Frustration Is Spreading Faster Than the Vaccine Is
theatlantic.com
theatlantic.com
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.
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.
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.
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.
Start delivering on demand and the manufacturing supply will take care of itself.
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.
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.
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.
The US is vaccinating fast.
There is a 'rough sequence' that people should be following.
Some gears in the system will be off, and some individuals will act poorly - but that's ok, it doesn't need to be perfect.
Speed of delivery probably takes preference over secondary quibbles about order of priority, as long as there roughly is one.
Take solace in the fact the US is way ahead of other nations, and thank God, because the amount of 'anti lockdown' populism in the US I feel has been considerably higher than in most other places and I don't think the population could handle any more lockdowns or more assertive measures without some very ugly populism in the streets.
Herd immunity by July, one way or another.
I feel that many areas will try to 'rush back to business' once most 65+ are vaccinated and just won't care much beyond that.
I read all sorts of blogs/comments around various news publications, trying to 'get a pulse' and it's a little disturbing to read a lot of comments from people who seem to think that 1-2% of US population 'written off' is just fine from their perspective.
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.
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.
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.
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).
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.
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.
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?
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.
This is not in line with any projections.
In the US it's around summertime.
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.
> This is not in line with any projections.
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.
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.
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.
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.
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.
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.
Maybe if you micro-benchmark it, but capitalism tends to have the food to distribute in the first place.
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.
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.
Amazon, FedEx, Wal Mart, others might disagree.
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.
I take the existence of this system at-all to be emblematic of the general failure of government vaccine distribution.
I’ll offer up my reasoning if asked, but I would like you to think about why I say this and what type of accounting we should actually be practicing.
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.
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.
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.
Because their production schedule is behind on their orders for the UK and the EU.
Frances Kelsey is just another example of bureaucrats flexing their power to aggrandize their own importance.
Frances Kelsey refused to approve the drug despite immense pressure to do so, and thus prevented releasing a drug causing birth defects.
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?
[1] https://www.theguardian.com/world/2020/dec/04/how-vaccine-ap...
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.