Why the Vaccine Distribution Went Badly

February 2021

It was all going too well. The Trump administration’s Operation Warp Speed pumped billions into helping private companies develop COVID-19 vaccines in months rather than years. By mid-December two stunningly effective vaccines were approved for use, and tens of millions of doses had already been manufactured. Health and Human Services Secretary Alex Azar predicted that 20 million Americans would be inoculated in “the next several weeks.” You could almost hear the country prepare to breathe a sigh of relief.

But then Operation Warp Speed hit a nationwide speed bump. Shipping the vaccine to thousands of distribution points went more slowly than anticipated. And even with doses on hand, health-care organizations, pharmacy chains, and state health officials weren’t initially prepared to administer shots at the hoped-for pace. By the time the New Year’s ball had dropped in Times Square, fewer than 4 million people had been vaccinated. At that rate, it would take years to inoculate the entire U.S. population.

The press responded to the news with a mix of dismay and poorly concealed jubilation. “Trump’s rollout of the COVID vaccine is an utter fiasco,” crowed the Los Angeles Times. An “astonishing failure,” echoed a New York Times editorial. You could almost sense their relief; they wouldn’t have to give the departing administration grudging credit for a public-health victory after all. Instead, they labored to uncover any screw-up—no matter how localized or inconsequential—that could be laid on the White House lawn.

“We came all this way to let vaccines go bad in the freezer?” the New York Times editorial page asked. The editors then offered a list of vaccine snafus. Some doses were “nearly wasted” when a nursing home ordered too many shots (actually, they were just given to others); a Palo Alto hospital vaccinated a few older administrators before some frontline workers; and in Wisconsin, some 500 doses were deliberately spoiled by a disgruntled pharmacy worker. No doubt if a random nurse had dropped a single syringe, that too would have been scratched up to Trump’s mismanagement.

In reality—and despite some setbacks—the U.S. is vaccinating its citizens at a pace almost unmatched in the world. Only China has administered more doses (of largely untested vaccines, it’s worth noting). And only Israel, Bahrain, and the UK have immunized larger percentages of their populations.

Still, the bumpy rollout of the COVID-19 vaccines reveals some troubling weaknesses in how the U.S. is handling this health emergency.

Some of these concerns can be blamed on Trump and his Warp Speed team. But others reveal the frightening ways in which progressive political ideologies have infiltrated our public-health system. While early-20th-century progressives focused relentlessly on health for all—with food- and drug-safety laws, sanitation improvements, and anti-malaria efforts—today’s progressives have a different focus. For too many, the question isn’t how to save the most lives; it’s which lives deserve to be saved.

But first, what went wrong with the vaccine rollout? For one thing, Operation Warp Speed officials seem to have underestimated the difficulties they would face setting up a distribution network for a highly perishable, time-sensitive product. Both approved vaccines must be kept frozen during shipping—at a stunning –70 degrees Fahrenheit in the case of the Pfizer-BioNtech version. Once thawed, the Pfizer vaccine can be kept under normal refrigeration for five days before expiring. Moderna’s vaccine lasts 30 days. Maintaining that “cold chain” is a challenge. In the frozen-food business, companies plan for a standard 2 percent spoilage rate, though losses of up to 5 percent are common, according to an industry expert I talked to. Nothing close to those levels of spoilage has been reported so far in the distribution of COVID vaccines. But cold-chain issues have complicated matters. For example, some batches of the Moderna vaccine allocated to a Texas medical center were delayed due to fears that their shipping-crate temperature sensors might be unreliable.

Poor communications compounded the problem: Instead of telling the public to expect some initial glitches, the administration trumpeted its rosiest scenarios. (“Underpromise and overdeliver” was not the sort of management advice much heard in the Trump White House.) But the kind of upstream distribution issues we’ve seen are among the easier problems to fix. Writing for the ardently anti-Trump Mother Jones, Kevin Drum compared the vaccine snags to the initially troubled rollout of the Obamacare website, predicting that “people will soon forget that it ever happened.” A tougher problem is planning for that “last mile” of vaccine delivery. The military officials who help lead Operation Warp Speed might have seen distribution as mostly a logistics challenge. But, as Claire Hannan, executive director of the Association of Immunization Managers, told the Wall Street Journal, logistics is the easy part: “Getting it into actual arms is the hard part.”

And which arms should those shots go into? The Centers for Disease Control assembled a panel of epidemiologists and medical ethicists to advise on which groups in U.S. society should receive those precious early doses. The panel recommended that health-care workers and residents of nursing homes get the vaccine first. No one argues with that. But who’s next? If our goal is to reduce overall deaths (as well as the burden on hospitals), it makes sense to vaccinate older people en masse in the second wave. After all, roughly 90 percent of U.S. COVID-19 fatalities have involved people age 55 or older.

But wait! It turns out that racial and ethnic minority groups are “underrepresented” among the nation’s older population, the committee noted. Meanwhile, minorities make up a disproportionate share of workers in “essential industries,” such as grocery stores. Since one of the committee’s stated goals was to “promote justice”—i.e., redress historical inequities in health care—the progressive logic was inescapable: Millions of young, healthy “essential workers” should be vaccinated before most older adults, the panel concluded.

In their report, the committee acknowledged that their recommended strategy would lead to many more deaths than the old-folks-first approach. That didn’t deter the committee from the plan. “Justice” doesn’t come cheap. After some pushback, the CDC eventually opted for a somewhat more sensible strategy. But a lot of damage had already been done. Weeks that could have been spent helping states craft mass-vaccination campaigns were instead spent debating who needed to be pushed back in the inoculation queue. By early January, for example, the Virginia Department of Health was still “reviewing the recommendations” for who would be eligible for early vaccination. The department’s website promised to “provide further guidance soon.” During this period, Virginia was recording an average of over 4,000 new COVID cases per day.

Some states, including West Virginia and North Dakota, are following straightforward approaches focused primarily on vaccinating the elderly. Not surprisingly, both those states have managed to do far better than most in getting doses into arms. New York, on the other hand, announced a more Byzantine strategy, one that put young residents of drug-treatment facilities, among others, ahead of most elderly people. (After a sharp backlash, the state eventually expanded access for residents 75 and older.) And woe betide any health-care provider that deviates from the protocols. One New York health-care network that briefly offered vaccinations to elderly New Yorkers who weren’t in the highest priority group is now under investigation by the state police and the department of health for “health-care fraud.”

In a classic case of “elite panic,” New York Governor Andrew Cuomo announced an executive order threatening any health-care provider that administers the vaccine to an unapproved person with a $1 million fine and the loss of medical licenses. With the state’s infection rate surging beyond even last spring’s horrific levels, the governor decided to focus on menacing providers who vaccinate too broadly. Doubling down, he also threatened providers with $100,000 fines if they don’t administer their vaccines fast enough. (I’m reminded of Robert Heinlein’s description of a totalitarian state in which “anything not compulsory was forbidden.”) If you wanted to discourage health-care companies and workers from having anything to do with vaccinating people, Cuomo’s schizophrenic plan would be an excellent start.

Governor Cuomo also cracked down on county officials who were poised to roll out their own mass-vaccination campaigns. In recent years, New York county health departments received millions in federal grants to create emergency vaccination centers in schools, fire stations, and civic centers. They’d recruited volunteers and held annual flu-vaccination drives for practice. Just before Christmas, Cuomo pulled the plug on those efforts, announcing that the state’s vaccine supply would initially be distributed only through hospitals under the governor’s direct supervision. “We’re still waiting to hear back from them,” one county spokesman said about efforts to coordinate with the state health officials. Meanwhile, as of the first week of January, New York State had administered only about a third of the doses it had been allocated. The rest sat in refrigerators, ticking toward expiration.

Critics of Operation Warp Speed say the White House should have emulated Cuomo’s approach, enforcing more centralized, top-down management of vaccine delivery. Incoming President Biden has suggested he’ll do just that, including taking more control of private corporations under the Defense Production Act. The Trump administration’s decision to let states take the lead put too much of the burden on state public-health agencies, critics say. Here they have a point. After nearly a year of coping with the pandemic, the state agencies are overstretched and underfunded. The coronavirus relief bill that Congress finally passed in December includes billions to help states distribute vaccines and expand testing. But imagine if those funds had reached the states back in the fall, when planning for the vaccine rollout should have happened. House Speaker Nancy Pelosi recently bragged about her political wisdom in delaying passage of the coronavirus bill until after the election. As a member of Congress, the 80-year-old Pelosi was vaccinated on December 18. Perhaps someone will ask her what the delay in COVID relief means for other elderly Americans desperate for their shots.

Even as vaccines reach medical facilities, some are encountering surprising resistance from their own employees. Hospitals in Riverside, California, were left with unused doses after roughly half of their frontline staffers declined the vaccine. Similar reports have emerged from Texas, Illinois, Ohio, and elsewhere. Sadly, vaccine paranoia has infected many corners of our society, and our leaders don’t always set the best example. In a September CNN interview, then vice-presidential candidate Kamala Harris said she did not trust the process of vaccine approval under the Trump administration. Federal health officials, she predicted, “will be muzzled, they will be suppressed, they?will be sidelined.” Pressed on whether she herself would take the vaccine, Harris demurred. “I think that’s going to be an issue for all of us,” she said. (In December, she and President-elect Biden did receive their shots.)

Throughout the Trump years, his critics have accused his administration of being “anti-science” and undermining important institutions. Lord knows, those critics were too often right. But when the nation faced its greatest health crisis in a century, many politicians on the left were also eager to cast doubt on both the science and the institutions we need to get us out of this disaster. And some of our most critical institutions themselves revealed a frightening lack of focus. I’ve written before in this space about how the “precautionary paradox” made the CDC slow to recommend masks, or even to acknowledge the risk that COVID-19 was an airborne disease. Then, when finally handed a tool that could arrest this scourge, the CDC again drifted off course. Instead of pushing for the fastest possible deployment of vaccines to the most vulnerable populations, it veered into postmodern discussions about health “justice.” Only a public outcry pulled the agency back on course.

In the end, the glitches in vaccine distribution will get ironed out. But we should remember this: At the peak of this crisis, our country’s key health agency—not to mention New York’s governor and too many others—was less focused on speeding up the vaccine’s delivery than on deciding which members of our society should be excluded from receiving it in time.

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