There’s a stark difference between the extraordinary technological achievement of companies developing, testing, producing, and winning FDA authorization to market three vaccines for COVID-19 in less than a year—and the utterly haphazard system for deciding who receive these products and in what order. Montgomery County in suburban Maryland presents a bleak case study: neighbors and friends eagerly share stories about acquaintances who got or did not get vaccination appointments. They scrutinize a Google spreadsheet that provides community anecdotes and success stories, as if trying to read prophecies in tea leaves.
The innovations of the vaccine developers will go down in history as an impressively fast and sophisticated response to an extraordinary global crisis. So why is the process for getting the shots so primitive? Marylanders are left with no choice but to hunt and gather because official websites from Montgomery County, the state of Maryland, and the federal Centers for Disease Control and Prevention (CDC) are uninformative and unhelpful for vaccine seekers. They’ve become a sick joke.
Of course, trying to administer vaccines to all willing adult Americans in the middle of a pandemic is complicated. So, let’s not discuss the large vaccine inventories (the cumulative number of doses delivered to states but not yet administered, ignoring any losses). CDC data imply such inventories, as of March 9, were 27 percent of cumulative doses administered nationally. These estimated inventories, roughly 26 million doses, may reflect some data-reporting delays, but they likely stem largely from providers’ fears of having inadequate supplies for the second doses for their patients. These doses are currently authorized for 21 and 28 days after the first doses for Pfizer and Moderna vaccines, respectively. The CDC has already said the second dose could be delivered up to 42 days later if it is otherwise unavailable; FDA can and should say something similar.
Instead, we should focus on the system of getting appointments. In Maryland, as in other states, people must provide detailed private information to “pre-register” for vaccines with up to ten different government and private providers. They may then be placed on a provider’s “vaccine interest list” or something comparable, but they do not get potential vaccination dates, guarantees of any future vaccination, or even a place on a waiting list.
Without information about status on a waiting list, Marylanders are understandably pre-registering with multiple potential vaccinating organizations. They sit at their computers repeatedly refreshing the webpages hoping for news to post of new vaccine availability. After all, to get an appointment, one has to respond to news or rumors of vaccine availability faster than eligible friends and neighbors. This Kafkaesque system essentially forces people to play a zero-sum game with uncertain, subjective, and unenforceable rules, with no referee, and huge implications for quality of life—if not disease and death.
For perspective, note that this distribution system falls well short of standard practices for managing excess demand at popular restaurants on a balmy evening. When potential diners arrive at a restaurant without confirmed reservations, the host or hostess, oftentimes an adolescent, will typically provide the expected wait-time and the number of parties ahead in the line. As the evening progresses, they’ll confirm the number of parties to be seated first, and provide updates about the wait-time, often via text message or phone call.
In contrast, today’s vaccine distribution system provides Americans seeking vaccines no information about their place in a queue; in Maryland, various providers deny the existence of a waiting list altogether.
The current process to get a vaccine appointment is especially difficult if not impossible for many older and essential workers who lack the skills or time to systematically and quickly search websites. It thus runs rough-shod over the equity concerns identified by the CDC—to provide vaccines first to underserved and higher risk populations. There are many heart-warming stories of youths volunteering time and energy to help relatives or acquaintances navigate the computer systems and book appointments, but the fact that such help is so necessary is shameful.
Worse, the criteria for eligibility—determined by guidance from the CDC and influenced by concerns over equity—involve personal questions with subjective and or unverifiable answers. Montgomery County asks about employment in “industries,” including “grocery store,” “information technology and communications,” “finance,” “manufacturing,” and “media,” as well as “other essential workers”. Maryland asks 11 questions about work that conflate occupation with industry of employment, and lack specificity.
Is a yoga instructor in the educational sector? Are accountants teleworking in finance or manufacturing workers to be treated the same as cashiers in grocery stores?
Questions soliciting subjective and unverifiable answers invite deception. A distribution system reliant on subjective and unverifiable data cannot be fair or equitable and invites deep cynicism about government competence.
The requirement to search among multiple websites for vaccine appointments—and to do it faster than others in the community—is a substantial and avoidable burden, somewhat akin to preparing tax forms. A lottery based on one’s birthdate or the last 4 digits of a social security number would be simpler, efficient, and fairer, especially to those without high-speed internet or time to search online for scarce appointments.
The burden of searching for appointments may be small relative to the full value of the vaccines, i.e., the protection they give from COVID or their implications for reopening the economy, but it is in principle avoidable. Americans know how to wait in lines for scarce goods, provided their place in line is identified and the process to get a place in line is known, transparent, and fair, as with a lottery.
Thus, the vaccine problem is not merely that there are insufficient vaccine doses to meet demand. It is that the vaccine distribution system is woefully short of the restaurant standard—people cannot get a schedule explaining when they might expect an appointment to get a vaccine.
Governors need to immediately adopt simpler systems respectful of citizens’ needs and prioritize vaccinations using only objectively verifiable data, like age and job function for certain certified registered workers, e.g., registered nurse or licensed schoolteachers. Important qualifying health conditions, such as being immune-compromised, ought to be acceptable only on an opt-in basis based on medical records from licensed healthcare providers. In addition, the Biden Administration and Congress must recognize the scope of the vaccine distribution debacle. The new Administration should immediately take steps to ensure accountability and transparency, and governments—federal and state—need to prevent similar fiascos in the inevitable next pandemic.
Taxpaying citizens ought to get a government that treats them with the same courtesy and respect they get at popular restaurants on the warm summer evenings that we all eagerly anticipate.
This piece originally appeared at RealClearHealth
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Randall Lutter is a senior fellow at the Manhattan Institute.
This piece originally appeared in RealClearHealth