Rethinking Our Vaccine Distribution System

I won’t pretend I got this right ahead of time, other than a sort of generic ‘recognize get vaccinated will be harder for some people than others’, but it’s becoming increasingly clear that, in the U.S., our distribution system for vaccines–’getting shots into arms’*–really isn’t meeting the needs of too many Americans (boldface mine):

We can aim our shots better by strengthening five platforms:

  1. Community vaccination sites, but with a twist. Allow no-appointment, walk-in vaccinations for residents of high-prevalence areas (offer it to them first, then everywhere). Vaccination clinics need extended hours every day to maximize access. Too many people, especially older people, find it difficult to navigate the path to vaccination.
  2. Ramp up vaccinations in doctors’ offices. Shots should be offered at every medical encounter, including dental, optometric and mental health visits. Some states are starting to do this, but many are not.
  3. Pharmacies, especially pharmacies in communities with the highest case rates, should provide walk-in, fast-track vaccination.
  4. Expand vaccination capacity to workplaces. Many worksites conduct vaccination clinics for seasonal flu each fall and, as workers return, can pivot to COVID-19 vaccination. Most of the more than 120 million full-time workers in America want the vaccine, and employers want them to get it.
  5. Offer vaccination in community sites, including shopping malls, bars, restaurants, churches, dollar stores and community events. It will be critical to strengthen partnerships with community-based organizations in the communities most at risk.

My impression is that most state and local governments built mass vaccination facilities, but, given the slow roll out, these facilities often were overkill, and had drawbacks such as inaccessibility. They are good for people who can navigate an atypical medical system–you don’t navigate a special government website to get a doctor’s appointment–and who have the time and, usually, a car.

Many people typically access their medical care through a doctor or clinic, along with a trusted pharmacist. In addition, the requirement in some places (especially at pharmacies) to have healthcare information for reimbursement purposes (government and businesses are trying to shift costs to insurers) seems to be a hidden, but non-trivial impediment to making appointments. Some people don’t have their healthcare insurance information handy (or know it at all), and I suspect some people are quitting at that stage, especially if they’re a little hesitant to begin with. This is where a little socialism would go a long way.

I can’t speak for other states, but in the mainland colony of D.C., pharmacies initially had a hard time dealing with the D.C. government, and in many wards, weren’t able or willing to vaccinate**. I know of one private pharmacist who was frustrated a couple of week ago, because his pharmacy was going to call all their elderly and disabled patients and make sure they had appointments, but couldn’t do so. Now, that’s changed, and we’re faced with the bizarre reality of pharmacies in many neighborhoods having excess appointments. In other words, we now have mismatches between availability and need: two or three weeks ago, I would have loved to get vaccinated at the CVS a block from my house, but now, it’s kind of irrelevant (my vaccinations have already started elsewhere).

Meanwhile, doctors and certain pharmacies don’t have enough vaccine. I think if we hadn’t had so much vaccines overall, Biden would have been in far more trouble politically because we really didn’t do a good job in terms of distribution or in recognizing the needs many people have.

*I hate pseudo-military phrases. I really do. We have a verb for this, and it’s fine.

**As best as I can tell, the pharmacy shortage was in the better-off parts of the city, which led people to use pharmacies in other parts of the city, which, in turn, led to all sorts of equity issues, as well as problems for people with mobility issues in those areas. The typical D.C. policy of provide only lower-income people services, and leave everyone else to fend for themselves really didn’t work so well in the case, since (most) everyone wanted a vaccine.

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1 Response to Rethinking Our Vaccine Distribution System

  1. Joe Shelby says:

    Northern Virginia did reasonably well on some of your criteria. Here in Loudoun, they used an empty anchor store (2-stories at that) at Dulles Town Center for everything (CVS which included Target stores could also handle seniors prior to the Phase 2 GA). Granted, DTC is as much as 45 minutes away from some parts of the county…but then again the west of the county is full of “masks don’t work open up the schools open the churches” types who may not have bothered with it.

    When J&J got approved, I expected corporations would start to pick things up on that as an option since the Feds were already handling the 2-shot brands. The corporations would be working with their corporate insurance provider who would then lobby the Feds for a little compensation (in particular, this seemed like precisely the kind of thing Kaiser loves to do). However, Biden stepped in with the Feds making the big purchase of Jansen instead by getting Merck into the deal.

    I can understand why – Trump had made a mockery of Federal logistics, and intentionally so – he was put in place by those of the right-wing who have insisted that the government doesn’t work, and then set out to prove it every time they get any power. So while a private-public arrangement that we generally like to see could have worked if handled well, Biden saw his first job as restoring faith that the government does actually work when given the chance and isn’t sabotaged. The country needed the confidence boost after the last 4 years.

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