Who's Jabbing Whom?

WHAR VACCINATIONS WHAR.

The good news on COVID-19 vaccinations is that the USA is finally getting more shots into arms after a really rough initial rollout, and is now averaging about 900,000 doses a day nationwide. As of Monday evening, the US Centers for Disease Control and Prevention reported that nationwide, 19.25 million people have received at least one dose of the vaccine. So yay, by the end of the reporting period tonight (8 p.m. Eastern), we just might meet the Trump administration's 20 million Americans vaccinated goal for the end of 2020. Unless you mean "fully vaccinated" with both of the recommended shots. That number is only 3.34 million as of Monday.

So let's talk about the "needs improvement" side of the equation. The vaccines are definitely getting into arms, but there are huge problems with and disparities between the various systems states have set up to distribute them. Lots of crashes of computer systems when people try to make appointments, lots of uncertainty, lots of anxiety about supply. And while the Biden administration's top priority is to get this all straightened out, it inherited a complete mess from the prior administration — not quite no plan, but a very shitty, disorganized excuse for a plan. Let's take a look at the clusterfuck, shall we?

It's Only Partly A Supply Problem

 Los Angeles Times business columnist Michael Hiltzik writes that he and his wife had very little difficulty getting vaccinated at a Disneyland parking lot in Orange County Friday, and why that's a problem. The fairly easy time they had illustrates one of the biggest problems with vaccine distribution: It's working out fairly well for people who already have healthcare, who are computer-literate enough (and have time enough to try over and over) to get registered for an appointment, and can drop work for a morning to drive to a vaccination center when they get a notification on their phones.

But what if none of these things were true? What if I didn't have broadband internet access, or the experience to navigate the rather intimidating [Orange County online] registration process? What if I didn't have a car to get to Disneyland?

Then I'd still be waiting, like millions of Californians and others across the country.

The problems with the vaccine rollout, he notes, are highlighting the country's existing healthcare disparities: Some of us have easy access to healthcare, and many of us just plain don't. And those who don't are also very often the people at the highest risk of infection, with the least access to the online registration systems many areas use.

What's needed, says former CDC Director Tom Frieden, who's now CEO of Resolve to Save Lives, a public health group, are vaccination campaigns that include

"ambassadors" circulating through hard-to-reach communities, or those generally mistrustful of government initiatives, to sign people up for vaccines and provide them access to mobile clinicians or convenient inoculation centers.

It should help that health equity is a key focus of Biden's pandemic strategy, as is, finally, a national strategy to get vaccines where they're needed. He's been in office almost a week, why isn't it fixed yet?

It also doesn't help that public health agencies never seem to be much of a funding priority, so there aren't enough trained clinicians to deliver vaccines. Hiltzik notes that at one LA County drive through vaccination site, there were three stations that could have been working, and plenty of nonclinical volunteers, but "enough clinicians to staff only two of them."

A lot of what's needed is actually in Biden's stimulus plan, including $20 billion in vaccination funding for state, local, and tribal governments, which would also include funding for FEMA to start setting up community vaccination centers and mobile vaccination clinics. Other funding would go to that "public health job corps" to get 100,000 workers trained to give shots and do testing and contact tracing. (Quick reminder: Similar efforts were included in House Democrats' stimulus package, which passed in MAY of last year. We didn't have to be trying to ramp up at the last minute!)

Some States Are Doing It Right!

The Brookings Institute also has a good look at why some states are getting a lot more vaccine to their citizens than others. To illustrate, the piece looks at a couple of states. One is wealthier, with the nation's second-lowest poverty rate and a more highly educated population, than the other.

The two states also differ in how well they've been doing with vaccination distribution:

One ranks 2nd in the share of its population that has been inoculated and has turned 83% of the doses received from the federal government into actual inoculations. The other ranks 35th for its inoculation rate and has delivered only 46% of doses received into its people's arms, well below the national average of 53%.

Thing is, it's the poorer, more rural state, West Virginia, that has the impressive vaccination stats, while the richer state, Maryland, seems to be dropping the ball.

There are two big differences between the two, the Brookings analysis suggests. For one thing, West Virginia is the only state in the country whose vaccination program for residents of nursing homes and other long-term care facilities ran through a network of local pharmacies, instead of through big pharmacy chains like Walgreens and CVS. Those smaller pharmacies made a big difference:

Because most had pre-existing relationships with local nursing homes, they began with extensive information about the facilities and their residents. And perhaps most important, relationships of trust existed between local pharmacy staff and individual patients, helping them overcome vaccine aversion.

The other big difference seems to be that West Virginia's vaccine distribution plans were directed at the state level, by the governor, instead of by each county, which, in Maryland at least, "has created confusion and has given residents with access to multiple information sources advantages over those with weaker networks and less Internet access."

The article also notes that even within Maryland, there are surprising disparities in vaccine delivery. Montgomery County, with Maryland's second-highest median income, isn't doing nearly as well at getting shots into arms as the city of Baltimore, which "has managed to inoculate a significantly higher percentage of its citizens" despite ranking behind Montgomery County on indicators of wealth. Unfortunately, the piece calls for more study and better transparency to figure out why exactly that is, so best practices can be more widely adopted.

What About The Children?

Vox has a nice overview of one of the upcoming challenges for vaccination: Once we get a handle on vaccinations for adults, what needs to be done to get kids vaccinated against the coronavirus? Because of the problems kids and families are facing because of school closures, the National Academy of Medicine is calling for kids to be a higher vaccination priority than the general adult population, about as high as essential workers. But none of the vaccines have yet been approved for use in people under 17, so there's still a lot of testing to be done and safety data to be collected. Fortunately, the process of testing and approval for kids may go faster than the full series of trials for adults:

That's because, in addition to seeing who among participants naturally got sick with Covid-19, adult vaccine trials have been measuring immune response to the vaccines (by looking for antibodies in the blood).

This immune response data provides a reliable shortcut for future trials, showing researchers what a successful immune response to the vaccine looks like. So pediatric studies will look for similar responses in children to assess whether it is effective in preventing Covid-19, rather than having to wait for dozens of them to come down with the disease.

Will kids be able to get vaccinated before next fall's school year? Mmmmaybe, but also it might not be quite as pressing an issue if we get enough adults vaccinated to create pretty strong herd immunity. The safety of opening schools is largely a reflection of the transmission rates in communities at large, so reducing overall infections remains the top goal. Vaccines for kids are coming — we just don't know when, yet.

Worst People In The World

If your blood pressure can handle it, read this absolutely infuriating story about a rich Canadian couple who chartered a plane so they could fly to a remote town in the Yukon and sneak into a mobile vaccination site intended to get the vaccine to First Nations elders. The couple have been fined a whopping $900 for breaking quarantine regulations, and the man lost his $25 million job as CEO of a casino chain, so that's a start. Being pariahs everywhere they go seems likely, too. At least until the Federalist praises them for their resourcefulness and individual initiative.

[ BBC / NYT / LA Times / Brookings / Vox / Alaska Daily News / Photo:  U.S. Air National Guard photo by Tech. Sgt. Michael Matkin]

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