Here in America, where covid-19 infections and deaths have recently been setting ever higher records, thousands are dying every day. Meanwhile, Britain has closed schools and locked down nationwide (again) to contain the spread of a new, more contagious strain that threatens to capsize its health-care system. South Africa’s hospitals are also struggling to cope with another more contagious mutation, and there are concerns that existing vaccines may not be effective against their variant.
The British strain is known to be circulating in the United States, and the other variant may be here as well. Which means that our vaccination program is more urgent than ever.
You wouldn’t know that, however, from state vaccination efforts.
South Dakota, which recently took a lot of well-earned flak for its poor pandemic control, leads the country in the share of its vaccine doses injected — yet it has barely used 60 percent of its stock. Six other states have managed to use half of their allotments. The rest of the country lags, in some places by a lot: One half of states have given out only about a quarter of their available doses.
Sure, the holidays slowed distribution efforts. But it’s not as though Christmas or New Year’s were surprises. States could, and should, have treated this like an emergency rather than a normal holiday.
Such a broad failure across large states and small, red states and blue, makes it tempting to blame President Trump rather than the states themselves. But while the federal government could have moved faster in getting doses delivered, the states actually distributing those doses aren’t giving out what they have. It wouldn’t help much to stuff even more vaccine in their freezers.
The federal government certainly could have given states more money to help with the rollout. But if cash were the main problem, it’s unlikely that low-tax states such as Tennessee and South Dakota would be outperforming California and Maryland by comfortable margins. Moreover, as economist Tyler Cowen points out, the funding states requested from the feds, which was delayed for months by political wrangling, amounts to 0.3 percent of state and local budgets. If those governments couldn’t reallocate that small percentage to allay the greatest public health crisis in the last century, they failed at their most basic function.
That said, the poor performance of the states points to one concrete federal failure: the Centers for Disease Control and Prevention committee that recommended an elaborately phased vaccination schedule. Last month, that model became a public scandal when people realized its prioritization of “essential workers,” such as transportation workers, over senior citizens would cost more lives on net — a trade-off the committee had accepted in part because its members believed that helped rectify the injustice of racial and economic health-care disparities.
But that now seems the much smaller scandal. What’s truly worrying is that the CDC’s committee of handpicked experts recommended an extremely complicated plan to state governments that seem incapable of carrying out even the first, simplest phase in a timely manner: vaccinating health-care workers and people in nursing homes, all of whose names and locations are pretty well known, and who are gathered together at the kinds of facilities that routinely vaccinate people.
There’s a legitimate argument over what kind of sacrifices we should collectively make to address long-standing disparities in health outcomes. But such debates are academic if there’s no realistic hope of executing your elaborate reparative program. It should have been obvious from the start that prioritizing large occupational categories was going to be more complicated than vaccinating “people in and around hospitals or nursing homes” or “old people,” and that this mattered.
With no central list of every grocery clerk, truck driver or meatpacker in this country, how were states supposed to notify those listed for vaccination? How would states verify shots were going into the right arms? How many doses would be given to the wrong people, or wasted because not enough people showed up?
Senior citizens, on the other hand, are all on Social Security rolls, though even that’s hardly necessary. Announce that vaccination is open to everyone over a certain age, then check driver’s licenses or passports when people show up. Don’t have either of those documents? Vaccinate them anyway if they look like they’re within striking distance of the right age. Senior citizens don’t show? Give it to the next-oldest-looking person you can find. Then repeat with a lower age until everyone’s vaccinated.
Is this ideal? No. But it’s better than that: It’s feasible. It’s obvious now that states needed to do a lot more planning. But they also needed a plan so simple no one could screw it up.
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