Now What: Federal Vaccine Distribution in the United States

With the release and emergency approval of a COVID-19 vaccination, the light at the end of the tunnel has appeared for many; what remains to be answered is how many, and how soon. The gross mismanagement of vaccinations on the part of the Trump Administration has been a cause of strife amongst many in the medical community and population as a whole. As of January 3, an average of over one thousand individuals have passed away each day as a direct result of the COVID variant. The need for a vaccine is more pressing now than ever, and though several are in production, the tragedy of every life taken is only further exacerbated by the inadequate and underdeveloped distribution plan. After promising twenty million vaccines in the month of December, as of January 6 under six million have been provided. Even if the widespread misinformation, anti-vaccination movement, and indifference towards already critically disadvantaged and underserved communities are put aside, the United States government has still fallen drastically short of its promises to the American public. While healthcare workers and long term patients and currently in the process of vaccination, the CDC published a seventy five page interim playbook – yet the contents are shockingly simple and arguably underdeveloped.

Before beginning to discuss the administration’s plan of distribution, it is important to first recognize that the current distribution of vaccines is the product of many months of planning, but still suffers from chaotic enactment and unforeseen consequences. Overseen by Gustave Perna, a four-star general and ‘logistics expert,’ Perna has taken personal responsibility for the shortcomings of the plan; however, it must be recognized that he alone did not make these decisions. Equitable and strategic distribution is not a clear cut topic, yet the lack of medical professionals overseeing and drafting the framework, alongside disregard for state input, have resulted in an underperforming committee, with vaccines remaining in storage without direction, with some even expiring. Furthermore, even if the guidelines set were followed, the framework is simple and thoughtless in terms of distribution.

Under a conservative executive branch, President Trump and his administration have taken on the traditional Republican stance, endorsing a small government approach. Yet, as in the past, the current administration’s concept of federalist balance is not only off par with that of a past presidencies, but not directly following Republican party’s small-government and states rights stance as well. After coming under fire last spring for irresponsible redistribution of medical supplies to supporting states, and repeatedly blaming state-level officials for COVID-related shortcomings, the administration has once again placed responsibility, including that of equitable and efficient distribution, in the hands of states. The number of vaccines allocated are dictated according to the adult population of a state, which is where the greatest of the issues begin. Such a number does not take into account states suffering with the highest COVID rates, those with larger vulnerable populations, or those with a greater number of healthcare facilities. While twenty million vaccines is enough to vaccinate the entire at-risk population, the present distribution model will result in less vulnerable populations in some states with low COVID rates being vaccinated before high-risk groups in others, in particularly eighteen states and the District of Columbia. Virginia and Massachusetts have both pledged to donate eight thousand vaccines to the District of Columbia, but the very need for such a transaction makes apparent the need for further and more thoughtful federal involvement. When asked to justify the distribution plan, Health and Human Services Secretary Alex Azar stated, “We wanted to keep this simple.” However, the model mirrors the highly criticized distribution of the H1N1 vaccination in 2009 and 2010, rebuked as ineffective by the MIT research facilities. Of course, thoughtless distribution between states is not the only consequence of this approach.

When basing vaccination on a state level, lobbyists have expanded say in the determination of distribution amongst hospitals and groups. Protocols differ from state to state as the CDC has imposed unenforceable ‘suggestions’ for vaccination. Healthcare workers complain of low-risk administration getting priority on the vaccine in private hospitals, and while the idea of vaccinating politicians to build trust amongst the American people is well-founded, it has led to a sense of unease concerning the privilege enjoyed by the nation’s most affluent and powerful. Further, the process of sending and administering vaccines has already been monopolized in our capitalist system: CVS and Walgreens are to be responsible for administration in nursing homes, and Pfizer is to be accompanied by UPS and FedEx in the shipping process.

While American outrage has been minimal thus far, it only takes a glance at a few other European nations to see the contrast. While the ineffective and inefficient distribution scheme of the United States may rightfully cause many to reconsider the efficiency our present healthcare system, nations such as Belgium and the United Kingdom still stand as examples for alternative distribution plans. With Belgium’s central system, invitations are systematically sent out to allow orderly vaccination, and all are free of charge and on a voluntary basis. The United Kingdom, while having questionable success with the three-tier austerity measures, has composed and enforced a priority list, and vaccine distribution has been sent to fifty National Health Service trusts, responsible for all hospitals in the nation. This has undoubtedly been assisted by the near universal healthcare system, and again calls for reconsideration of our present privatized and profit-driven healthcare system. Of course, competition is both healthy and necessary in medical research, as the vaccine itself is a product of such competition, yet perhaps there are some regards in which competition can be detrimental – such as when it comes to saving lives.

Every death since the conception of the vaccine has been not only a tragedy, but a potentially avoidable toll, and with each death, the blood of American citizens pool on the steps of the White House. Now is not a time for simplicity. We cannot be cutting corners, and we cannot be doing anything less than the best, especially when American lives hang in the balance.