America’s Covid vaccine campaign is not a disaster

A true confession to start the new year: I am now a giddy, guilty, vaccinated-American.

I therefore would like to comment on the current profound disappointment many in the United States — from President-elect Joe Biden to prominent physicians, to talking heads parading across our screens — have voiced about the Covid-19 vaccine roll-out: The US vaccine campaign is not a disaster.

Rather, I think it is predictably mediocre (in “admin-speak,” it meets expectations), but is a major achievement, given the fierce political headwinds and cynical rope-a-dope the Trump administration continues to play.

Without question, the administration has continued its unbroken string of “I don’t take responsibility at all” Covid-19 failures with its chaotic vaccine program. Testing for the virus is still lousy, supplies for hospital workers are still lacking, as is implementation of basic public health measures. Worse, the current hobbled response seems a point of some perverse pride from the President as he again blames underfunded (by him) states for the lumbering mess.

But consider the context. Just last month, in the heady days of early December, after the BioNTech-Pfizer and Moderna results were presented for public review, Alex Azar, the Secretary of Health and Human Services, which oversees key aspects of the development, approval and distribution of the vaccines, confidently suggested that it was possible to distribute 20 million vaccines by the end of the year. The “20 million” remark has since been viewed as a federal promise. And for many, this was interpreted to mean not only distribution to but vaccination of 20 million citizens.

We are far short of this. Per the US Centers for Disease Control and Prevention tracker, as of December 30, we are at 12.4 million vaccines distributed and a little over 2.7 million persons vaccinated.

The wide gap between “distributed” and “administered” suggests many vaccines are sitting on a shelf somewhere in a clinic, waiting for people to figure out how to proceed (only DC and Connecticut have given most of their supply, as of December 30).

But that’s unlikely. In this regard the US vaccination program is a lot like voting for the president, including in the time lag between voting and the tallied, then reported, vote totals. As we learned November 3rd (and 4th and 5th and 6th…), though the votes were “in,” the final tallies were not yet known. So, too, with vaccinations given: more arms have received the Covid-19 vaccine than is reflected in the CDC numbers. Accuracy takes time.

Indeed, voting and vaccination share a second similarity: the experience itself. Or so I thought as I received my shot. As with voting, I was given a time and place for the vaccine. Like voting, there was a (much shorter) line that was divided into smaller portions of waiting — at this desk, then that — as another small but necessary piece of the process was added. Everyone whispered as if in a public library. There were papers to sign and details to agree to. And there were smart, concerned, organized people everywhere.

Then, as with the exciting moment when the voter closes the curtain and picks the candidates, I sat in a quiet room to roll up my sleeve and wait for the shot. Then the ouch. Then the odd, triumphant march outside, post-event, trying to conceal a smile (though masked). And finally, as in November, a tiny jump for joy.

Both voting and vaccination are individual adventures that require repeating millions and millions of times within a population. Then tabulating. Then pushing those tabulations up a chain locally, then to state authorities and agencies and then on to their federal equivalents. Plus, public interest demands frequently updated totals on television, online and clogging your Twitter feed. That’s a lot of moving parts.

Adding to the disappointment at the blah results thus far is a sense that the last big hurried vaccine program, which was carried out in New York City in 1947 against smallpox, was a unified, organized happy-to-stand-in-line-for-a-cause event. But maybe it wasn’t. Newspaper reports from back then show the smallpox vaccination “miracle” to actually be a familiarly human mish-mosh of arguments, deceit, shortages and perhaps a funny way to add numbers.

Similarly, nostalgic views of previous influenza vaccine programs overlook a critical difference between those campaigns and this one: both Covid vaccines require additional regulatory paperwork because they have been made available under Emergency Use Authorization. Such products are not approved by the US Food and Drug Administration and therefore need additional layers of documentation, scrutiny and caution. This slows down the already laborious process.

And finally may I remind one and all of the comparably klutzy roll-out of www.HealthCare.gov, the online sign-up for the Affordable Care Act, a decade ago? Planning is a wonderful and necessary part of any national program, but in no way is it sufficient to account for the countless unexpected events that inevitably occur when so many humans are involved. People are people.

Given both the intrinsic difficulties of choreographing a national program ASAP and the clear lack of urgency from the White House, it is safe to assume that a better program simply won’t happen during President Trump’s leadership.

But there is every reason to think that the Biden administration will increase the pace and address all the contingencies efficiently and without politics.

This week, Biden’s “Covid-19 Response team” was named and includes a national vaccine coordinator, a Covid digital director, a supply coordinator, a data director and others. People to plan and implement and report facts.

This group immediately will be met with a major challenge. Compared to John or Jane Citizen, vaccinating a health care worker is relatively easy. This population is mostly healthy — after all, they showed up for work. Hospitals know how and where to give vaccines; health care workers themselves routinely explain risks and benefits to patients and so are quick to grasp the issues; help, if needed, is nearby with everyone from a trained allergist to a cardiovascular surgeon.

The rest of the country is not similarly prepared. Which means it is a perfect time for the Biden team to take over. Just as the pandemic has revealed President Trump’s style and priorities, so too will the execution of the Great Covid-19 Vaccine Campaign be the defining first act of the Biden’s presidency. We can all only hope it’s a smash hit.