Unsanitized: America’s Vaccine Rollout Should Infuriate You

A host of problems have hindered our national response in inexcusable ways. This is The COVID-19 Daily Report for January 4, 2021.

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First Response

As of Sunday, 4.33 million Americans have received a dose of one of the two coronavirus vaccines made available for emergency use. Trump administration officials with Operation Warp Speed initially promised 20 million people vaccinated by the end of the year, meaning 40 million shots. We didn’t get within 10 percent of that goal. Only one state, South Dakota, has administered doses for as much as 3 percent of the population, and in deep South states stretching from North Carolina to Mississippi, the number’s closer like 0.75 percent. Georgia and Kansas have only used 17 percent of their allotment; the average usage rate is around 30 percent.

This is an abjectly terrible, inexcusable performance. If we need 85 percent immunization for true herd immunity, after three weeks of vaccinations we’re barely above 1 percent. That puts us in good shape for herd immunity by June 2025.

It’s made worse by the fact that a more transmissible variant of the virus has established itself in the country. If this was a race between immunization and mutation, the mutation would be Secretariat and immunization would be the rest of the field. With more transmissibility, hundreds of thousands of people could die before we start to reach enough at-risk communities to get those numbers down. Moreover, the more botched the rollout looks at the early stages, the more fuel given to anti-vaxxers to demonize the value of the effort.

We knew this vaccine effort was coming really since the first declaration of a pandemic. We’ve had months to strategize and plan and work out the logistics. We deliver hundreds of millions of flu shots every year; while this was a heavier lift, it’s not that much heavier. In that context, the lack of preparedness is unbelievable and yet also perfectly predictable and a fitting coda to a year of deep exposure to the realities of our frayed social structure.

When you have such a full-spectrum disaster, there are a thousand reasons why. Let’s go over some of them, in an effort to figure out if we can rebound from the failures:

Read all of our Unsanitized reports

A Complete Lack of Leadership: This is really the big one. The president is too busy leaning on Secretaries of State like the world’s worst mob capo to care about vaccinations. If the vaccines aren’t golf balls he doesn’t know about them. The one time he’s bothered to make any excuses, it was to correctly, and horrifyingly, explain the mass immunization process: the federal government supplies an allocation to each state, and it’s up to them to figure out how to get it into people’s arms. Sometimes they’re only given a couple days notice to the states before that allocation goes out. Then the states have to manage keeping doses ultra-cold in storage, shipping to every part of the state, finding the trained professionals to give the shot, working up priority lists, educating people on the importance of the vaccine, keeping track of recipients who need to come back for a second dose, etc., etc.

No Money: Before the COVID relief bill was finally signed December 27, states had received only around $340 million to pull this off. For the whole country. There’s another $8 billion on the way with the relief bill but even that’s an undercount. For those who say this is a miniscule part of state budgets, reallocation amid severe revenue shortfalls, especially when the feds were promising distribution support, isn’t realistic. Donald Trump walking away from his responsibilities is the biggest factor in the disastrous rollout.

Bad Process: Public health departments, which have been doing testing and tracing and recommendations for distancing, and are already pretty stressed, have to handle all this. Some states have shifted to hospitals to take the lead in distributing the vaccine, rather than public health departments. Hospitals, you might recall, are busy with trying to save people from dying from the virus; they don’t have the capacity to take on this project. In states with severe outbreaks like California, too many health workers are attending to patients to pull some off to give the vaccines. That’s why a Public Health Jobs Corps should have been stood up months ago. Other hospital networks just don’t have the facility with mass immunization; that situation in West Virginia, where patients got monoclonal antibodies instead of the vaccine, is an example of what can happen when you throw responsibilities onto overwhelmed entities at the last minute. The chaos of long lines and unclear delivery timing is another example.

Hostile Takeover: The overcorrection to Donald Trump’s complete absence has been something like what we’re seeing in New York, where Andrew Cuomo blustered into a process health officials had been preparing for years and took it over. He’s now building the plane while it’s in the air, when county officials had the plane already prepped for takeoff.

Holding Back: A large segment of doses have been deliberately held back, about half to give to nursing home facilities administering through a separate federal process with CVS and Walgreens that could take months. (So much for handing over immunization to chain pharmacies; they’re performing perhaps worst of all! The “private sector is always more efficient” religion is pernicious.) Other doses are being held back to ensure enough doses are available to give out the second shot. That seems like a significant mistake. Just today, the U.S. has floated cutting the Moderna dosage in half, instantly doubling the available amount. Between that and the extra doses found in Pfizer vials, I don’t see the necessity in holding back doses for the second shot, as more product continues to roll off assembly lines.

The Vagaries of Prioritization: We have a sick society caught up too much with whether someone, somewhere is getting a better deal than us. This manifests itself in the endless discussions of priorities and “line jumping,” when every shot in every arm is marginally better news for everyone in the country. The aforementioned Cuomo is mandating criminal penalties for not following prioritization, which seems like a popular idea but is one that guarantees throwing lots of shots in the garbage when they expire. The least effective shots are the ones not distributed. Tying oneself up in knots to ensure the perfect rollout has corrupted the rollout. America doesn’t do such nuance well.

Holiday Hours: Seriously, holiday hours! There wasn’t enough staff around to administer vaccines because of Christmas and New Year’s. That will self-correct of course but it’s really shocking, especially because we had a few months’ warning that the vaccine was likely to be active around that time. In Israel, they opened 24-hour pop-up clinics and got rabbinical dispensation to keep them open on Shabbat as a medical emergency. Well over ten percent of the population is vaccinated as a result.

The Resistance: There have been health care workers who have refused to take the vaccine. This is a minor issue that will be ameliorated as more become comfortable with its effectiveness, but the problem is that the system in place appears paralyzed over what to do in such a situation, and this could lead to spoilage rather than just getting the shots out to whoever wants one.

This was always going to be a bumpy rollout, because we have historically underfunded the entities most responsible for distribution, and we have an executive branch that’s checked out. I wrote in September that “the last people you would trust to execute this well would be in a Trump administration consumed with clinging to power post-election.”

Can Biden turn it around? He’s committed to using the Defense Production Act to increase vaccine supply, but it’s the distribution plan that’s needed. Mitt Romney has a thumbnail of a plan that at least understands the urgency required. We are treating something that will save millions of lives and our economy with the nonchalance of a half-planned dinner date. This should be the only thing government is doing for the next 4-6 months.  

Days Without a Bailout Oversight Chair

There is no more bailout to oversee, so this feature is officially retired! I’ll find something else to count down tomorrow.

Today I Learned

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