A Vaccine Has Arrived and the U.S. Is Still Screwing Up
Magical thinking doesn’t work to stop pandemics
I really don’t know why anyone is surprised by recent revelations about Covid-19 vaccine manufacturing and distribution snafus. For nine months, our government has failed to create working supply chains for both testing and personal protective equipment (PPE). We still lack raw materials, manufacturing capability, data on need, logistics, price supports, and equitable distribution. Why would we expect vaccines to be different?
Back in March, many of us called out that the health care supply chain was broken. I wrote about it with Ashish K. Jha and Valerie Griffeth in the New England Journal of Medicine. Nothing that we talked about or called for has been fixed. Instead, the feds developed a mess of a system to meet our health care systems’ PPE, testing, and other supply chain needs — a “fumbling” effort by “inexperienced” people with no background in supply chain logistics, manufacturing, disaster preparedness, or health care.
We learned very early in this pandemic that our national strategy was one of bluster and photo ops — not one of doing the hard work to get supplies into the hands of those who need them.
Alarm bells have been ringing for months about the lack of strategy for vaccine manufacturing, distribution, and messaging.
In the face of immediate need for PPE, we set up workarounds — groups like Get Us PPE developed data networks and equitable distribution strategies. For testing, the country relied on public-private partnerships, like Rhode Island’s (and other states’) partnership with CVS.
But let’s be clear: these efforts are simply substitutes for a federal strategy.
They are in no way equivalent to a good, organized, 50-state, publicly funded effort — which brings me to vaccines. Alarm bells have been ringing for months about the lack of strategy for vaccine manufacturing, distribution, and messaging.
In September, Trust for America’s Health, a nonprofit, and David Lakey, vice chancellor for health affairs at the University of Texas, wrote a piece for STAT imploring “Operation Warp Speed” to come up with a plan. Simultaneously, potential breakdowns in the cold-storage distribution chain were highlighted by Ed Silverman and others.
In October, the Association of State and Territorial Health Officials sounded the alarm that they still had no funds and no federal guidance on strategy. As of November, despite knowing that multiple phase 3 trials were nearing the end, and despite earlier promises to release vaccines pre-election, there was still no central repository for distribution plans, according to Kaiser Health News.
Not to mention the fact that months on, few people in positions of authority are talking about how to handle long-standing, well-founded mistrust from Black and Brown communities.
Without trust, even the best supply chain is useless.
With consumer confidence in the federal government at an all-time low and misinformation campaigns at an all-time high, even health care workers have expressed hesitancy about the vaccine.
Meanwhile, the guy who is directing Operation Warp Speed can’t explain why President Trump is making certain executive orders or why we passed on buying an extra 100 million doses of the vaccine.
Let’s be clear:
- More than 300,000 Americans have died.
- Another 150,000 will likely die before inauguration.
- A vaccine is the best chance we have at getting things back to normal, quickly.
But what good is a vaccine if it stays on the shelves?
So, to those who expect that a miracle will be wrought and Covid-19 will simply disappear? Sorry, not gonna happen. To those who expect that herd immunity will naturally come to pass? Also not gonna happen. Just look at Sweden or New York City. To those who think the states will magically figure it out without funding or clear national guidance? Nope.
For the next 33 days until the inauguration, we’ll just continue to bumble along through the goodwill of philanthropy, the forethought of a few great states’ departments of health, and the hard work of health care workers, pharmacists, and techs who have already sacrificed so much.
And we’ll continue to watch our number of preventable deaths grow.
At the end of the day, despite having sunk billions of dollars into the creation of a vaccine, our feds have failed to close the last-mile gap — just as they failed with testing and with PPE.
To fix it, we need investments in manufacturing and supply chain. We need investments in data architecture and equitable distribution. We need clear public health messaging, stat. Magical thinking doesn’t work to stop pandemics.
This was pulled and lightly edited from my December 8 Twitter thread.
