Bottlenecks and Resolutions
Happy New Year! Like most, I am happy to put 2020 behind me. Other than our revival of the Washington Health Foundation, there was little this past year to celebrate. On to a better year- starting with a resolution for better health for all.
Achieving this better health seems directly linked to our success with the distribution and efficacy of COVID-19 vaccines. Our Healthiest State in the Nation program of years gone by (washhealthfoundation.org) included an annual New Year’s Resolution challenge. It sure seems like our 2021 resolutions need to start with one to make this vaccination work, and soon.
The scourge of the virus is now bursting on top of the Thanksgiving surge, reaching record heights nationally and in many states. To add to the threat, the virus is also changing, with a new variant strain that spreads even faster now among us.
Social distancing and masks will continue to be important tools in our defense this year. We must resolve to be vigilant in these efforts as we work on the bigger solution- vaccination.
My last WHF blog discussed the problem that historic and general public resistance to vaccinations will present to our solving the danger. But, with the start of the new year, the greater problem is not really this but the slow distribution of vaccines to people quite ready to take them. Tens of millions of doses have already been manufactured and much more is on the way. Yet, as I write this, we have only actually vaccinated a little over 4 million people.
Getting a handle on the problem is a bit hard. The feds blame the states, the states the feds, and private-public partnerships are tossed around as if the term means something without clearer specifics of the relationships and accountabilities. I find myself incredibly frustrated with the slow pace of vaccination, and the continued insanity of Americans politicizing a critical public health response to the worst medical threat to our health in the past century.
Let’s dispense with the blame game by just saying that a strategy based on using our current fragmented patchwork of a health system to deliver a vaccine without some direct and strong tactical guidance was a foolhardy premise. The time may be past where we can put that mistake back in the bottle, as implementing a new national grand strategy for getting people vaccinated would take even more time now.
We must find a way to get vaccines on the fast track by building quickly on the hand we already got. What would I do? I would allow the positive things that have been developed with regard to vaccinations to continue, while adding some practical solutions to the mix.
First, let us acknowledge that it is remarkable that we have these vaccines, and that the data on efficacy and safety is so positive. And that we have several of these in play already. Keep up the research and development - including for additional vaccines- and keep the scientists in charge of this.
There was also good work done to produce supply in advance of approval for use, successfully making the very expensive bet that these vaccines would be of use. As a nation, we are also really good at producing things in mass, and quickly. If need be, it looks like the Biden Administration will be willing to use federal defense law to ramp up supply.
There has also been some good work by the Centers for Disease Control to outline priorities for vaccination. It is a good framework for considering a rational staged delivery of the vaccine. Health care workers must go first, and the elderly in nursing homes and other congregate care centers have borne the brunt of deaths to date. And, as I have written before, there is no denying the need to deal with the racial and ethnic health disparities at play with COVID-19 and health and health care in general.
I am also fine with letting the states adjust these priorities to their circumstances, within reason.
It is how our federated system works, and if a state sees a need to move a group up or down based on local realities, let this be. Unless they start doing it on the basis of politics or money, or some other biased consideration.
If science shows we can extend the supply by lowering the dose amount, sure. As long as science is what is dictating that decision.
The major addition I would make is to take a portion of the vaccine supply that is now sitting on shelves - including national reserves- and allow those who are ready and willing to take the vaccine to do so, now. The people on the prioritized lists are in most cases on the list for a reason- and this reason in many cases will add time to the process of actually getting them the vaccine.
We can and must work through such issues, but we can do so while also allocating a certain amount of our growing vaccine supply to start mass immunization sooner rather than later. If need be, limit this to certain groups in the beginning, such as those in certain age brackets or service industries or whatever.
Use retail pharmacies to start getting the doses into people’s arms- they know how to do this with flu shots and can rapidly get this rolling and to scale, and in an organized way, including record keeping. As our supply grows, this distribution method will then be well oiled for the rest of the population.
The logic of this is that we need to get down the path to herd immunity with a lot more speed, if nothing else to stay up with the impact of the current faster spread of the virus. Otherwise, COVID might overwhelm our health care system- as it has begun to do in some places already.
Millions of Americans are ready to get their shot- such as most likely almost all of us who have no problem getting a shot each year to help prevent the regular flu. Heck, we can make having done that be one of the criteria for getting this vaccine, as many of us did so through retail pharmacies!
Importantly, I am saying we can work through the prioritized lists and the beginning of more general vaccination at the same time. It is not that hard to do- like walking and chewing gum at the same time. The first decision is dividing up the supply into two pools of action.
Again, we need to focus on prioritized need AND speed up the need for mass immunization. That should be our New Year’s Resolution for 2021.
And, one more thing. If any politician gets the vaccine outside of either of these processes, we should take their pay away, if not their office. I found it shocking and disturbing to see politicos getting their shots, especially those who found it so easy to trash public health recommendations as the virus raged across the Nation this past year. Enough of the nonsense and hypocrisy already.
To all, a happy and healthier new year.