of adults — or almost 148 million people — had received at least one shot. That has contributed to a steep decline in infections, hospitalizations and deaths across all age groups, federal officials said.

But despite a flood of doses available, the pace of vaccination has fallen off considerably over the past two and a half weeks. Providers are now administering an average of about 2.19 million doses per day, about a 35 percent decrease from the peak of 3.38 million reported on April 13, according to data from the Centers for Disease Control and Prevention.

Mr. Biden called for 160 million adults to be fully vaccinated by July 4 — an increase of 55 million people, or more than 50 percent. About 35 million more adults would have to receive at least one shot to reach the president’s goal of 70 percent of adults who have received at least one shot. While this next phase of the vaccination effort is “easier because I don’t have to put together this massive logistical effort,” Mr. Biden said, “in the other sense it’s harder, it’s beyond my personal control.”

Asked whether the United States would help other countries that are worse off, the president promised that by the Fourth of July, his administration will “have sent about 10 percent of what we have to other nations.” It was not clear whether he was referring only to doses from AstraZeneca, which is not authorized for distribution in the United States, or to the nation’s vaccine stock as a whole. He also pledged to move quickly “to get as many doses from Moderna and Pfizer as possibly can be produced and export those around the world.”

Until now, White House officials have stuck to formulas that allocated vaccine doses to the states by population, and they were extremely reluctant to send doses of approved vaccines abroad. The administration had been unwilling to shift doses to states that were faster to administer them out of a concern that rural areas or underserved communities would lose out to urban or richer areas where residents were more willing to get shots.

But as the pace of vaccination slows, officials have decided that the benefits of a looser system outweigh that risk.

States that want more than their allotment will be able to request up to 50 percent more doses, officials said. States that do not claim all of their doses one week will not be penalized and will still be able to request their full allotments the next week, officials said.

The shift makes little difference to some states that have routinely drawn down as many doses as the federal government was willing to ship. But it could help some states that are able to use more than the federal government was shipping.

Jen Psaki, the White House press secretary, said on Tuesday that the move offered governors more flexibility. “Even just a few weeks ago,” she said, “we were in a different phase of our vaccination effort when supply was more constrained, and states for the most part were ordering at or near their full allocation.”

Virginia is a case in point. Last week, for the first time, the state did not order every dose it could have, said Dr. Danny Avula, the state vaccine coordinator.

Now, he said, “supply is exceeding demand across the state, and the work will be much slower and harder as we find ways to vaccinate a few people at a time.” Dr. Avula said the change “will be very helpful for the handful of states that still have localized areas with high demand.”

States with low demand, like Arkansas, may find that their allotted doses are being shipped elsewhere. Arkansas has used only 69 percent of the doses delivered to it so far, data shows. Last week, a state health department spokeswoman said, the state did not order any doses from the federal government. Just over a third of adults in Arkansas have received at least one dose, one of the lowest totals in the country.

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Ms. Psaki said the administration was working with states to determine what kinds of settings made the most sense at this point in the vaccination campaign.

“We’re constantly evaluating the best delivery mechanisms,” she said, “and if something is not the most effective one, we will make changes.”

Mr. Biden suggested that family doctors and pediatricians will play a key role in propelling the vaccination program, as will other community figures. If the Pfizer vaccine is authorized for adolescents, he said, the administration plans to immediately make it available to them at about 20,000 pharmacies that participate in the federal vaccination program.

But some doses will be shipped directly to pediatricians so that “parents and their children can talk to their family doctor about it and get the shot from a provider they trust the most,” the president said. Dr. Vivek Murthy, the surgeon general, said last week that about “80 percent of people who are trying to decide about a vaccine say that they want to talk to their doctor about that decision — and we’ve heard that loud and clear.”