Although the lion’s share of COVID-19 infections and deaths in the United States is over, Americans should embrace their inner Yogi Berra, who once observed that “it ain’t over till it’s over.”
Indeed, a number of issues regarding COVID-19 remain active, including hundreds of thousands of patients potentially stricken with long COVID-19 and the mystery of the virus’s origin. But among the most important and least appreciated issues is a public accounting of how the vaccine was distributed and administered throughout the country. The vaccine distribution system was not our finest hour, and the process must be upgraded for future health emergencies.
Whatever one believes about Donald Trump, Operation Warp Speed was one of the most effective research projects ever undertaken. Considering the time pressures, employing an mRNA platform permitted rapid development of a vaccine that was relatively safe and resulted in fairly effective protection from hospitalization and death.
The success of Warp Speed was tempered almost immediately by distribution. The first test was meeting demand for the vaccine when there was a limited supply and no ability to direct demand to where the vaccine actually existed. This, coupled with the daunting task of shipping and storing the rapidly perishable vaccine (after the seal was punctured, every dose had to go into an arm; otherwise, the unused doses were discarded the same day), represented a significant logistical challenge.
Distribution went from federal to state and local governments then to health care providers and community groups. The result was a confusing patchwork of distribution policies from the government, national health care providers, state governments, local public health departments and the ultimate providers: hospitals, pharmacies, fire departments and jails.
Even where there was an adequate supply of vaccine, it was often difficult to impossible to locate. Is it any wonder low-level chaos ensued? How many times was a provider or pharmacy asked, “Do you have the vaccine?”
Distribution policies were not simply confusing. For example, New York senior citizens faced a 51-step online registration process, including multiple uploads of information. They also were often contradictory. By common agreement, essential workers received the vaccine first, but after that, politics played an outsize role. In certain locations, those with preexisting conditions and the elderly – who were most likely to die from COVID-19 – received lower priority in favor of low-risk patients in the name of “public health equity.”
Powerful teachers unions secured a priority status for teachers in many jurisdictions, even for many educators whose schools had closed. And residency restrictions meant people might be turned away if they traveled to a neighboring county to get vaccinated, even if the distribution site was much closer than one in their home county. Remember: The goal was to get every available dose into a waiting patient’s arm, but these shambolic approaches meant wasted vaccine and potentially lives lost.
In too many instances, providers and the government tracking systems did not know exactly where “their” vaccine was. There were few reliable websites or maps that the public could consult. A group of private volunteers in California set up a workable phone tree to identify the location of available vaccines, based on the most reliable sources they identified: local pharmacists and pharmacy chains.
According to data from the Centers for Disease Control and Prevention, pharmacies, states, U.S. territories and federal agencies discarded 82.1 million COVID-19 vaccine doses from December 2020 through mid-May 2022 – just over 11% of the doses the federal government distributed.
All too often, the goal seemed to be deciding who would get the one dose the system could administer capably, but little effort was put into guaranteeing the four remaining doses in the vial went to eagerly waiting patients. The decision at some vaccination sites to discard unused vaccine at the end of the day was scandalous. In Israel, providers simply went out into the street and gave the day’s unused vaccine doses to anyone who wanted them.
Another scandal was the part played by our multitrillion-dollar tech industry – Google, Apple, Microsoft, Facebook and Amazon, the greatest knowledge-based system the world has ever known. These companies can ship and track any delivery, map the entire country precisely, store virtually everyone’s personal information and create super-sophisticated websites.
Yet they seemed to work at arm’s length from the government. Where were their skills in the vaccine distribution scheme as people wasted time, low-tech style, frantically dialing their phones looking for vaccine doses? What was their exact obligation to the public to streamline distribution – contractual with the government or moral? Either way, some of the country’s unused vaccine and COVID-19 mortality can be attributed to tech industry inertia.
And the biggest scandal of all? To date, there has been no comprehensive debrief on how the federal and many local governments bungled the country’s COVID-19 vaccine distribution plan for 2021 to 2023 – no public post-mortem, no national commission, no published report and no accountability from whatever entity was ultimately in charge.
As the pandemic, with its crowded emergency departments, packed intensive care units and morgues, fades from our collective memory, there is diminishing imperative to create a more effective mass vaccination plan for the next pandemic.
What reason do we have to believe the next time will be better? Besides our inner Yogi Berra, we might also want to channel the person who noted that “by failing to prepare, you are preparing to fail.”
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