Musings from the Bunker 1/25/21
Good morning! We have been living in COVID anxiety for nearly a year and now we are living with vaccine anxiety. When the approval of the Pfizer and Moderna vaccines was announced, there was a collective sigh of national relief. It has been nearly two months since the vaccines began being administered. The promise of 20 million by the end of 2020 was missed. Whether there will be 100 million in the next 100 days is up for grabs. And while this is a laudable goal, it falls far short of what will be needed to eradicate the virus. There has been profound failure on the part of the federal and state governments to ensure the delivery of vaccines, provide clear protocols for their administration to maximize inoculations early, and deliver clear messaging to the American public to insure mass inoculations. Those trying to obtain the vaccine had to read up on confusing rules and navigate unnecessarily complex websites that crash by the hour. It raises the question of how the United States could possibly have been so incompetent through this process. THANK YOU FOR DOING YOUR JOB! There is a revisionist history going around suggesting that ex-President Trump (love saying that…) somehow was this great leader who conquered the coronavirus through his wisdom, prescience and leadership. Were it not for his creation of “Operation Warp Speed” we would have been without vaccines. Certainly Mr. Trump deserves accolades for actually doing his job by encouraging drug companies (which no doubt will be rewarded handsomely) to do their jobs. It must have taken a lot to get Mr. Trump, who only acknowledged the COVID pandemic after a prolonged attempt to bury the story and minimize its impact, to prioritize vaccinations. That said, he finally did. What Mr. Trump failed to do, however, is something government seems incapable of doing these days, namely, engaging in the harder, long-term, less politically beneficial work required to ensure actual implementation of the program. There were multiple complex undertakings at play—manufacturing the vaccine, distribution to healthcare providers and clinics, public education, websites and sign-up processes. There was no short term upside to Mr. Trump in the more mundane aspects of the inoculation program (after all, it was either in his second term or on someone else’s watch). LOGISTICAL CONSIDERATIONS SEEMED NONEXISTENT Much has been said about Mr. Trump’s unwillingness to consider the advice given by experts or to depend upon research, scientific inquiry or historic perspective. But it isn’t just Mr. Trump’s failure that is so astounding. In this great country of ours, we have many experts at logistics, both in the military and private industry (see, e.g., UPS, DHL, Amazon, FedEx), yet apparently failed to seek their guidance. It is equally difficult to understand how the myriad of websites, so confusing and prone to crashes, can have so much conflicting information and difficulty of use in a country that invented the Internet. Is it impossible to believe that one of the large tech companies would have created a better interface pro bono? The responsibility for the failures in delivering the vaccine can be shared with the states and localities for their convoluted and unclear direction for implementation. Implementation seems to have fallen largely to individual clinics and health care providers, who themselves are laboring under threat of penalty from the states if the mandates are not followed. EVERY STRATEGY IS BASED UPON A SERIES OF GUIDING IDEALS It is curious how quickly vaccines administered in Israel compared to the United States. In mid-January, there was a point where the number of vaccines administered in each were approximately the same (the U.S. has 35 times the population). The two systems are worthy of comparison:
In Israel, officials were guided by the primary objective of getting as many vaccines administered as quickly as possible and the secondary objective of vaccinating the elderly, who are prone to more severe cases, sooner. That meant that no vaccines were sitting in refrigerators, waiting to be distributed. In this way, the most people were being immunized earlier, and the process wasn't confusing, helping everyone get to herd immunity faster. Hospitalizations of those 65 and older have dropped by 60% since the strategy was implemented.
In America, officials were guided by the primary objective of appearing fair and the secondary objective of vaccinating people in the order of perceived short term importance to society. As a result, vaccines go wasted, older people are not provided clear access to immunization sites, and the government seems obsessed with ensuring that vaccinations are not provided out of order.
What the American system did was create a complex series of tiers and subtiers that seemed primarily motivated by the idea that we must appear to be equitable, even if that meant slowing down the process and leaving vaccines in refrigerators for days at a time (and, particularly in the earlier days, allowing some to spoil). A simple system, like Israel’s, would have prioritized and vaccinated health care workers and the elderly first and quickly. Then move down in five year increments. Instead, so fearful of appearing inequitable, vaccines were withheld until all health care workers were vaccinated (eventually we learned the futility in this because many health care workers were not heeding the call and missing appointments). The current system still seems to think that part-time 20-something Grub Hub drivers should be prioritized over 63 year olds. Meanwhile, there are counties in Los Angeles where not all congregate care facilities have been reached.
The State advised health care providers that there would be severe penalties if they varied from the complex roll-out. But because people are people, work-arounds arose. Board members, service providers and retired staff at hospitals and clinics are reported to have received vaccinations. Doctors who have only been practicing telemedicine received vaccinations.
IT’S THE WILD WEST OUT THERE
Finally, the state relaxed the penalties and/or it became too difficult to enforce. So clinics charged with inoculating health care workers who didn’t show up became sites for vaccination for those who were “vaccine chasers.” Look up the article in the Los Angeles Times. It’s fascinating. Importantly, these clinics did the right thing. Rather than leaving the bottoms of vials unused, they created their own triage policies and administered a lot of vaccines otherwise unaccounted for.
How did vaccine availability depend upon who was the most computer literate, was the most tenacious, was the most savvy at working the system, and had the most control of their own time? Hardly the equitable distribution sought by the government.
I’m pretty astounded by the lack of a widespread campaign to inform the public. Public service campaigns used to be the rage. One floods the media with important information delivered by celebrities. Our governmental officials had months and months to plan for this—but there is precious little on the airwaves.
I’m all for equitable distribution of the vaccine (or, for that matter, all government services), but not at the expense of endangering the public welfare and certainly not if the drive for equity doesn’t even achieve equitability.
Government simply opted to appear equitable in this circumstance. What they failed to do was get out the word to people who needed the vaccine and actually act equitably. The fact is that we know who’s been getting COVID and suffering most greatly—the elderly, health care workers (who should have been the primary recipients early on), and those living in crowded, often-multi-generational, conditions. The public relations campaign we needed, in order to serve those truly in need and most vulnerable, needed to be in multiple languages, particularly Spanish, and communicated by recognized personalities in these communities.
Government is inefficient
Politicians care about the short term but seem unmotivated to plan for the long-term
Officials care to appear equitable but do little to implement these equitable principles.
Left to its own devices, government will create the most complex system, difficult to understand or implement. And in this case, where alacrity is critical, they don’t move nearly fast enough.
The feds and the states should have recognized that, after a massive blitz of misinformation from the President and his allies questioning masks and distancing, recommending unproven therapies, and assuring us this would all go away, there is serious lack of trust in our institutions. A large scale program of information—put out by celebrities—should have been organized and aired on a massive scale on television and through social media.
To encourage inoculations made it to the communities most in need, this public relations campaign should have included Spanish-language and other populations with a large number of people for whom English is not their primary language.
GETTING THE VACCINE EARLY One group I do not judge is those who attempt to get the vaccine early. I say if you can, you should. The more people vaccinated as early as possible, the better it is for all of us. Without government’s establishment of a clear system it seems it’s everyone for themselves. HANK AARON The past few months have witnessed the passing of many baseball greats. And without diminishing their greatness and humanity, I feel one stands above the others--certainly in his impact on the game of baseball but also in his humanity and the racism he had to overcome off the field to achieve greatness on the field. This outfielder, playing for a southern team, the Atlanta Braves, was chasing the career home run record of Babe Ruth. I was one of a generation who grew up knowing the number "714," as if it were the number of a psalm. This career record seemed as unassailable as the 60 home run season that was beaten by Roger Maris. Maris was disrespected and subject to unfair abuse as he moved up on the Babe's record. The famous "asterisk" alongside his record, because eight more games are played in the modern era than were played in a season during the Babe's career, remains a silly concession to the purists (no such asterisk exists for similar single season records). But a career record seems even more impressive. And Hank Aaron did it not with the towering home runs fans love but often the line drives that sometimes barely cleared the fence. He was not an easy out. As Curt Simmons said, "trying to sneak a baseball past Hank Aaron is like trying to sneak the sunrise past a rooster." I encourage those who want to relive this moment (and even those who haven't should), Google "Hank Aaron Vin Scully" to see the feat and hear Scully call the home run hit against Al Downing and the Dodgers. Scully's silence to take in the crowd noice was brilliant. As the song goes, "Move over Babe; here comes Henry." Best, Glenn