by wj
We’re starting to see what some of the implementation challenges will be when we start to roll out the covid-19 vaccines. Some are pretty obvious. Others far less so, but no less important.
First up: priorities – who gets the vaccine first? ICU doctors and nurses, obviously. But do other doctors and nurses in a hospital go before, for example, ICU orderlies? And even after you get thru medical personnel, ambulance staff, and police and firemen, you still are going to be making priority decisions all the way thru the population. Do retail workers, who interact with lots of different people, come before office workers? Count on facing lots of people who will be unhappy at the state making decisions which, at least implicitly, say that they are less important than some other people.
Second, infrastructure. Two of the three vaccines require refrigeration. California is already working on getting enough refrigeration capacity together. Poorer states may not be able to acquire it. But that’s not all. You also have to have people to administer the vaccines. Considering how long the lines currently are to get tested, this may not be trivial. Especially in poor, rural counties where there may not be any medical infrastructure at all. (There’s a tendency to deal with these things at the county, rather than state, level. Which is fine if there is a country level. But in some places you can have a county with several thousand people, and just one doctor, and one ambulance driver. Period.)
And in addition, there is the detail that two of the three vaccines require a second vaccination. You have to track who is due for a second shot. And have some way to notify/remind them to come in. Email? Text messages? And for those who don't have that technology? Phone calls? Regular mail? And do you do personal follow-ups if they still don’t show? With what personnel?
AND you have to track who got which vaccine, so you don’t end up giving the second Pfizer vaccination to someone whose first vaccination was the Moderna vaccine, or vis versa. Plus, you need to track everybody who has been vaccinated, just so you can work out who still needs to be. Which means you need to figure out who "everybody" is. This may make the Census look like a walk in the park. And you need the software to do the tracking. (California has a state-wide Immunization Registry which we can use as a basis. Do other states? And how do you deal with people who move across state lines while all this is going on?)
Third, resistance. We’ve talked about the anti-vaxxers. Are they, or at least their children, going to be forced to be vaccinated? (Could be lots of fun, and lengthy, court cases on that. Not least because some of them may figure out that, with the current Supreme Court, claiming a religious justification might help their cause.)
But there is also a lot of resistance in minority communities, even though they are apparently hit harder than others by the virus. The Tuskegee Study casts a long shadow. A major sales effort may be required to overcome that history.
In short, even once we have a competent administration, which actually cares about getting the job done, it's going to be a mess.
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