Similarly, CBC news reports about Allegations of vaccine queue-jumping at Ontario nursing home [1].
I suspect that we should tone down the outrage over the edge cases (end-of-day left-over doses). The Atlantic article points to the need in the U.S. for a more consistent online queue/registry for timely left-over doses while the CBC piece makes clear that Ontario is way behind the U.S..
Perhaps the concept of continuous improvement should be discussed more widely during these trying times.
Central Maryland resident here (same general area as the article's author is talking about). The situation is insane. My elderly parents are in Group 1A and are still waiting on their turn. But Group 1B got opened up, so teachers and others could get vaccines. Oh, and Group 1C also opened up, including other essential workers. At this point I think half of the adults I know are eligible to receive the vaccine for one reason or another.
Three people I know (1 in her 20s, 2 in their 30s) fit the description of hospital staff who got vaccinated despite doing non-patient facing work, entirely or mostly from home.
Schools are being pushed to open back up, and why shouldn't they, right? Teachers have been eligible to be vaccinated for a while now! But I know of plenty of teachers who still haven't been able to get an appointment.
I've been playing the "refresh 7 different websites" game to find appointments for my family and I finally managed to snag ONE yesterday! Except it's in Cumberland, which is technically Maryland but might as well be West Virginia. So now I have to decide whether it's worth spending 4 hours in a car on Monday to get one of us a shot. And presumably do that again in a few weeks for the second dose.
They mention having to enter insurance and other details repeatedly.
Why didn't Maryland simply create a MarylandVaxAuth site, where you create credentials and enter all your details like insurance and age.
Then their distribution centers can still have a scheduling system, but the first step is to log in with MarylandVaxAuth SSO and the 2nd step is to pick a time slot. If you already have a valid session cookie then you wouldn't need to type in your password. Just click yes allow Safeway Covid Vaccine Scheduling access to my vaccine related health details. Just need to give each partner an API key so they can set up sso and fetch patient details in case they want to automate things like checking for double-bookings or eligibility.
I think back in March people were expecting that we might need to vaccine our way out of this. It's been 10 months. Why do we only have shitty web applications? I think this is the most outrageous part. I don't understand how complicated it is to create and expand a distribution network for vaccines but I understand that building out an SSO system would dramatically help and it doesn't take 10 whole months to develop.
I don’t understand why there isn’t a simple system where you register your interest in vaccine, age, medical conditions and leave your contact info to be called in when your shot is ready.
There seems to be one of those per county. And no one seems to have gotten contacted as a result of registering via those sites. Everyone I know who has gotten vaccinated has done it either through their employer or as a result of bombarding the grocery store/pharmacy websites.
And the state of Maryland opened their first "mass vaccination site" yesterday ... along with, you guessed it, their very own website for folks to sign up to express their interest in a vaccine.
I know my county has a "communicate your interest" form, but nothing in the surrounding language has me convinced that it doesn't just forward to /dev/null.
We’re naturally inclined to a technical solution here with a web application. No matter what, this will flummox some fraction of the population. Also, when dates open up, the ideal of “first-come, first-serve” degenerates into a game of chance based on who can get through. Given this, a solution would have been to get the Selective Service System involved and use something similar to the algorithm NIST came up with for the draft (obviously there would need to be separate async registration for that since everyone doesn’t have to register for the draft). There’s enough demand for this that people are willing to reschedule their life around their vax appointment, so choosing an appointment slot is unnecessary.
If it weren’t for the flight attendant and pilots unions you wouldn’t have to wear a mask. However, if it weren’t for deregulation, you might not have to hunch over as much, or as long, waiting.
I get it, but you've made it 11 months already, case counts are falling rapidly, spring is coming, and people getting vaccinated will drive down new cases even more. Calm down and wait another month or two.
The case counts will go up again within the next 2 months due to little vaccination and multiple mutations making their way through many countries. Germany and US will look like Britain, fighting B117, not too long from now.
Germany is "already" discussing to losen the lockdown and open schools again. It's really stupid in terms of epidemiology, fully understandable socially, and actually necessary in terms of economy. Germany has vaccinated a measely 2 million people, only 900k got the second dose (https://esri-de.maps.arcgis.com/apps/opsdashboard/index.html...)
There's a wave of suicides coming from people who have lost a lot during the lockdowns.
To be honest, I get the sentiment. Arrival of vaccines was greeted as huge relief, and months after that, all I see is squabbling of politicians yet again caught completely unaware of realities of life. Companies not delivering what they promised, referring to some small prints in the contracts (which to be fair, were stupid to be signed but I suspect that states either accepted the contracts or didn't get anything). Big pharma industry is after all about making money just like any other, helping people is just a side effect.
Maybe US will quickly get the stuff done, if anybody you guys have the potential, and now also the leadership. But here in Europe, it looks beyond pathetic. Vaccines nowhere, cases stagnant for at at least a month during current lockdowns. My 93 year old grandparents had first jab (this one maybe 30% immunity), second nowhere to be seen, so not much protection. Our friend who works in intensive care in biggest hospital in Switzerland (exactly with all the covid patients on ventilation), wants to protect herself and her family and also get pregnant soon, can't get any.
I expect, and desperately hope that I am wrong, that in 2-3 months, we will be at exactly same place as right now, just more tired and desperate.
It's strange what you write about Switzerland, it's supposed to be the 4th best country in number of vaccinations (at 4%). Is that a lie?
At the same time I understand that pregnant people don't get vaccines, as the vaccine was not tested on pregnant people and it's hard to know the effects on the babies. It makes sense to skip them and get to herd immunity without them instead of harming the baby.
I don't know if its a lie, just saying what I see around me. That friend isn't pregnant yet but planning soon, but at the most risky doctor job one could have with covid, in biggest hospital, and still unable to get vaccinated.
My wife is pregnant, and as you write they don't get vaccination, just hope for the best and not catching it (since it has some potentially pretty nasty effects on pregnancy).
In Canada, it was 'by end of summer' - and now - it's 'anyone who wants a vaccine by end of 2021'.
And that's without the vaccine delays which have flatlined the roll-out, meaning, that timeline is now optimistic.
There is a material chance that many segments won't get vaccinated until way into the fall in Canada, supposedly a '1st nation' which is cause for revolutionary rethink of the incompetence of bureaucracy in face of an existential problem.
The opportunity cost of: 'lives lost, living conditions suppressed, massive economic damage' of the ongoing situation imply we should have been spending billions to refactor production sites and build out supply chains long before vaccine trials were complete. Even with the distinct likelihood that most vaccines wouldn't work or be deemed unsafe, it would still have made sense to at least ramp up manufacturing many months ago. Several billion dollars 'wasted' towards bad vaccines only to get a single good one, is orders of magnitude less than the 'wasted' lives and billions faced by many months delay in roll out.
It's a very simple calculation actually - spend a billion today to ramp up early, most of which might be wasted - to save 10 billion tomorrow in terms of early vaccination rollout.
In times of crisis, the press becomes a little bit propagandistic - what everyone is suppressing right now (because we plebes can't fathom to see it) is that governments around the world are spending the equivalent of an entire generation of deficit just in a few months. Frankly, the Capitol Hill Riots were a giant distraction from the severe underlying reality.
In that context, the speed and efficiency of the roll out is exceedingly consequential.
These are generational issues, this is our 'World War', the stuff that will define our era, and be studied for decades.
Sorry, I meant a month or two for someone 65 or older. Most of the story's gripes were among that group; outside of those with compromised immune systems or preexisting conditions, people seem resigned to waiting 4+ months.
What’s to remain calm about with a State government too busy trying to figure out who it is most fair to inject shots into arms, losing doses in the time it takes to figure it out, rather than getting shots into arms?
Start delivering on demand and the manufacturing supply will take care of itself.
You're kinda proving the point here. The source article is about exactly the opposite problem: Maryland is widely distributing vaccines rather than micromanaging fairness, so there are a lot of random tricks available for people to get vaccines faster, and the author is frustrated about that. When there's no perfect strategy available, we can and should push for continual improvement, but there's a point where we have to accept people are doing their best instead of getting mad about it.
My point is the entire process is over-bureaucratized.
If you want to prioritize anyone, with COVID specifically you come to two conclusions about who you might want to prioritize first: the very old and any employee involved in front-line healthcare work.
For the former, there’s a Federally administered healthcare system specifically for anyone 65+. For the latter: they work within, are affiliated with, or have relatively straightforward access to hospitals and generally clean spaces to inject a vaccine. They are also showing a lot of disinterest in getting the vaccine, and many of them have already been infected and survived COVID.
So States largely don’t need to involve themselves in vaccinations for the 65+ but they can provide additional resources of necessary, if Medicare can do it instead, and I’ll go out on a limb and say health care workers should get priority. Fine, but by this point most of them have had the opportunity and accepted or declined, and the priority access should be time-limited, not based on what percentage of them chose to accept. The time has passed, let’s move on.
For everyone else, if someone shows up, wants the vaccine and you have it; inject it. Need more? Order more. Manufacturing is not the bottleneck at this point. Just getting a goddamned appointment is, and this is bottlenecked by stupid rules about who is allowed to get an appointment in some States including mine, because some people are sitting behind desks at home paid by the government throwing around words like “push for continual improvement”, “strategy” and “doing their best”.
You want a strategy? It’s called a factory line. I was always amazed whenever I walked into a Kaiser with a buddy of mine anytime she needed blood work and impressed by how they had industrialized the process of drawing large quantities of blood from up to 10 people at a time in a small office space in under 5 minutes. Never been to another hospital like it. Injecting people should look a lot like that, and if you need to spread people out like we do, that’s fine, there’s plenty of space when you’ve made this a national priority. We have nothing but space.
> Manufacturing is not the bottleneck at this point.
This is just nonsense. We are manufacturing quickly, but vaccine production absolutely remains the bottleneck. We will not have sufficient doses for everyone who wants a shot for several months.
I understand your point, but the strategy you're describing is exactly what the author is frustrated by. Maryland doesn't have "stupid rules about who is allowed to get an appointment", and all doses which become available are quickly claimed - as a consequence, if she wants to claim a dose for her parents, she has to run around at odd hours checking with everyone who might have new availability. Until we have enough shots available for everyone who wants one, there's no way to make everyone happy.
Her problem is a good problem to have. Mine is not.
That means people in Maryland are readily receiving the vaccine and between whoever has already been infected, those who are likely to survive infection with little consequence and the daily increase of people who are now vaccinated, the entire State of Maryland is becoming more resistant by the day which will do as much to mitigate risk to her parents as everything else.
A 95% effectiveness rate still means that every 5 out of a hundred vaccinated people will still be vulnerable to infection post-vaccination. Either one of her parents could be one of those 5.
Given we have now reached the point that society will refuse to open up properly until we have vaccinated tons of people, let’s get people vaccinated, lots of them and quickly.
As a Maryland resident, I certainly feel we have "stupid rules about who is allowed to get an appointment" at a statewide level AND we've got a bunch of providers interpreting those stupid rules in inconsistent and arbitrary ways.
My doctor's office has apparently received some vaccines but are only vaccinating people in Group 1A because they feel that's the most important. But the governor claims we've moved into Group 1C, and if I can snag an appointment with a different provider, I might be in luck.
It is hard for people to calm down when some scientific advisers to governments are telling newspapers that social distancing must last until the entire world is vaccinated, to prevent new COVID mutations, so they recommend the status quo until 2024–2026.
Also, governments have handed virtually all authority over lifting lockdown to their health ministers, who generally prioritize saving every possible life above all else. Most of the population will, at some point or another, be willing to accept some number of deaths in order to reopen the economy and freedom of movement, but they legitimately worry that their voices aren't being heard.
> governments have handed virtually all authority over lifting lockdown to their health ministers
This does worry me, but in Europe and the US, the consensus seems to be that it's not possible to stop it, so settle on some sort of a "live with it" strategy. During the fall, I remember Europeans looking at the US and saying "they just needed a real lockdown." As winter came and case counts rose again in Europe, there wasn't much of an appetite for another round of hard lockdowns.
My best guess for developed countries is that things start getting back to normal by late summer one way or another because either vaccines are effective enough and bring down the case counts or they weren't, but people are willing to accept the risk and move on. Support for strict government policies only works if there's a light at the end of the tunnel.
You are right there wasn't much appetite for the hardest degree of lockdowns, but what Europe got instead is bad enough. Borders closed in spite of Schengen, putting a stop to things like cross-border relationships and the sort of everyday interaction between European peoples that staves off nationalisms. Then you have closure of restaurants, concert halls, etc. which has led to a wave of bankrupcies, and governments show little interest in compensating these sectors adequately for their lost business.
When politicians saw that they could get away with hard borders again and closed businesses without too much popular protest (and that is, to a large degree, due to popular protests being banned), I worry that these restrictions could last much longer than just this summer. After all, as I mentioned in my post above, when the scientific advisers to your country’s government are interviewed in the news and recommend restrictions in perpetuity, where is the light at the end of the tunnel?
"Listen to the epidemiologists" has been some of the worst messaging through all of this because they've never actually stopped a pandemic before (other than smallpox), and they don't necessarily understand the politics, economics, psychology, or legality of their ideas.
I wonder what has happened to human culture worldwide that 'safety' has been given primacy over all other considerations. If hitler had invaded france in 2020 instead of 1940, would the world have united to liberate france? I'm really not sure.
Yes, but as people 'open up' it may happen explosively as they feel more confident, leading to a material increase in cases.
COVID spreads pretty easily, we've taken quite a number of measures to keep it wrapped up. If people get lazy, it will get out of hand.
There's a kind of American hubris and self-belief, sometimes confused with 'courage and independence' (and sometimes not) that leads to this kind of activity.
It's very easy to think 'it's not going to affect me' when problems are on the margins, especially if there are vaccines at the ready.
In a way, it's a very dangerous time - even as rates start to climb, authorities may have a really hard time reeling people's behaviours in.
Most Canadians are under a curfew right now and vaccines are not coming. We may not reach critical mass until Sept/Oct and there will be riots if we have to do another curfew.
It's not a good situation - we need to be thinking in WW3 terms about getting those vaccines made and out.
Any rich country that doesn't get it done by Sept. should re-think their status as a developed nation.
Legitimately humorous how the article associates America's failure with a communist distribution system, when communist countries worldwide have completely knocked their coronavirus response out of the park - so much so that it is considered unfair to compare America's atrocious coronavirus response with these countries instead of its "cohort" of countries failing just as badly, like the UK.
Conveniently remove your own relatives from nursing homes and long term care facilities, then institute forced lock downs and mandate that they accept Coronavirus patients.
The people can't get out, but do your best to guarantee that the virus will get in.
No one disputes that authoritarian governments do some things better. Even the Romans built it into their republic: they could appoint a tyrant during wartime to make quick decisions before returning power to the senate.
It's incomplete (to the point of being irrelevant) to say that communists did Covid response better and not to mention all the other things they do worse.
Given the choice, I'd still take a 10x worse Covid-19 over living under Xi or Kim.
> they could appoint a tyrant during wartime to make quick decisions before returning power to the senate.
That's the entire point - the fact that many contemporary liberal societies can no longer use such tools is worth introspection. Many countries had quarantine act or equivalent emergency power structure designed for pandemics, but what good are they if current political climate make them infeasible. This overlooks the fact that harsh authoritarian responses have been in line with epidemic response playbooks drafted by the CDC. It was what was expected.
The myopia is thinking this is a choice between authoritarianism and liberalism, but between society where you can rely on leadership to do difficult things for the greater good versus one that cannot.
What is a historical example of a country with a mechanism for "temporary authoritarianism" where that mechanism was not abused to create permanent authoritarianism?
First the communist countries deployed extremely autocratic measures that wouldn't befit free societies. Second, their numbers are far more likely lies than the US ones. These countries are extremely adamant about their public image. That's why they sent police to a doctor's home in Wuhan instead of taking the problem seriously and maybe, you know, stopping international movement to that city.
This zombie they're lying about their numbers! cope needs to die. Look at Taiwan. Look at Korea. Both of them handled the virus fairly well, with much less extreme measures, and have good relations with the US so you have no reason to doubt their numbers.
One is an island, and the other might as well be an island? I applaud their successes, but a year in, empirically what works in Hawaiʻi and Guam isn’t going to work in Chicago.
Both Taiwan and South Korea's values are in direct contrast with what we call Western Values.
Violating the right to privacy is one of them.
South Korea's spying on its citizens is second only to China.
Yes, that's the point. You won't believe numbers from any communist country. So I provided nearby non-communist countries who have significant overlap in strategy, with good success, whose numbers you will believe. We can infer that even more stringent measures would have resulted in even better outcomes. Thus the communist countries are likely not lying about their numbers.
According to WHO numbers, South Korea has almost as many cases (80k) as China (100k). I believe the SK one, but I can't believe the numbers for a big country such as China. They have 50 times the population of SK.
Note that likely the number of infections is larger than the official numbers in the western countries as well. But I trust the ones from the west (or SK) far more than the Chinese numbers.
> America’s distribution plan is no more fair or logical than a Soviet-style queue for cabbage.
I don't see how a capitalist distribution system (if you have money you get it earlier) is in any way more fair than a system which is based on need.
Capitalism's strength is in extracting resources and increasing production and efficiency in things there is a good market for. But it's not good at all in distributing things.
When it comes to serious diseases I don't think we are ever in the 'realm of fairness'.
In an ideal world, we would vaccinate every single person at the same time. But we can't do that so we have to prioritize based on varying strategies.
The EU and the US have both been entirely inept when dealing with SARS-CoV-2 vaccines. The rollout has to happen FAST on a planetary scale. Mutations happen as we speak and if we are in bad luck, one of those will knock-out the vaccines and get us back to square one.
We need to vaccinate countries that we usually just don't give a shit about because they may be a mutation source in the future.
I do not know about the US, but the problems of the EU are with acquiring enough vaccines (ordering too little and too late), not with distributing it. Distribution even is a per country thing. I cannot speak about the other EU countries but at least in Germany we have a fair vaccination queue based on risk and vaccination centers that are sitting idly just because there's not enough vaccine here yet.
Both my grandparents that still live are over 80 and I worried about them the most. They both were vaccinated in the beginning of January.
Oye vey. I totally understand the sentiment of this article. The vaccine roll-out in the US has been maddeningly frustrating. But could we please stop comparing everything to "communist Russia"? IMO this article is nothing more than a fluff piece meant to generate outrage and clicks. No actual reporting went into explaining why the vaccine rollout is stalled. The author instead chose to write down some unsubstantiated anecdotes and cap the story off with the specter of communism. Perhaps I am being too harsh but I find articles of this nature incredibly frustrating and corrosive to productive discourse.
First Dose First and approving more vaccines are the easiest answer to this question. The prioritization is not working well, for the reasons outlined in this article.
However, we can give approximately 4x the rate of people getting 100% protection from ICU/death.
First dose first gives you approximately 2x the throughput (all first doses from all vaccine candidates thus far are fully protective from death).
Approving Astrazeneca, J&J, and Novavax today would give you a group of vaccines that don't rely on cold storage, so can be run through different distribution channels.
At 4x the rate, these prioritization concerns are much less important.
The US is flatlining in its number of doses administered, which means that by prioritizing 2nd doses, we will start to vaccinate very few new people soon (choosing instead to administer 2nd doses). We can see a looming shutdown of any progress towards herd immunity, and urgent action is needed.
Throw the computer system out the window onto the car of the guy who thought spending time and resources on this was a good idea.
All we care about is how many people were vaccinated, and how many doses are thrown out before use.
Obviously we care about how many are vaccinated. Why do we care how many are thrown out? To show where and how we failed. We didn’t get SARS. This is our SARS moment, but more importantly, we are in the process of proving out an entire new class of vaccines that were never used before, are easier to produce on a per virus basis than any vaccine before it, and more effective than what we did before using traditional methods. So where are we failing in the distribution, and why?
Three forms you can file electronically with less info than a birth certificate.
1. Patient ID. First dose or second dose, and the address of the Office they were vaccinated.
2. Vaccine disposal. Basically a summary of how many were thrown out and why these doses were wasted.
3. A reorder form.
At this point we have dumped trillions of dollars of relief into the economy with a promise from House Democrats to dump trillions more. Trying to keep a perfect record of where every single dose is in the country rather than just injecting them in anyone who wants a vaccine is expensive overhead and wasted effort.
> Trying to keep a perfect record of where every single dose is in the country rather than just injecting them in anyone who wants a vaccine is expensive overhead and wasted effort.
I hear this and I also think there’s value in mechanisms preventing abuse at scale.
Also, bean counters gonna bean count and they happen to allocate resources so bean counting is always a priority. That’s a human / perspective issue built into the system of prioritizing bean counting.
The FDA's continual foot dragging on approving AstraZeneca is criminal. The UK has already thoroughly reviewed it and decided it was safe for approval. Is there any reason to believe that British scientists are any less competent than their American counterparts?
If the trials were successful in the UK, it's a complete waste of time to insist that they be duplicated in the US. Especially when thousands die every day. It's not like biology works different in the Western Hemisphere. This is just another example of bureaucrats flexing their power to aggrandize their own importance.
The FDA's continual foot dragging on approving Thalidomide is criminal. West Germany has already thoroughly reviewed it and decided it was safe for approval. Is there any reason to believe that German scientists are any less competent than their American counterparts?
Frances Kelsey is just another example of bureaucrats flexing their power to aggrandize their own importance.
Covid kills more people every day than the entire number of birth defects caused by thalidomide in its entire history. Maybe it's time to start living in the here and now, instead of worrying about a minor incident from more than half a century ago. It's easy to count type I errors, now actually make an effort to quantify that against the countless number of type II errors.
I'm willing to bet you any amount up to $10,000 that AstraZeneca vaccine does not result in more than ten thousand deaths worldwide within the next two years. You clearly believe otherwise, since you think it's prudent for the FDA not to approve it. If you're not willing to risk your money, why are you willing to risk people's lives? Do you accept?
Here is a good article that explains how drug approval is different in the US from Europe/UK [1]. Basically, the FDA has a reputation for being more thorough and for not taking the drug companies at their word and instead looking at the raw data from their trials. IDK if that is the best approach for approving the AstraZeneca vaccine but as this article explains, the FDAs approach did prevent thalidomide from being used in the US which was later found to cause birth defects in Europe and Canada.
Thalidomide occurred more than fifty years ago. Do you think it's maybe possible that medical science has advanced a little bit since then?
Also the total number of birth defects that thalidomide ever caused over its entire lifecycle, is less than the number of Covid deaths per day. Relative to the number of lives that hang in the balance, thalidomide is a rounding error, and shouldn't be considered.
On net, there's absolutely zero evidence that European drug approval is dangerous vis-a-vis the US. European healthcare systems produce much better outcomes than the US. And they have for decades.
I suspect that we should tone down the outrage over the edge cases (end-of-day left-over doses). The Atlantic article points to the need in the U.S. for a more consistent online queue/registry for timely left-over doses while the CBC piece makes clear that Ontario is way behind the U.S..
Perhaps the concept of continuous improvement should be discussed more widely during these trying times.
[1] https://youtu.be/HL5Ww-YBaDo