Opening vaccine eligibility up, and allowing walk-ins if doses will expire, is part of how Israel was so successful at distribution. Multiple priority queues are nice in computer science, but managing them with time-sensitive vaccine doses is hard. Simple, imperfect and fast is better than perfect, complicated, and slow.
Getting a large swath of people vaccinated is more valuable than perfectly getting prioritization right. Prior to this change, NY was attempting to perfect prioritization, and was discarding many doses as they expired.
In my opinion, the US’s top level goals were wrong (over focus on equity versus utility) and the US bureaucracy is neither flexible nor creative as evidenced by its refusal to buck top level orders and it’s continuing slowness. These are signs of a decaying system.
> the US bureaucracy is neither flexible nor creative as evidenced by its refusal to buck top level orders and it’s continuing slowness. These are signs of a decaying system.
Yes, and it’s because the priorities rank as follows for each individual:
1) personal liability
2) organizational liability
3) utility
Where liability includes both legal and public relations consequences. It’s exhausting to constantly think about open ended and unintended consequences that you might be held accountable for, with no recourse.
I completely agree with you about the US over-focus on equity with the vaccination effort. By all means attempt a best effort at vaccinating at-risk populations first... But at the end of the day, even the at-risk-but-vaccinated folks are still at risk as long as herd immunity isn't reached (the vaccines are 95% effective, not 100%). Lots of shots in arms, quickly, is more important than being extremely particular about whose arms the shots are in and in what order they are inserted. Israel will eliminate COVID as a serious concern by March; is it more "equitable" that Americans will likely continue dying through the summer, but at least they're dying in the right order?
Also, they paid a lot to have early access to a lot of vaccine.
Michigan (my state) is doing about 35,000 doses on weekdays at this point, which is frustratingly slow. But if they had spun up twice as fast, we wouldn't be doing 70,000 doses a day, we'd be out of vaccine.
The most recent shipments have been ~120,000 vaccines/week for 2 weeks and then none for a third week. So if the tempo of Federal allotments is 120,000 a week, the 35,000 a day is not a bottleneck. They should of course be building capacity anyway, with the idea that deliveries will increase (and making a plan for what to do if/when the adenovirus vaccines are approved in the US; fortunately it looks like that can be "send it everywhere").
Anyway, wasting vaccines is obviously stupid, I'm not trying to argue about that.
We should also open up expired vaccines to whoever wants them. Expiry dates are usually quite pessimistic and medicines often have efficacy long after they're officially expired.
This is a different model of expiration. This isn't "two-year shelf life can be extended to five years w/ stable temperature and humidity and only a 10% loss of efficacy."
This is "once this vaccine is pulled out of the super-cold freezer, it starts breaking down, and you have X hours before it's worthless at best."
Worse than "worthless" is the idea that people might get a useless expired vaccine anyway, think they're protected, and then be a vector for future transmission.
Well, at the begining it caused a lot of mess. And then it was much more controlled.
I wouldn't say this is what help us in the efficient distribution.
What really helped is a very centralized healthcare system with a very long history of managing public emergencies.
This is because Israel was founded as a socialist welfare state, and the impressive healthcare system is one of the leftovers.
Getting a large swath of people vaccinated is more valuable than perfectly getting prioritization right. Prior to this change, NY was attempting to perfect prioritization, and was discarding many doses as they expired.