Photo: Lev Radin / Pacific Press / LightRocket via Getty Images
The rollout of immunization, like the virus itself, has exposed leadership failures around the world. Politicians at all levels of government, in just about every locality, state and nation (with few exceptions, like Israel), have collapsed dramatically. Philadelphia has outsourced part of its vaccination campaign to a group of enterprising students, with disastrous results. The EU was surprised and finds his freezers empty of bottles. Italy has become bogged down in a plan to roll out temporary vaccination flags designed in the shape and colors of a primrose. They promise to be pretty and also to cost as much as luxury apartments and can accommodate roughly the same number of guests. New York is grappling with a cocktail of scarcity, panic, confusion, skepticism and misinformation. Put them all together and what you get, as Council member Mark Levine said, is The hunger Games.
No one expected a global mass vaccination campaign without frictions or hiccups, but we have compounded inevitable problems with innovative self-defaults. Among them is a misconception of how to distribute vaccines equitably. The goal should be to prevent death and limit more infections, not to correct the inequalities the pandemic has exposed. Of course, those most at risk of contracting the disease or dying from it must first be vaccinated. Beyond that, however, we should stop treating vaccination as a form of privilege, right or reward: it is a public health measure. We have spent almost a year trying to promote the idea that protecting your own health is a public service to others. The same goes for the vaccine. We need everyone to get stung, and each day late is another day of shared grief and collective loss.
Giving hundreds of millions of injections of a new vaccine is a complicated task. But in the absence of a centralized federal system, unprepared and underfunded states, cities and caregivers together threw a jumble of websites that threw this complexity into the knees of individuals. Want a shot? Alright, first determine what category of eligibility you are in (1B-C? 1C-A?) By examining a dizzying variety of color coded tables which vary from state to state and county to county. Then create a one-or-one account, to hedge your bets, all – local websites. In New York, it would be the state portal, the city vaccination center, the city Health and Hospitals Portal, private emergency care networks, individual hospitals, community health organizations, pharmacies, etc. – each representing a different team trying to guess how many doses they will have on hand in weeks. A successful search for an appointment, if any, results in an email with instructions to arrive no more than five minutes early, but on the day of the inauguration, at the vaccination center of the city of the Walton Educational School in the South Bronx, people waited several hours in the cold, the appointment schedule was dropped, and first-dose recipients were told to start all over again in order to get the second dose. If you were trying to design a system to discourage participation and slow distribution to a creep, that would do. The poor but entirely bureaucratic pursuit of fairness has produced its opposite.
Millions of New Yorkers feel they are particularly incapable of navigating the system – that it is rigged against success. Some fight, others try to complete the process, many probably give up. Far too many people may never bother to try, convinced that the whole program is a government scam, an attempt to force experimental concoctions on a population of sheep, to collect private information or to attract undocumented immigrants in the arms of the ICE. In a multilingual metropolis like New York, the whole battle of inoculation is fought in a language many do not speak.
We’ve been here before – just last summer, when the city was desperately trying to get its entire population to respond to the census, a critically important process that many New Yorkers initially treated as someone else’s problem. “There are a number of hurdles that we have to overcome when trying to convince people, especially blacks and brunettes, to take action that the government tells them to take,” says Amit Bagga, former deputy director of the city’s census effort, which is now a candidate for city council. “For many immigrant communities, one of the biggest barriers is the ability to understand not only what is being said, but also Why It is said. Some have fled places where the government is repressive or non-existent. More recently, disinformation and disinformation are real problems. The only way to avoid this situation is to have trusted and valuable partners who channel this information.
The good news is, we have a tool that works. During the census, under the city’s auspices and with funding from the city, Bagga and her colleagues created the Complete Count Fund, a network of 157 community groups whose members could explain to their neighbors (in Mixtec, Quechua, Tlapaneco, Bangla and a dozen other languages) why it was in their best interest to complete the form. Even amid a pandemic and a relentless assault on the census by the Trump administration, nearly 62% of the city’s (estimated) population completed the questionnaire, a higher response rate than there was. is ten years old, or that in any other big city.
This rapidly deploying corps of civic messengers could be mobilized now, with clipboards and leaflets, in every neighborhood. “I had in mind the idea that we were putting in place a civic engagement infrastructure that could be activated in challenges like this,” Bagga says.
Instead of reaching communities, we pit them against each other. After The city reported that commuters were squeezing through the city line and occupying slots at the Fort Washington Armory, the hospital that runs the location announced that it would start booking all appointments for city residents and to reserve 60% for residents of the largely Latino neighborhood that surrounds it. That’s fine, if these quotas don’t cause more bureaucratic turmoil, complications, frustration, delays, and wasted doses discarded – which they probably will. Fairness means ensuring that everyone gets vaccinated as quickly as possible, without fighting over who gets vaccinated this week.
And yet, inequity is built into a system that compels the public to find out. As soon as you demand that people compete for a rare commodity, those with more resources and better information will win. Instead, let’s use a template we already have. Everyone is called for jury duty, on a given date, and responsible for introducing himself. Yes, jurors can get adjournments and pick dates that work best for them, but we don’t have a pool of millions, all haggling over schedules at the same time. Everyone should be asked to simply sign up for a vaccine and then contact them with assigned appointments, a system that would be reassuring and promote patience.
We know how to do this: We have a whole economy based on the urgency of delivering mass-produced products to individual consumers at high speed. The rapid development and manufacture of multiple and highly effective vaccines is a triumph for Big Pharma. Maybe it’s time to call Big Logistics. I can order plant food on Amazon by following an extremely simple procedure, and several hours later it materializes at my front door. Apple somehow manages to deliver millions of copies of every new product to a hungry planet on the same day. Lettuce passes from greenhouses thousands of miles away to my local bodega before it has a chance to wilt. Credit card companies handle millions of simultaneous transactions, alert customers to possible fraud, and answer questions 24 hours a day. Federal funding is needed, but it also requires appealing to the civic sense of businesses that do. made a fortune from the movement of goods at a time when the movement of people was restricted. They also want the economy to be buzzing again.
The job, after all, is not just to secure and distribute this week’s dose quota, but to plan a six-month (or longer) campaign. The smoother it goes, the sooner we can get the kids back to school and start to get our future back. We should stop doing the equivalent of building primrose pavilions in Italy, reinventing the systems we already have.