A long article by Patrick McKenzie, who was CEO of VaccinateCA. He also announced on Twitter that he's leaving Stripe at the end of the year. I guess that means he's allowed himself to get more...
A long article by Patrick McKenzie, who was CEO of VaccinateCA. He also announced on Twitter that he's leaving Stripe at the end of the year. I guess that means he's allowed himself to get more political than he usually does.
From the article:
The single greatest solvable strategic issue facing the US vaccination effort early on was that we had overwhelming demand for the vaccine, limited supply of vials, and no ability to direct the demand to go where the vials actually existed.
This was directly caused by decisions in how to distribute the vials. They were directed into multiple parallel and overlapping supply chains that had extremely imperfect knowledge of one another. We’ll get to that, but for now let’s oversimplify: Vials were allocated by the federal government to states, which allocated them to counties, which allocated them to healthcare providers and community groups. The allocators of vials within each supply chain had sharply limited ability to see true systemic supply levels. The recipients of the vials in many cases had limited organizational ability to communicate to potential patients that they actually had them available.
Patients then asked the federal government, states, counties, healthcare providers and community groups, ‘Do you have the vaccine?’ And in most cases the only answer available to the person who picked up the phone was ‘I don’t have it. I don’t know if we have it. Plausibly someone has it. Maybe you should call someone else.’ Technologists will see the analogy to a distributed denial of service incident, and as if the overwhelming demand was not enough of a problem, the rerouting of calls between institutions amplified the burden on the healthcare system. Vaccine seekers were routinely making dozens of calls.
This caused a standing wave of inquiries to hit all levels of US healthcare infrastructure in the early months of the vaccination effort. Very few of those inquiries went well for any party. It is widely believed, and was widely believed at the time, that this was primarily because supply was lacking, but it was often the case that supply was frequently not being used as quickly as it was produced because demand could not find it.
There were widespread media reports in early January of patients only finding the vaccine after making dozens of phone calls in California. The numbers were even more brutal than the anecdotes. California had to report to the feds the number of vaccines they had injected against the number they had been shipped. Their reported efficiency at getting shots in arms placed them 49th in the nation in mid-January; they told the feds they had administered 27 percent of delivered shots and, by implication, 73 percent of them were still in the freezer.
This seemed bonkers to me.
[...]
VaccinateCA was told, more than a few times, that merely listing the availability of the vaccine and eligibility requirements on a publicly accessible website compromised the desire of some group or another to earmark ‘their’ doses for ‘their’ clients.
We had a golden rule here: We’d obey instructions from medical providers regarding their operations. If a pharmacist wanted to be delisted, for any reason, we’d do it. Everyone else in society was welcome to their opinion. If a politician or civil servant complained that listing doses available in their district complicated their ability to reward favored constituencies, they were welcome to tell us so. It’s a free country. Did I personally have to take immediate action to implement their opinion? It’s a free country.
[...]
When the residents of those neighborhoods dear to the state showed up to receive healthcare, they had to hope that the person providing it knew that the residency restriction was only supposed to apply if you were a disfavored patient. But that policy could not be written down, and the actual written policy said that the rules applied to everyone. And the rule was frequently that you could not get treatment without proving residence.
Remember, the state was extremely adamant that they would terminate the license (and thus career) of any healthcare provider who ignored instructions during the pandemic. And so many healthcare providers did what the state told them to do and enforced the residency restrictions to deny healthcare to the people the residency restrictions were instituted to benefit, including in the places where they factually lived.
At the time I benefited from this policy, being in a favored zip code. But a couple weeks later they loosened the requirements, so I'm not sure it mattered much.
Here's another bit from this very long article that I somehow haven't reached the end of yet. The US had an official website for finding vaccines, called VaccineFinder. Why didn't it work very...
Here's another bit from this very long article that I somehow haven't reached the end of yet. The US had an official website for finding vaccines, called VaccineFinder. Why didn't it work very well?
As I’ve mentioned, software problems are people problems.
The US had negotiated spiritedly with pharmacies to get them into the FRPP. Some of those pharmacies requested, as a condition of their cooperation, that availability data based on their (mandatory) reports to the CDC not be published.
Why would a pharmacy do that? Some didn’t want bad publicity. Again, brute logistical reality meant that seekers were going to outnumber doses for the first few months. Everywhere was going to be out of stock most of the time. While that was a good thing, because we wanted shots in arms, not shots in freezers, people would be furious at the chains showing little supply.
Being desperate, the United States of America agreed.
[...]
Some pharmacies believed that their pharmacists, individual people with names who report to a known address daily and whom they owe a duty of care to, would be targeted for harassment or worse for administering the vaccines. They accordingly wanted the government to scrub the data, which included, e.g., the names and phone numbers of pharmacists signing off on required reports, of information which they believed would put their people at risk.
Being desperate, the United States of America agreed.
It may have not realized it was agreeing, because this one was subtle: The system, long since built and used for routine vaccinations (this was why it was picked!), had an opt-out button and a pharmacy chain ticking it per their standard operating procedure meant, now in the context of the Covid pandemic and not the years-ago flu shot, that America’s vaccine site would not display their doses at all. No one felt like they had the authority to swiftly un-negotiate or simply technologically dismantle a promise made by the United States of America.
Meanwhile, the other half of the doses were being distributed by the states, which he speculates caused other problems:
[M]any governors were not in on the plan. But it gets worse. Since the optics would be terrible if America appeared to serve some states much better than others on the official website that everyone would assume must show all the doses, no state doses, not even from states that would opt in, would be shown on it, at least not at the moment of maximum publicity. Got that? Great. (This theory is a theory, from a person with much more experience in DC than me.)
This gave VaccinateCA an advantage:
VaccinateCA had no negotiated nondisclosure agreements with pharmacies. Nope, we had the default deal under the First Amendment: a near absolute right to publish true information, made even stronger (under the jurisprudence and traditions of the US) because we were operating on an issue of intense public concern.
The government of the United States is an intrinsically political entity. We were formally nonpartisan (and even better, as a 501(c)(3) nonprofit, had to be). Informally, to quote a memo I wrote early on, we would do a deal with the devil himself if it got one more patient one more dose. We didn’t need to worry about compromising anyone’s reelection chances by being too maniacally focused on shots in arms to consider the big picture. We had no responsibilities to allies in our party, like not overshadowing their efforts, because we had no party and, for that matter, no shadow.
I knew that many political actors wanted to hoard the facts of their operations so that they could claim credit for them. I just didn’t particularly care. If an actor had a dose available to the public, it was going to be publicized anywhere we could cause it to be.
A long article by Patrick McKenzie, who was CEO of VaccinateCA. He also announced on Twitter that he's leaving Stripe at the end of the year. I guess that means he's allowed himself to get more political than he usually does.
From the article:
[...]
[...]
At the time I benefited from this policy, being in a favored zip code. But a couple weeks later they loosened the requirements, so I'm not sure it mattered much.
Here's another bit from this very long article that I somehow haven't reached the end of yet. The US had an official website for finding vaccines, called VaccineFinder. Why didn't it work very well?
[...]
Meanwhile, the other half of the doses were being distributed by the states, which he speculates caused other problems:
This gave VaccinateCA an advantage: