3 ms·

I get that the idea is to marginally increase utilization across millions of doses, but I struggle to understand how much of this was just tilting at windmills.

I get that the idea is to marginally increase utilization across millions of doses, but I struggle to understand how much of this was just tilting at windmills. With the limited roll out, it wouldn't take much capacity for individual sites to schedule their available doses. And for example, in my smaller town, there were 4 sites, comprised of public health, the hospital and 2 pharmacies. People looking are gonna start at those places.

striking 2y ago
> The recipients of the vials in many cases had limited organizational ability to communicate to potential patients that they actually had them available. > Patients then asked the federal government, states, counties, healthcare providers and community groups, ‘Do you have the vaccine?’ And in most cases the only answer available to the person who picked up the phone was ‘I don’t have it. I don’t know if we have it. Plausibly someone has it. Maybe you should call someone else.’ Technologists will see the analogy to a distributed denial of service incident, and as if the overwhelming demand was not enough of a problem, the rerouting of calls between institutions amplified the burden on the healthcare system. Vaccine seekers were routinely making dozens of calls. San Francisco, for example, has a lot of places where vaccines can be administered and a whole lot of people that wanted them. Difficulty scaled with population density.
- crote 2y ago
  > Difficulty scaled with population density. How much of that was due to government dysfunction, though? I live in a quite dense urban area. For me, getting the vaccine was a walk in the park. There was a single nation-wide website to register your vaccination slot, and it was administered in a factory-like workflow. The government literally hired out a large event space and turned it into a single smooth operation, calling up whatever med student, military doctor, and retired nurse they could find. There was a single plan from the national level, and it was implemented by the pre-existing government structure which normally handles childrens' vaccines and the medical part of disaster response. It seems the US did basically the opposite thing, with dozens of government entities all delegating responsibility downwards, and relying on ad-hoc implementation by commercial entities. That might work fine in a normal situation, but it's not exactly a surprise that it breaks down during a disaster. Stuff like this is literally what the government is for!
- maxerickson 2y ago
  It's not clear to me that difficulty scaled faster than capacity of the entities actually doing the administration. But maybe I live in bizarro world, my employer notified me that the hospital was accepting appointments about the time I became eligible.
patio11 2y ago
With the limited roll out, it wouldn't take much capacity for individual sites to schedule their available doses. You'd think so, right. You'd think that the state of California was certainly able to successfully inject more than 25% of doses delivered in January 2021, right. You'd think that simply calling around for places that had nobody coming in could not possibly work, right. A thing that continues to blow the minds of many: there is literally no one whose job it is to generate demand for most doses at most locations which were allocated doses. This was entirely on a pull model. If there was no pull, then they would have sat in the freezer until discarded. This didn't just strand doses in the freezer at places like Rural Clinic For Low-Income Farm Workers Who Accidentally Got A Supersized Allocation Due To Political Considerations. It stranded doses in the freezer at e.g. the third largest pharmacy chain in most well-populated cities because people called the first largest, heard a No, and then assumed "Well if they don't have it clearly no one has it."

striking 2y ago

> The recipients of the vials in many cases had limited organizational ability to communicate to potential patients that they actually had them available. > Patients then asked the federal government, states, counties, healthcare providers and community groups, ‘Do you have the vaccine?’ And in most cases the only answer available to the person who picked up the phone was ‘I don’t have it. I don’t know if we have it. Plausibly someone has it. Maybe you should call someone else.’ Technologists will see the analogy to a distributed denial of service incident, and as if the overwhelming demand was not enough of a problem, the rerouting of calls between institutions amplified the burden on the healthcare system. Vaccine seekers were routinely making dozens of calls. San Francisco, for example, has a lot of places where vaccines can be administered and a whole lot of people that wanted them. Difficulty scaled with population density.

crote 2y ago
> Difficulty scaled with population density. How much of that was due to government dysfunction, though? I live in a quite dense urban area. For me, getting the vaccine was a walk in the park. There was a single nation-wide website to register your vaccination slot, and it was administered in a factory-like workflow. The government literally hired out a large event space and turned it into a single smooth operation, calling up whatever med student, military doctor, and retired nurse they could find. There was a single plan from the national level, and it was implemented by the pre-existing government structure which normally handles childrens' vaccines and the medical part of disaster response. It seems the US did basically the opposite thing, with dozens of government entities all delegating responsibility downwards, and relying on ad-hoc implementation by commercial entities. That might work fine in a normal situation, but it's not exactly a surprise that it breaks down during a disaster. Stuff like this is literally what the government is for!
maxerickson 2y ago
It's not clear to me that difficulty scaled faster than capacity of the entities actually doing the administration. But maybe I live in bizarro world, my employer notified me that the hospital was accepting appointments about the time I became eligible.

patio11 2y ago

With the limited roll out, it wouldn't take much capacity for individual sites to schedule their available doses. You'd think so, right. You'd think that the state of California was certainly able to successfully inject more than 25% of doses delivered in January 2021, right. You'd think that simply calling around for places that had nobody coming in could not possibly work, right. A thing that continues to blow the minds of many: there is literally no one whose job it is to generate demand for most doses at most locations which were allocated doses. This was entirely on a pull model. If there was no pull, then they would have sat in the freezer until discarded. This didn't just strand doses in the freezer at places like Rural Clinic For Low-Income Farm Workers Who Accidentally Got A Supersized Allocation Due To Political Considerations. It stranded doses in the freezer at e.g. the third largest pharmacy chain in most well-populated cities because people called the first largest, heard a No, and then assumed "Well if they don't have it clearly no one has it."