First-Come-First-Vaccinated

Lots of hot takes on yesterday’s events in DC, but given that I already shared mine (look for the novel forthcoming any year now…), I thought I’d address another debacle today: New York’s vaccine rollout.

Tl;dr – it’s not going well. (Here are NYC, NYS (oops), and US vaccine dashboards for your perusal.)

Slightly longer version, in spite of being more or less the hardest hit state in the country to date (technically, by deaths per population, it’s New Jersey) and having had many months to prepare for the arrival of safe and effective vaccine(s), New York, under the indefatigably autocratic leadership of Governor Andrew Cuomo, has thus far badly bungled the vaccine rollout. City & State has two good pieces out – entitled, respectively, “Why can’t NYC vaccinate like it’s 1947?” (subtitle: “New York City gave smallpox vaccines to 5 million residents in just two weeks 74 years ago. What have we unlearned?”) and “Don’t let COVID-19 vaccines expire” criticizing the Governor’s vaccine strategy.

I took the time to read New York’s 80+-page vaccine plan (the NYS website is not optimized for finding dated documents, or I’d link to it here) when it was released some months ago, and to give due credit, it was thorough, well-considered, and humane. Here’s the problem: As means-tested programs are wont to, it has also failed. Of course, in this case the testing isn’t by financial means (though I have no doubt that many very rich people are finding ways to buy early vaccine access), but by phase/category eligibility; be that as it may, logistical challenges, vaccine skepticism, and the artificial barrier of eligibility restrictions have badly limited the amount of vaccine actually being administered in New York City, New York State, and across the country.

Truth be told, I don’t doubt that vaccine distribution will start to scale up pretty dramatically in the coming weeks and months regardless of what approach is taken, but given that a deliberate, phased approach has been tried for almost a month, and is not working, I think it is high-time that we shift to a first-come-first-vaccinated approach. Of course, the idea was that high-risk individuals and those at highest risk of COVID exposure should get the vaccine first, but given the glacial pace of vaccination, and the fact that NYS is currently sitting on roughly 2/3 of its to-date-allotted vaccines, clearly, high-risk individuals, healthcare workers, etc. are not being harmed by not giving those unusued vaccine doses to others. They might be being harmed by other failings of the rollout, but that is a different matter.

Open the floodgates. Let anyone who wants to get vaccinated get vaccinated. Put demand pressure on the producers to keep the supply of vaccines coming, and start rapidly building towards social consensus on the need to get vaccinated as the flood of people (a significant majority of US residents) who want to get vaccinated rush to do so. Might this produce other problems? Sure. I’m not proposing a free-for-all, and it would be reasonable to have an online registration process or something so as not to oblige US residents to stand in yet another endless queue (as they did throughout most of 2020 for food, COVID tests, etc.).

Making the wrong choice for the right reasons is admirable, but once it becomes clear it was bad, there’s no merit in standing by a bad idea. One can even easily imagine a mechanism by which the elders, healthcare workers, other essential workers, and those with underlying health conditions that put them at higher risk from COVID are given the ability to jump the line, thus honoring the spirit of the phased system while still staying focused on the main goal – as public health folks often put it: Getting shots in people’s arms.