coronavirus
politics
The Vaccine Rollout Has Been a Disaster, Here’s How To Fix It
The Production Board
Baylor College of Medicine
0
0
Genesis
Response
January 15th, 2021
I never worry about action, only inaction. —Churchill, 1940
The COVID pandemic rages. 4,000 deaths and $3.3B in lost GDP per day.
With over 100M highly-effective doses of vaccine delivered, or in transit, to the Federal government, and approximately 3M doses being produced daily, we can end the pandemic in 45 days by vaccinating 1% of the population each day. Unfortunately, we are at less than 1/10th that rate, with the vaccination process a maelstrom nationwide.
Getting vaccinated often means finding a care provider with available doses, meeting the qualifying criteria for the currently approved “tier”, having a patient record on file, making an appointment, filling out a multi-page questionnaire, driving to an overburdened site, providing insurance and ID cards, and waiting in line.
None of this makes sense.
Denying available vaccines to the general population (holding doses until “equitable” allocations are meted out first), asking already overburdened hospitals to manage mass vaccinations, and only vaccinating when the appropriate paperwork needed to mitigate institutional liability has been completed, is outright negligent, frustrating a nation already fed up with the effects of the lockdowns and a loss of life not seen in a generation.
Meanwhile, the virus is mutating and, soon, immunity to the current strain may not be enough. Immunization is not about the individual benefit, it is about the group benefit—achieving herd immunity before the virus mutates is the only path to safety for any, and all, of us.
To get this done, we must surge, and we must adopt the requisite attitude—this is a war.
During wartime, perfect is the enemy of good. The perfect person receiving perfect care at the perfect time is not a standard we can afford, or should allow. Speed must be prioritized above all else.
It is time to organize, act imperfectly, but act.
I propose a simple, imperfect approach to accelerate our vaccination effort:
— Use the powers vested in Emergency declarations to eliminate the liabilities and administrative burdens associated with traditional healthcare systems. Eliminating paperwork means trained volunteers can vaccinate more people, faster.
— State governments assume direct responsibility for administering vaccines, letting private care providers focus on patients.
— States set up 1 care center per 100,000 people. These centers can be in high school gyms, churches, malls, sports stadiums, or community centers, or their parking lots.
— National Guard identifies sites, sets up drive thru lanes, coordinates traffic, and ensures adequate supplies are available to support the effort.
— Each care center operates 24/7, with one full-time doctor, 2-3 registered nurses, and 20-30 vaccinating volunteers onsite at any time.
— There are 3.8M registered nurses and 5M+ suitably trained potential volunteers—EMTs, firefighters, nurses, dentists, medical students—and the CDC has specific training materials already available.
— Anyone can drive up or wait in line and get a shot. No ID, no proof of residence, insurance, patient record, or CYA questionnaires required. No denial based on job, health, or age. Two lines—over 65 / under 65—means allocating extra resources to the most-at-risk population can be a priority.
— After their shot, patients wait 20 minutes to ensure no allergic reaction, then go home (0.5% of patients have reactions and will be supported by the onsite doctor and nurses).
— With a 3-minute turnaround time per shot, a center with 20 average active volunteers over a 24-hour cycle, can deliver 10,000 shots per day, 10x the target needed to end the pandemic in 45 days.
— If patients don’t get their second dose, get it sooner or later than recommended, or get more than two doses, that is alright—one dose is 50-70% effective (reducing group transmission rates)—and additional, early, or delayed doses present minimal health risk. Perfect care for each individual is not the objective.
Achieving herd immunity in the shortest time period possible, effectively ending the pandemic, means fighting this war with speed while accepting imperfect individual outcomes. This plan certainly incorporates naive assumptions, but can be implemented in days, simplifying a complex supply chain that is not working today.
We have waited for the science to deliver. The doses are ready. Now, we must surge.
We must win the war.
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