Complexity is Killing the Cat — Why we Need to Simplify Vaccine Distribution Now!
Today’s New York Times has alarming news: “Logistical Issues Put U.S. far Behind Its Vaccination Schedule.”
While the article details many practical issues, including lack of staff resources, holiday staffing shortages, and the difficulty in visiting nursing homes, these are compounded by and ultimately rooted in the fractured and dispersed, mostly privately-run American healthcare system.
Vaccination campaigns are really nothing new. Let’s be real: getting a shot is pretty much the most basic medical procedure possible. Billions have been vaccinated for pennies in the remotest regions of extremely poor “third world” countries.
New York City vaccinated 6 million people (the overwhelming majority of the population) for smallpox in less than a month in 1947! So why is this such an immense challenge?
We have no nationalized health care service like Britain’s NHS. This fact, plus overly restrictive patient privacy laws (how about passing serious laws preventing medical discrimination instead?) means that we have no tested database or systematic way of reaching out to individuals eligible for vaccinations. This holds up the entire process.
The national CDC-recommended tranches of groups in line to receive the Covid-19 vaccination have been adopted by the the ultimate decision makers — the states — in widely varying ways. What’s worse, many people, including, surprisingly, health care workers, are declining to receive the injections even when they are next in line. Florida even let seniors wait in hours long lines, first come, first served.
When the Moderna, or especially the Pfizer vaccine, is taken out of cold storage, it needs to be used or thrown away within hours. Due to the necessity of a rapid vaccine rollout, the drug companies are not able to manufacture individual doses. They must be prepared by a nurse out of a glass vial with enough juice for 4 to as many as 10 people. If you do not happen to hang out in hospitals, you have to be ready and willing to travel immediately when your name is called.
Our overly complex “public” health system is responding to the Coronavirus vaccine campaign in the only way it knows how — with more complexity. The American political class loves complexity; it gives them the polish of being “problem-solvers” and makes them look modern and progressive. Not to mention it usually requires great sums of money and stimulates the economy — and more than occasionally their donors’ pockets.
It doesn’t take a scientist to expect that software built by the government quickly to track vaccine distribution will fail spectacularly, especially given the overly ambitious mission to track the entire supply line from warehouse to arms. The disastrous rollout of the Affordable Care Act website is a case in point.
Software development is damn hard; it doesn’t proceed linearly, and doesn’t respond well to traditional top-down management structures. Google, Apple, Amazon and the like are successful *precisely* because they are the rare ones that do it well. (It doesn’t hurt that excellent pay, benefits and stock options get them the very best talent.)
To be charitable, introducing complexity is sometimes the best way to address society’s inequities and to help the disadvantaged populations (for example latinos in LA, blacks in Michigan) who have born the brunt of the pandemic.
The CDC voted 13–1 to offer the vaccine to “frontline” workers (e.g. grocery store employees and firefighters) before the elderly, in part, to address these inequities. But how do you prove that you work in a grocery store; who’s going to give me a certification? How are you going to get a trained nurse out to a possibly coronavirus-infested workplace to give shots, that in rare instances, can cause a severe allergic reaction? Oh and don’t forget to keep everything freezing cold.
The vaccine needs to be distributed quickly to the most at-risk healthcare communities first. Hospitals and nursing homes will have to get their act together. Show an ID badge, get a shot. If they can’t do it, who can?
Next, come the elderly and health compromised populations. Set up a well-equipped tent in the corner of hospital parking lots. Start with age 75+ and divide them up by last name. Everyone over 75+ with a last name starting with A-K will get a shot this week at the Local Community Hospital. Promote in newspapers, TV stations, on a billboard outside. As soon as the lines get much shorter, open up the next tranche. No vaccine should go to waste. Vaccinate as many susceptible people as possible as quickly as possible. A volunteer corps can man a hotline for less mobile people to pick them up and bring them safely to the tent.
If your group has been previously called, you can go anytime. When the time comes, the second booster shot will be given out on Tuesdays and Thursdays with first round vaccinations continuing on Mondays, Wednesdays, and Fridays.
Equity must be addressed. Fortunately, because of community-spread, the most COVID-disadvantaged tend to be geographically grouped. Making sure that vaccination sites (and vaccine supplies) are available in East LA, Queens, and other such communities will help immensely. Move extra staff and resources from other places to these areas on the weekends.
Imagine if everybody exiting an airplane had to go through the same boarding process: “We’d like to welcome all of our triple diamond club members and military personnel with children under six to exit the aircraft.” Hell no. You disembark front-to-back, grab your bag and go. If you are taking too long or have no urgency, you let the others behind you go first. The quality of your disembarking experience will improve dramatically as the plane becomes emptier. Likewise, vaccinations will move into doctor’s offices and drugstores, nurses will be scheduled travel to workplaces. But to do this now is insanity. Let’s get on with it.
