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Ask HN: Why don’t we have mobile vaccination vans for the USA?

It’s appalling how disorganized CA has been with the distribution of the vaccine. The mRNA vaccine is likely the most effective, most tech advanced and with least side effects compared to viral vector vaccines(Astra Zeneca) or inactivated virus(sinovax/novavax) due to least antigenic properties. But the bottleneck is in storage(minus freezing refrigerator units needed) and distribution(insurance/hospitals staff when patients go to get the vaccine) all this also makes the vaccine more expensive. Why not have mobile vaccination camps. Load up vans with storage capacity and drive to peoples homes. And deliver the vaccines. Mobile medical vans are not uncommon in Africa and Asia and India. This is how they get billions of people vaccinated. Surely I can’t be the only person who thought of it. Either it is not practical(I don’t buy it) or there is some other reason why there is so much inefficiency even in CA where everything is ready for vaccination roll out. If developing nations can do it..why are we lagging behind in California??

hkarthik 6y ago
The logistics of mobile distribution of a fast expiring product are much more complex than you think, and spoilage and expiration losses need to be acceptable at some level to proceed. I think in the case of the vaccine, the latter is well understood, but no one wants to be responsible or held accountable for any vaccines expiring, due to the optics of the situation. I worked on Uber briefly while we tested the early version of UberEats which involved distributing burritos in San Francisco during lunchtime. The restaurant making the burritos would have to pre-make the burritos between 7am and 10:30am and ensure that they were made available to supply depots around the city. From 11am-1PM we would accept orders in the app. An order would be dispatched to a bike or walking courier who would walk the burrito from the supply depot to the consumer who ordered it. The goal was to make sure you had a hot lunch and could get it quickly. When it worked, it was awesome and it helped validate the consumer demand very clearly. But we lost a lot of burritos due to spoilage and no amount of data analysis and better supply positioning could make up for it. It was also not at all economically viable to bake in a 20-30% loss rate and price the burritos high enough to grow as a business. People will pay a lot for on-demand food, but we found they were willing to wait 30 minutes (if it came straight from the restaurant) and pay a little more (if we dispatched with more courier delays), so the on-demand marketplace was born. With the COVID-19 vaccine, right now I think it would be political suicide to accept a 30% daily loss rate on expired vaccines, even if it meant we vaccinated people twice as fast. There would need to be a higher vaccine supply available where vaccine expiry becomes as moot point as a spoiled burrito.
- vlod 6y ago
  >With the COVID-19 vaccine, right now I think it would be political suicide to accept a 30% daily loss rate on expired vaccines, even if it meant we vaccinated people twice as fast. There would need to be a higher vaccine supply available where vaccine expiry becomes as moot point as a spoiled burrito. Or use the Oxford vaccine: https://www.independent.co.uk/news/health/oxford-vaccine-covid-coronavirus-latest-b1721276.html https://www.independent.co.uk/news/health/oxford-vaccine-cov... which can be stored at a more reasonable 2C - 8C (35.6F - 46.4F)
  - jelliclesfarm 6y ago
    The Oxford vaccine is viral vector type and has more antigenic properties. mRNA vaccine..in my limited reading..seems to be a far superior tech when it comes to antigenic effects as it’s simple. So minimum short term and long term side effects
- jelliclesfarm 6y ago
  Thanks for sharing the Uber Burrito experience. Have you heard of Mumbai’s dabbawallas? What are your thoughts about that system? https://en.m.wikipedia.org/wiki/Dabbawala https://en.m.wikipedia.org/wiki/Dabbawala https://phys.org/news/2006-06-bombay-dabbawalas-high-tech.html https://phys.org/news/2006-06-bombay-dabbawalas-high-tech.ht... [..] Indeed the Dabbawala's method of lunch delivery is unique. Their origin dates back to the 1890s, a period when Bombay saw an influx of people from various communities and regions of India migrating to the city to seek livelihood. According to the Association, there were no canteens or fast-food centers then, and those who could not take a packed lunch from home since they had to leave early invariably had to go hungry. Besides, different communities had different tastes and preferences that could only be satisfied by a home-cooked meal. Recognizing the need, a migrant from the Indian state of Maharashtra called Mahadeo started the lunch delivery service with about 100 men, and the rest is history. For over 115 years these lunch deliverymen who were subsequently started to be called Dabbawalas have been collecting lunch packed in three or two-tier metal boxes (called dabbas) from subscribers' homes and delivering them to their workplaces. Today the 5,000 Dabbawalas make about 200,000 lunch deliveries in the city and have become famous for their clockwork precision and efficiency. Reportedly their mistake rate is just 1 in 16 million deliveries, which caused the Forbes Global magazine to award its Six Sigma certification in 2001. According to Forbes the Dabbawalas work with 99.999999 percent accuracy.[..]
nickysielicki 6y ago
Because most Americans have cars and are capable of traveling to a facility. The bottleneck in our vaccination pipeline is actually getting enough doses, not getting people to clinics. The same is not true in less developed countries — over there, getting people to come to a clinic is an actual bottleneck.
- jelliclesfarm 6y ago
  I don’t think the problem is with Americans driving to hospitals. How many staff do you need..how many parking spaces per hospital..how do you schedule and the exposure risk while congregating so many people. While we are discouraging people to assemble in large numbers due to virulence, it makes no sense to invite people to ‘come and get it’. Further: The cost of installing storage and refrigeration units for a small amount of doses is a lot more than mobile units because mobile units can service a lot more people and there will be less wastage due to spoilage.
runjake 6y ago
Because former POTUS Trump had no plan to deal with COVID 19, aside from "wait it out."
bluGill 6y ago
The vaccine doesn't need the ultra cold storage at the point of use. Vaccine vans make sense for areas without normal medical access. This is why developing nations do it: it is the easiest way to roll out medical care to people who don't normally have it. In the US (and most of Europe...) people have plenty of access to more equipped medical facilities. My local pharmacy that I go to for the flu shot has more drugs than would even fit in a van - even assuming one does of each drug. This is typical for any developed country. So it makes sense for us to use that existing supply chains as much as possible. Note that West Virginia - the state that has the best record as to getting vaccines into arms stated the key to their success was using the existing pharmacies in the state (not just the big national chains, all the independents). The states that are doing the worst are trying to develop some new infrastructure just for this.
- jelliclesfarm 6y ago
  > My local pharmacy that I go to for the flu shot has more drugs than would even fit in a van - even assuming one does of each drug. This is typical for any developed country. But do they have enough staff? Enough parking spaces? We are asked to socially distance. California has 40 million people. W.Virginia has 1.792 million population. A lot of Latinos ..esp working in Ag fields in CA(I am thinking of that sector here especially) live in close quarters and use shared transport. There are many family members in one dwelling. Many don’t have insurance and are undocumented.
  - bluGill 6y ago
    Sure, there are a lot of them, and only a few vaccines. If we tried to vaccinate the whole country in a day there would be able problem, but over two months most people go to a pharmacy anyway. (Many are in some other store)

hkarthik 6y ago

The logistics of mobile distribution of a fast expiring product are much more complex than you think, and spoilage and expiration losses need to be acceptable at some level to proceed. I think in the case of the vaccine, the latter is well understood, but no one wants to be responsible or held accountable for any vaccines expiring, due to the optics of the situation. I worked on Uber briefly while we tested the early version of UberEats which involved distributing burritos in San Francisco during lunchtime. The restaurant making the burritos would have to pre-make the burritos between 7am and 10:30am and ensure that they were made available to supply depots around the city. From 11am-1PM we would accept orders in the app. An order would be dispatched to a bike or walking courier who would walk the burrito from the supply depot to the consumer who ordered it. The goal was to make sure you had a hot lunch and could get it quickly. When it worked, it was awesome and it helped validate the consumer demand very clearly. But we lost a lot of burritos due to spoilage and no amount of data analysis and better supply positioning could make up for it. It was also not at all economically viable to bake in a 20-30% loss rate and price the burritos high enough to grow as a business. People will pay a lot for on-demand food, but we found they were willing to wait 30 minutes (if it came straight from the restaurant) and pay a little more (if we dispatched with more courier delays), so the on-demand marketplace was born. With the COVID-19 vaccine, right now I think it would be political suicide to accept a 30% daily loss rate on expired vaccines, even if it meant we vaccinated people twice as fast. There would need to be a higher vaccine supply available where vaccine expiry becomes as moot point as a spoiled burrito.

vlod 6y ago
>With the COVID-19 vaccine, right now I think it would be political suicide to accept a 30% daily loss rate on expired vaccines, even if it meant we vaccinated people twice as fast. There would need to be a higher vaccine supply available where vaccine expiry becomes as moot point as a spoiled burrito. Or use the Oxford vaccine: https://www.independent.co.uk/news/health/oxford-vaccine-covid-coronavirus-latest-b1721276.html https://www.independent.co.uk/news/health/oxford-vaccine-cov... which can be stored at a more reasonable 2C - 8C (35.6F - 46.4F)
- jelliclesfarm 6y ago
  The Oxford vaccine is viral vector type and has more antigenic properties. mRNA vaccine..in my limited reading..seems to be a far superior tech when it comes to antigenic effects as it’s simple. So minimum short term and long term side effects
jelliclesfarm 6y ago
Thanks for sharing the Uber Burrito experience. Have you heard of Mumbai’s dabbawallas? What are your thoughts about that system? https://en.m.wikipedia.org/wiki/Dabbawala https://en.m.wikipedia.org/wiki/Dabbawala https://phys.org/news/2006-06-bombay-dabbawalas-high-tech.html https://phys.org/news/2006-06-bombay-dabbawalas-high-tech.ht... [..] Indeed the Dabbawala's method of lunch delivery is unique. Their origin dates back to the 1890s, a period when Bombay saw an influx of people from various communities and regions of India migrating to the city to seek livelihood. According to the Association, there were no canteens or fast-food centers then, and those who could not take a packed lunch from home since they had to leave early invariably had to go hungry. Besides, different communities had different tastes and preferences that could only be satisfied by a home-cooked meal. Recognizing the need, a migrant from the Indian state of Maharashtra called Mahadeo started the lunch delivery service with about 100 men, and the rest is history. For over 115 years these lunch deliverymen who were subsequently started to be called Dabbawalas have been collecting lunch packed in three or two-tier metal boxes (called dabbas) from subscribers' homes and delivering them to their workplaces. Today the 5,000 Dabbawalas make about 200,000 lunch deliveries in the city and have become famous for their clockwork precision and efficiency. Reportedly their mistake rate is just 1 in 16 million deliveries, which caused the Forbes Global magazine to award its Six Sigma certification in 2001. According to Forbes the Dabbawalas work with 99.999999 percent accuracy.[..]

nickysielicki 6y ago

Because most Americans have cars and are capable of traveling to a facility. The bottleneck in our vaccination pipeline is actually getting enough doses, not getting people to clinics. The same is not true in less developed countries — over there, getting people to come to a clinic is an actual bottleneck.

jelliclesfarm 6y ago
I don’t think the problem is with Americans driving to hospitals. How many staff do you need..how many parking spaces per hospital..how do you schedule and the exposure risk while congregating so many people. While we are discouraging people to assemble in large numbers due to virulence, it makes no sense to invite people to ‘come and get it’. Further: The cost of installing storage and refrigeration units for a small amount of doses is a lot more than mobile units because mobile units can service a lot more people and there will be less wastage due to spoilage.

runjake 6y ago

Because former POTUS Trump had no plan to deal with COVID 19, aside from "wait it out."

bluGill 6y ago

The vaccine doesn't need the ultra cold storage at the point of use. Vaccine vans make sense for areas without normal medical access. This is why developing nations do it: it is the easiest way to roll out medical care to people who don't normally have it. In the US (and most of Europe...) people have plenty of access to more equipped medical facilities. My local pharmacy that I go to for the flu shot has more drugs than would even fit in a van - even assuming one does of each drug. This is typical for any developed country. So it makes sense for us to use that existing supply chains as much as possible. Note that West Virginia - the state that has the best record as to getting vaccines into arms stated the key to their success was using the existing pharmacies in the state (not just the big national chains, all the independents). The states that are doing the worst are trying to develop some new infrastructure just for this.

jelliclesfarm 6y ago
> My local pharmacy that I go to for the flu shot has more drugs than would even fit in a van - even assuming one does of each drug. This is typical for any developed country. But do they have enough staff? Enough parking spaces? We are asked to socially distance. California has 40 million people. W.Virginia has 1.792 million population. A lot of Latinos ..esp working in Ag fields in CA(I am thinking of that sector here especially) live in close quarters and use shared transport. There are many family members in one dwelling. Many don’t have insurance and are undocumented.
- bluGill 6y ago
  Sure, there are a lot of them, and only a few vaccines. If we tried to vaccinate the whole country in a day there would be able problem, but over two months most people go to a pharmacy anyway. (Many are in some other store)