COVID VACCINE DISTRIBUTION IS A MESS

 Everyone has a plan until I punch them in the face. ~ Andrew Cuomo     

It is no surprise that the distribution of Covid vaccines has proven challenging. Getting precious vaccine into 330 million Americans’ arms was never going to be a slam dunk, given the fractionalized nature of our healthcare system.

We should not downplay or forget the astonishing success of the development of these vaccines. The vaccines were created with technological brilliance at near light-speed –with $18.5 billion of federal government support. But the vaccines’ distribution is another matter.

Supply shortages of the Covid vaccines have been expected and present since Day 0 of their distribution. This scarcity have been mostly sidestepped by politicians. They rarely couch their Covid pronouncements with clarity about how long increases in vaccine supply may happen, except to make generic (and optimistic) statements about the future.

With my medium-priority status as an ancient diabetic in mid-December I estimated there would be 124 miles of people ahead of me in Alameda County’s line to get the vaccine. That translated into my being in back of 2,954 miles of folks in California’s line. While proverbially waiting in either line, I needed to remember at least to bring a camp chair and water.

Forecasts of vaccine availability have always been colossally optimistic. Last Fall, Operation Warp Speed stated there would be 300 million (M) vaccine doses available in the US by the end of 2020. By the mid-December, the CDC said it expected between 30-45M doses by yearend. In fact, only 1,008,025 doses were administered by last Christmas. Should we believe updated dosage forecasts that are stated by “experts”? I’d advise against it.

At this point, vaccine supply isn’t expected to increase at all before two months from now for the already-approved vaccines. Why? Because additional production capacity is currently unavailable.

If all the now-expected supply were used, the US could average over 2M shots per day, but state and local vaccination centers have failed to manage and use the current flow of vaccine, let alone more. So why are governors adding even more “prioritized” people to the vaccine-eligible lines with no additional supply until April?

Some relief will come once the Johnson & Johnson single-dose vaccine gets FDA emergency use approval. If expeditiously approved, the J&J vaccine might start to be available in early March according to the experts. J&J has agreed to deliver 100 million doses to the US by the end of June, assuming smooth sailing. Are you holding your breath?

Covid vaccine distribution has been a calamity in California and elsewhere. Fundamentally, the vaccines’ delivery system is founded on a conflict between the inclusive logic of having ever-more people become safer by getting fully inoculated – something politicians and everyone else wants to happen the day before yesterday – and the selective logic arising from shortages of vaccines because at any point in time there’s a fixed, inflexible supply that is far less than the public’s demand.

To reduce the shortage, vaccines have been rationed, requiring some people to be non-prioritized and thus having to wait. No public official ever uses the term rationing to describe the situation because of its fraught connotations. But that’s what is behind the CDC’s and each state’s tiers and sub-tiers. Unsurprisingly, the alluring artform for some of securing “unfair priority” to jump ahead in the line is itself reaching epidemic proportions.

As of February 1, California has vaccinated 7.2% of its residents with at least one dose, 1.5% with two doses, and utilized just 61% of all doses delivered. California ranks 38th highest of all the states for doses utilized. Each of these percentages is below the mediocre US averages. Nevertheless, thank goodness vaccination rates are slowly rising.

State politicians have established “vaccine delivery systems” that involve many interdependent moving parts among multiple agencies/institutions grating together, in which every piece needs to work rapidly, competently and seamlessly for success to occur. It hasn’t.

This week Dr. Anthony Fauci, now President Biden’s chief medical advisor, acknowledged this very problem, “You cannot give a definite answer [about when the Covid vaccine system will return us to “normal”] when you have so many moving parts.”

I’m reminded about such challenges in keeping our multi-faceted Covid vaccination systems working by this image of Charlie Chaplin in his renowned 1936 Modern Times movie. So many gears, so many parts grinding on each other that have to be kept working flawlessly together. No wonder he and we are exhausted.

Charlie Chaplin enjoying Modern Times.

California’s vaccine distribution system has been changing rapidly, which adds yet another fateful, often confusing influence on getting this essential task done timely and effectively. If it’s Wednesday, do I keep unsuccessfully calling an 800 number, or do I use the newly-introduced but error 408-laden website? The systems’ shortcomings have resulted in every relevant party pointing fingers, at others.

Gov. Newsom’s approach seems to pay only slight attention to the vaccines’ omnipresent shortages that everyone is facing despite California’s utilizing only 61% of delivered vaccines. His approach that emphasizes inclusive vaccinations has increased the demand for the vaccine. Not the supply.

Gov. Newsom announced January 13 that the state was “significantly increasing our efforts to get these vaccines administered, get them out of freezers and get them into people’s arms” by increasing the number of people eligible to receive shots to everyone 65 and over. Except sufficient vaccines aren’t available for an additional 6 ½ M elder Californians.

And the governor knows every person demanding a shot is a voter, be they a healthcare worker, elder, school teacher, parent, diabetic, firefighter, meat processing plant worker, lettuce picker, or grocery worker – virtually all of whom consider themselves “essential” in some manner.

Thus, the governor’s system has all too often worsened the situation by increasing the number of “prioritized” people who qualify for getting the vaccines, without a concomitant boost in supply, over which he has no control.

Individual states cannot directly contract with vaccine suppliers, only the federal government is allowed to. Thus, exhortations by governors like New York’s Andrew Cuomo about ordering their own vaccines have, at best, only fleeting PR value, but no legal or practical consequence.

Pfizer’s and Moderna’s production facilities have been running at full-tilt 100% capacity. As mentioned before, the intricate vaccine production process cannot change that rapidly, even if governors like Mr. Newsom somehow expect it to with the flick of a few words.

Thus, the lines get ever-longer; the public’s expectations are rarely met and people understandably get more upset and frustrated. Hence, the emergence of a misbegotten campaign to recall Newsom, promoted by the ever-endangered species, California Republicana.

Perhaps this political action is part of why Gov. Newsom last week again changed his vaccine distribution system. This time more fundamentally. Until last week, the governor’s delivery system revolved around the state’s Public Health Departments (PHDs) who had responsibility for allocating the vaccines across the State, county by county.

He shocked California’s vaccine delivery system by removing the PHDs. Critics said the PHD-based system was a piecemeal patchwork of confusion. The authority of the PHDs should have been sidelined long ago in favor of larger-scale healthcare providers who are far more experienced dealing with customers, and already have the systems to do so.

The governor’s new vaccine management-distribution system will be run by Blue Shield of California, with assistance from Kaiser Permanente, two of the largest healthcare providers who together serve more than 10M people in the state.

The PHDs have been challenged and stretched by their vaccine responsibility even before they officially started Covid vaccination management in mid-December. For years PHDs have been under-budgeted, understaffed and now they’ve became overwhelmed, which has led to their ineffectiveness. Their distribution efforts have been faulted for inflexibility, spotty data collection and a lack of statewide coordination among the 61 local health jurisdictions with regard to eligibility requirements.

One person familiar with California’s PHD-based system stated, “In short, there is no clear and easy way to tell people when it was their turn and where to go when it was.” Another knowledgeable observer said the bar for Blue Shield’s and Kaiser’s success is pretty low; “The whole thing has been managed so disastrously.”

My personal example: on January 14 I completed the online Alameda County Health Care Services’ Resident Vaccine Notification Form and submitted it – apparently to neverland. Since then, I have never received any notifications, even from Tinker Bell, about my status. On my own, I was vaccinated at Kaiser on January 19 via a phone call to Kaiser that included a 2.5 hour wait to get an appointment. Let’s hope my second dose isn’t delayed.

New York state has just made changes in its vaccine management system, similar to California for similar reasons. New York ranks 24th highest of all the states for doses utilized, at 65.7%.

After New York’s vaccine rollout became problematic and fewer available doses were actually being administered, Gov. Cuomo declined to adopt plans previously developed by the State Department of Health and local health departments. Recently he became more displeased with local public authorities’ and public hospitals’ poor performance, calling the PHDs’ operations excessively rigid. The magnitude of the pandemic had swamped New York’s public health planning efforts.

Finally, the governor said he punched the PHDs’ plans in the face, using a cheekbone-close adaptation of the famous Mike Tyson quote[1]. Late last week Gov. Cuomo announced that private hospitals now will be “hubs” for vaccine dispersal throughout the state, not PHDs.

Meanwhile back in Washington, President Biden is changing lots about #45s plebeian Covid plans. He has ordered FEMA personnel and active-duty soldiers to become directly involved with vaccine distribution. They will operate large, federally-supported vaccine centers in several states including Arizona, Nevada, Texas and Washington.

Additionally, the president’s Department of Homeland Security recommends that undocumented immigrants should be vaccinated, together perhaps with incarcerated people that others insist should be inoculated ASAP. If large numbers of such folks received dosages before “ordinary people,” it isn’t hard to imagine how badly the public might react. Such are the judgements #46 and other authorities now face.

So, here’s an FYI message to Charlie Chaplin (see above). In order to improve our Covid vaccination system, the president is adding additional large gears to the nation’s already hugely complex vaccine machinery. I’m sure you understand. Perhaps hope springs eternal with further intricacy. Let’s see how it all works, keeping every finger crossed, with uniformed and non-uniformed federal personnel now swiftly meshing with the other thousands who’ve been engaged in this herculean task for far longer. Onward towards herd immunity.

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[1] Mike Tyson said “Everybody has a plan until they get punched in the mouth,” in response to a reporter's question about whether he was worried about Evander Holyfield's fight plan before their 1996 championship fight. It turns out Mike got punched and lost the fight.