Dr. SJ and I aren’t kids anymore. She’s a health care provider. We’ve waited patiently to learn when and where we should get our vaccines. The silence has been disappointing, if not deafening. Nobody seems to know, and our primary care docs are getting annoyed with people asking because they have no answers.
It’s easy to blame Trump, because that’s both the cool thing to do and everybody does it, but when it comes to the actual distribution of vaccines, it’s local politics. The states get their vaccine and then are left to move it from vial to arm. This raised the usual problem, Governor Andy caught between getting on TV to spew empty platitudes for his next book about what a great job he did to knee-jerk punitive fixes to the ordinary combination of people being people and people still being people.
New York Gov. Andrew Cuomo has given hospitals a conundrum. Fail to use all of your COVID-19 vaccines within seven days of receipt? That’ll be a $100,000 fine. Vaccinate someone out of the state-designated order? That’ll be a $1 million fine.
Damned if you let your vaccines expire, damned if you don’t let your vaccines expire—by using them on anyone outside of the approved hierarchy.
The hierarchy, or as it’s officially called, the distribution plan, is a product of politically correct fear.
The state’s distribution plan mandated that a slew of people receive the vaccine before the elderly, including health care workers, patient-facing employees at long-term care facilities, first responders, teachers, public health workers, grocery store workers, pharmacists, transit employees, those who uphold “critical infrastructure,” and individuals with significant co-morbidities. Such a plan is common across the U.S., and it requires a robust logistical framework to execute properly.
Which group are you in*? When is it your turn? Do you show up (and if so, where and when) or await notification? The plan isn’t really a plan at all, as much as a lot of words that provide the most vague and generic descriptions of “priorities” and not much else, Some want to cut into line. Some want to wait their turn.
The former gave rise to the $1 Million fine because they used their “privilege” to violate the state-mandated equity. The latter left vaccines expiring in the freezer because nobody told them to come get their shot, a mere $100,000 fine plus loss of future vaccines, which will certainly save those who will need to be vaccined but won’t get it because their provider is now on the naughty list.
In New York, most individuals over 65 were not eligible to receive the vaccine until recently—when the state graduated to Phase Three of its plan—which partially explains the sluggish rollout. That prioritization, or lack thereof, inspired backlash from politicians and armchair pundits alike, many of whom argued that the elderly should have been first in line to receive the vaccine.
Talk is cheap. And yet, there is almost no talk about coming in next Tuesday to get the vaccine. The argument about who should be prioritized is one thing. The lack of any discussion about why no one is being told that it’s their turn, come on down, is another. It makes little difference if you’re third or fifth in line if no one tells you when to show up for your shot. We’re just sitting here, waiting to hear something, anything, about when our turn rolls around, and what we hear is that if we appear too soon, there’s a million dollar fine, and if we don’t appear, there’s a hundred thousand dollar fine as the vaccine expires.
Of the nearly 900,000 vaccinations sent to New York, only about 275,000 first doses have been administered. That’s 30 percent. Some states lag even farther behind: North Carolina clocks in at around 26 percent, California at 24 percent, Florida at 23 percent. Kansas is at 15 percent.
But New York leads the way in filling the process with fear and red tape. In Washington, D.C., by contrast, the Department of Health is reportedly encouraging health care providers to administer surplus vaccines nearing expiration to any willing recipient.
Instead of putting his bureaucracy into motion to get information out, to let people know when to get on line, get the shot, and get on with it. It’s not that communication isn’t possible, as Governor Andy has made sure that everybody knows how he has unilaterally come up with fines to make it financially dangerous to show up out of turn or let expiring vaccines expire. So what about letting people know when and how they should get those glorious vaccine shots?
In MacMillan’s case, he lucked out when two people didn’t show up for their scheduled appointments—something that is bound to happen and is out of health care workers’ control. The pharmacist “turned to us and was like, ‘Hey, I’ve got two doses of the vaccine and I’m going to have to throw them away if I don’t give them to somebody,” MacMillan said on TikTok. “‘We close in 10 minutes. Do you want the Moderna vaccine?'” In D.C., that’s one more person who’s been vaccinated against COVID-19 and one tiny step closer to herd immunity.
Had that happened in New York, the pharmacist might be out of a job.
Damn that Trump.
*To be clear, Dr. SJ should be in the Priority One group. Is she? Nobody knows, and nobody will tell her if she can get her shot.
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You have to hand it to the Guv for stumbling upon the ideal incentive plan to ensure no healthcare provider in NY will be stupid enough to sign up for distribution of any further vaccine allotments.
I give it one week before Andy starts threatening $5M dollar fines against providers who refuse to take on “their fair share” of future allocations
Look, NY’s gotta make up that budget shortfall somehow, ok?
I wonder…Was it God’s will, a force of nature, or somebody’s decision for the Federal government to send vaccines to the states and let them figure it out?
I won’t bore you with a list of all the other ways the Federal government might have handled the situation.
It’s almost as if states and local governments have no reason to exist, and everything should be handed down from the almighty Washington to magically land on your street corner and make your world wonderful and fix everything.
And to be fair, your list would almost certainly be a bore, not to mention, uh, unsmart.
All things? No. Pandemic response? Well as you’ve pointed out, even your favorite state is missing the mark.
Formulating a sound plan and then executing it competently are hard. It’s much easier simply to mandate the desired outcome. Why didn’t anyone think of this before?
People say a centralized command economy is incapable of efficiently manufacturing and distributing anything, including a vaccine. But that’s not entirely true, because they’re exceptionally good at manufacturing and distributing blame. Who knows when (or even if) you’ll get your vaccine, but you can rest assured you’ll soon be informed of who’s to blame, or at least a plausible stand-in for them.
To be fair, there was no sound plan emanating from anywhere, but the buck still has to stop somewhere.
To be fair, your information is incorrect. Public health authorities — most notably the CDC and the National Academies of Sciences — have long provided guidance about vaccine distribution in an epidemic. NAS published a framework for allocation of the COVID-19 vaccine in October, and urged the federal government to adopt the framework. That didn’t happen, and now we have very little coordination and guidance from the feds as they send the vaccine to public and private entities at the state, tribal, and local levels and advise them to distribute however they see fit.
This is not business as usual for a disaster, which is what a pandemic is. After a hurricane, FEMA does not tell local government: “Hey, we’re shipping blue tarps, trailers, and some cash to public and private entities in your county — and it’s y’all’s call to figure out what to do with that stuff.” This effectively is what’s happening with vaccine distribution, to the detriment of the general public.
Good thing we can’t die from COVID-19.
You are such an official person. There was no “nuts and bolts” plan at the CDC for distribution. It was fine for the 35,000 feet view, but that’s not what we’re talking about. As for your FEMA analogy, analogies are not your strength. You should never make another analogy.
You keep telling me that Kathryn Kase is a great person and lawyer, but her comments invariably tell me otherwise. If she’s so smart, why are her comment so dumb?
Miles.
States have been required by federal law to maintain a pandemic influenza plan since 2009, on pain of losing access to CDC pandemic preparedness grants which have totaled nearly $20 billion since 2005 (see 42 USC § 247d-3a(g) ).
The NY State plan, for example runs a cumberous 400 pages, of which 22 pages in Section 6 are dedicated specifically to how the vaccine is to be shipped and distributed from the “Albany Vaccine Depot” in NYDOH’s Wadsworth Center HQ. Additionally it covers the IT systems hospitals and pharmacies will use to track and dispense the vaccine, detailed plans for standing up and staffing dedicated immunization clinics, etc. (Respecting the long-standing links policy, the plan is easily found by using the following Google query – NY State Pandemic Influenza Plan site:questar.org
Mind you, this was all ready in 2006 – including the various IT systems used to distribute the vaccine, one to track trained medical volunteers who can be called upon in an emergency, as well as one to manage deployments of “medical corps” of such volunteers in the field.
Since 2006, NY State received over $100M in federal grants solely for pandemic planning to extend and expand on what was already built.
Since Day 1, Cuomo has decided to freelance his way to a solution (did I mention the plan addresses the issues with distribution of PPE, additional support for nursing homes during a surge, etc). In essence he is re-inventing on the fly portions of the same plan that already exists and cost a fortune to create.
Meanwhile the cost for this megalomania is borne by the public in the flesh and in the wallet.
One thing FEMA does do is organize coordinating meetings, practice sessions, “fire drills”, etc. There they mutually discover who is responsible for what, who to contact, what the people are like, what resources they have, etc. They practice.
If you look into the results you find that the local and state government are responsible for most of the action for floods, tornadoes, and hurricanes. To a very large extent the situation really is ” …we’re shipping you stuff and it’s y’alls call to figure out what to do”. But it’s worked out initially in practice sessions.
These sessions also reveal large lists of things to be fixed, gaps, problems, etc. The report from the Lousiana practice hurricane session (2 years before Katrina) revealed dozens of major problems. Sadly, federal, state, and local agencies had not fixed them when Katrina hit. The problems revealed during practice happened when the real hurricane hit.
Sports teams grasp the concept that you practice before the real games. Feds, state, and local government are rather hit or miss.
States and localities who have received preparedness funds (all of them have) are required to hold a health emergency planning drill on an annual basis and report the results and lessons learned back to the CDC per 42 USC § 247d-3a(b)(2)(C).
Some examples, have included the Southern Nevada Health
District partnering with local casinos to design a pop-up immunization clinic within the casino, that would immunize all hotel workers, their families and all guests. They then used that for the basis of their planning drill.
Meanwhile, in 2018, Los Angeles County satisified its drill requirement by simulating how they would stand up 8 vaccination sites in response to a simulated anthrax attack – one of which would be built from scratch in the middle of Granada Hills Park. Starting in the morning on the first day of the drill, all sites were operational and ready for the public by 4pm that same day (at least based on the after-action report).
Lack of planning (although who knows if it was truly effective) is not the missing variable.
I always marvel when one person goes othogonal for no particularly good reason, and, more often than not, a bad reason, and then others chase after them down the rabbit hole. And then there’s a whole bunch of very thoughtful comments having nothing to do with the post. This is one of the reasons so many others have chosen to eliminate comments altogether, yet here you are, making me wonder whether why I allow comments.
Are any of you getting the message here?
I used to chuckle at the old training cartoons featuring Private Snafu, Seamen Tarfu and their brother, Fubar (who worked in “Intelligence”). The reality of incompetence in this world is that the most far-reaching and destructive incompetence is not that of the average Joe Sixpack, but that of the lofty givers of directions and issuers of edicts. Take anything that is cocked up, and you can make it worse by putting a complete idiot in charge of it.
Down here in Texas things are moving along ok. The groups are a lot tighter than NY appears to have made them, but Texas was at 40% distributed a few days ago and the pace is picking up a lot this week.
In fact, I’m getting dose 1 in a couple of hours.
Our gov has been ok thru this. Not great but ok. Perhaps the problem is that your governor is incompetent. That group seems very unwieldy.
Why do people from Texas feel compelled to tell others about things in Texas not involving barbecue?
I’m not technically FROM Texas, but I’ve lived here for a bit. And I don’t have an answer to your entirely legitimate question.
I don’t understand how our nondescript governor can be doing ok while your superhero governor isn’t. That’s why I posted, no intent to brag.
Don’t hate us because Texas is better, we’re just trying to set an example for the lesser states to follow.
A selection from Coopers helps the medicine go down.
https://www.coopersbbq.com/Combination-Boxes/products/1038/
Are you teasing me?
Well, if we’re gonna go there then go for the best.
https://store.blacksbbq.com/blacks-bundles-c7.aspx
I would say to get the Lockhart bundle or the summer feast but you really can’t go wrong with any of them.
Rational decision making is not Andy’s strongest skill. In fact, I don’t know if he has a strongest skill.
Bloviating is Andy’s prime skill.
I would have termed it verbal masturbation. I don’t think it rises to the level of bloviation.
Incidentally, logistics is a bitch.
Logistics is a bitch. That can’t be said enough.