Covid Vaccination: America Is Failing At the Boring Part

No plan survives its first contact with reality. But not having a plan - as is the case at the federal level - almost guarantees dysfunction. JL

Shannon Palus reports in Slate:

Having reached the goal of actually having a vaccine to distribute and on an impressive timeline—America is now struggling with the next step: getting the vaccine to people. 4.5 million people have received the first dose of a vaccine, with just shy of 15.5 million doses distributed to states. Vaccination started during the holidays, when scheduling and staffing can be more difficult. Unpredictable shipments are making it hard to schedule appointments. Even with all of the discussion about who should be prioritized ethically, distributors are realizing they’re not sure what to do when someone misses a time slot.

Operation Warp Speed had the ambitious goal of immunizing 20 million people by the end of December. There were supposedly going to be enough doses on hand for those 20 million people to even get their follow-up shots. Science adviser Moncef Slaoui was stating this on national television as late as mid-December, after just one vaccine had earned Emergency Use Authorization. The second authorization was just days away, meaning the miracle had happened: Under (or in spite of) the leadership of Donald Trump, two vaccines were going to be ready to use in record time, with high efficacies and minimal side effects.

But having reached the goal of actually having a vaccine to distribute—and on a staggeringly impressive timeline—America is now struggling with the next step: getting the vaccine to people. As of Monday morning, a little over 4.5 million people have received the first dose of a vaccine, with just shy of 15.5 million doses distributed to states, according to the Centers for Disease Control and Prevention.

It’s hard to track every single thing that has impeded delivery, but the snafus started when states received smaller shipments than they’d expected. The New York Times reported that it was the result of a “scheduling hiccup.” Pfizer put out a press release saying that the issue was not that doses weren’t available to ship: “We have millions more doses sitting in our warehouse but, as of now, we have not received any shipment instructions for additional doses.” A few days later, Operation Warp Speed’s chief operating officer Gustave Perna explained to reporters that the issue was “a delay between what is available and what is releasable.” Apparently, he had failed to account for the fact that the Food and Drug Administration needs to receive a quality control analysis before each lot of shipments goes out. According to the Washington Post, Perna declined to explain much further.

Meanwhile, even the doses that are available have run into issues in terms of being fairly and efficiently allocated. There have been stories about the breakdowns in the very process of booking an appointment. At Mass General Brigham in Boston, the app to sign up for appointments relied on physicians adhering to the honor code to not skip the line, NPR reported; hospital leadership said there was simply no way to automatically restrict 80,000 staff members from signing up out of turn. The app initially crashed, which left front-line health care workers without a clear way to get an appointment. In Florida, counties are using the ticket platform Eventbrite to sign up eligible elderly people for slots—a solution that does in fact seem to be working, if it also belies the lack of polished and reassuring strategy. “This is the only option we have right now, this is the quickest, easiest, and most efficient way that we can think of to help the department of health solve this issue right now,” one county’s communication specialist told the Verge.

Still, how can there be so many doses that have been distributed but not yet administered? One reason might be that vaccination started during the holidays, when scheduling and staffing can be more difficult—fewer than 200 doses were given in New York City on Christmas Day, for example. Unpredictable shipments are making it hard to schedule appointments, too. And some hospital workers are choosing not to take a vaccine yet, though it’s unclear to what extent this is vaccine hesitancy, a scheduling issue, an altruistic desire for someone else to get it first, or something else. Even with all of the discussion about who should be prioritized ethically, distributors are realizing they’re not sure what to do when someone misses a time slot. At a Giant Foods in Washington, two random people got doses that would have otherwise spoiled. This is probably the right thing to have happen—the vaccine should go into someone’s arm, rather than to waste. But optics-wise, it makes it easy to imagine things devolving into a free-for-all sooner rather than later, doing away with all the planning to distribute the vaccine in accordance to how it can make the biggest impact on public health. “I think the best thing to do at this point is have roving bands of doctors roam the streets and jab random people with vaccine doses,” NYU’s Jeff Sebo tweeted over the weekend—a joke, but also, maybe more practical than whatever is happening currently.

What is so frustrating about the current situation is that so much money and effort was poured into the creation of a vaccine, but apparently that same investment was not given to the process of actually getting it into arms. The COVID-19 relief bill passed over the holidays includes money for states to help with it—promising, but a little on the late side, considering how much more advance preparation could have helped. Organizing shipping times and appointment slots might not be as scientifically difficult as coaxing mRNA to do something complicated inside a cell, and it’s certainly harder to brag about in the pages of history. But it’s still an enormous amount of work, requiring effort and cooperation. We haven’t been great about all the banal, day-to-day stuff that requires us to get through the pandemic. America is failing at the boring stuff. I wish I were surprised.