D.C.’s Data Problem

And I mean the District, not Wor-Shing-Tun.

While most people focus on D.C. statehood as a way for Democrats to gain two Senate seats (and a House seat), it actually would make a difference in the lives of D.C. residents. If you’re even remotely a data nerd, one of the constant frustrations is that D.C. is left out of analyses. The fifty states will be discussed and analyzed, but D.C. is ignored*. Granted, D.C. has more people than two states, and is fairly close to several others in population. In terms of GDP, D.C. is not small at all, and, of course, we not only have taxation without representation, but extreme taxation without representation.

Right now, D.C. is getting screwed on the vaccination statistics. The CDC numbers include things like allocations to federal agencies, which have no plans to vaccinate D.C. residents. The only trustworthy data from CDC appears to be the percent of residents who are partially or fully vaccinated, as that number is based on the residency of the vaccine recipient.

This might sound minor–it’s not like when Congressional Republicans prevented D.C. from having needle exchanges, leading to hundreds of unnecessary HIV infections–but the problem is no one in D.C. really knows if we’re doing a good job of vaccination. That is important. In fact, a surface perusal of the data would incorrectly lead one to conclude D.C. is doing a poor job (boldface mine):

Ultimately, about one-third of all vaccine doses administered thus far within the District—more than 94,000—have gone to out-of-staters. Another wrinkle is that vaccine allocations for the roughly 141,000 people who work at the federal agencies within D.C.’s borders come out of the District’s population-based ration, even though the District doesn’t administer those doses. The upshot is that D.C.’s population-based vaccine allotment—44,440 this week, the third-smallest allocation in the country, after Wyoming and Vermont—likely falls short by one-third to one-half. How could that happen?

Because D.C. isn’t a state. If a federal agency isn’t serving a state well, it can expect to hear complaints from that state’s congressional delegation. But D.C. doesn’t have a congressional delegation. It has one delegate to the House of Representatives, Eleanor Holmes Norton, who is one of the very best members of Congress—but who is not permitted to vote on the House floor. Norton can vote in committee, but she doesn’t sit on the House Appropriations Committee, so she can’t bring HHS to heel by threatening to cut its budget. No D.C. delegate has ever sat on Appropriations. Were Norton to chair some other House committee, she might have the means to intimidate HHS, but no D.C. delegate has ever held a full committee chair, either. When District residents complain of “taxation without representation,” this is what they’re talking about.

Blame HHS for the fact that the District has inoculated so few of its residents; the department is not giving the District enough vaccine doses. Blame Congress for resisting D.C.’s demands for statehood, which would give the capital more clout in such situations. As for D.C.’s poor efficiency record at delivering the few doses in its possession, the city government’s performance may not be quite as bad as it looks.

Ankoor Shah, who’s leading the vaccination program in the District’s health department, believes that the CDC’s 72 percent efficiency statistic is just wrong. Here’s how Shah explained the problem to me: The doses allotted for D.C. are deposited into three buckets.

Bucket 1 is the D.C. health department. “D.C. has complete control over that,” Shah said.

Bucket 2 consists of community health centers and pharmacies that have partnered with the federal government through two programs managed by the CDC and the Health Resources and Services Administration, a unit of HHS. The District has a supervisory role here, but in practice, Shah, told me, “it’s more a collaboration, because we can’t make those strategic decisions for them about how to order doses.”

Bucket 3 consists of federal agencies located inside the District. These agencies receive vaccines for employees who work in the city. The District has no supervisory role here at all, and Shah told me he’s been unable to glean from the CDC any information about how many doses are being assigned to these agencies and how many are being used. “That’s a black box,” he said. (For what it’s worth, the federal agencies’ vaccination performance across all 50 states is a respectable 79 percent.)

The reason the CDC’s efficiency score for the District is so dismal, Shah said, is that the CDC includes all three buckets in the denominator (total vaccine doses delivered in D.C.) but only Bucket 1 and Bucket 2 in the numerator (total vaccine doses injected into arms). I asked the CDC press office to confirm this assertion, and to clarify, percentage-wise, how D.C.’s vaccine allocation is divided among the three buckets, and what proportion of each bucket gets used. This query, made by email and in repeated telephone calls, went unanswered over three business days.

The District finally addressed the garbage-data problem on Monday, by releasing a breakdown of Bucket 1 and Bucket 2. Bucket 3 remained a black box, but for the first time it was possible to assess what was going on in the first two buckets. The District’s overall efficiency was, by this reckoning, a still underwhelming 76 percent, putting it in the bottom third among the states.

But the D.C. health department’s own vaccinations—Bucket 1—are efficient. The health department has gotten 85.3 percent of the doses it’s received into people’s arms. That’s better than California and New York (78 percent), better than the adjacent states of Maryland and Virginia (78 percent and 82 percent, respectively), and better than the national average (78 percent).

D.C.’s overall efficiency is poor because of Bucket 2. The community health centers and pharmacies that partner with the federal government have received 17 percent of the District’s allocation (not counting the opaque Bucket 3), but they’ve failed to administer most of these. When I say “most,” I mean quite literally “the large majority.” Bucket 2’s efficiency rate is a dismal 21 percent….

In the meantime, some D.C. residents are giving up on their city altogether and crossing into Maryland, where more groups have become eligible for vaccination and residency is not always required. The state isn’t exactly advertising this fact, but word is slipping out. It beats waiting.

And this kind of thing happens far too often. Statehood can’t come soon enough.

*Unless you want to say something nasty about Black people or Democrats, then opinions are like assholes (everybody has one).

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  1. Pingback: When D.C. Becomes a State, Our Wards Need to Become Counties | Mike the Mad Biologist

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