Any plan implies a “method for achieving an end,” according to Webster’s Ninth Collegiate Dictionary. Of course, a plan to plant azaleas in a garden is quite simplistic compared to a plan to vaccinate enough Americans to reach “herd” immunity—that is, between 230 and 265 million Americans—before the Fall of 2021. The method required to accomplish that plan demands a very comprehensive design, in fact, a complicated system replete with contingency plans and feedback loops that can either address anticipated shortcomings or allow appropriate intervention for the unanticipated. This system begins with supply of the necessary vaccine, but proceeds to shipping, distributing to vaccination centers, staffing—and likely training—healthcare vaccinators, scheduling required follow-up vaccinations, and ongoing monitoring, coordination, and control of the entire process. Development of this system would necessarily have begun as soon as the earliest availability date for a viable vaccine was announced. And that date was early September 2020, when the FDA projected one or more vaccines would be available by mid-December. As of January 2021, no such system existed. Dumping vaccine supplies on hospitals throughout the country is not a plan. It does not account for delivery to remote populations, match vaccine supplies to vaccination scheduling, or assure appropriately trained immunizers where needed. Nor does it coordinate vaccine shipments with initial and follow-up immunizations. Without a system to coordinate and track these immunizations, there is no control or assurance of success—just the promise of ongoing chaos.
Development of this system should have begun with the assembly of a team representative of every state and with a compilation of demographics. That team would have been made responsible for locating facilities in reasonably sized population centers. Staffing and training requirements, as well as coordinated immunization and vaccine shipments, could have been forecasted and therefore planed well in advance of December. Moreover, the team’s advanced planning also would have allowed for the development of a tracking mechanism to assure that every bottle of vaccine was delivered were needed without undersupply or oversupply and that follow-up vaccinations were administered on schedule. That tracking mechanism would necessarily be a computer system with similar screens for recording vaccinations and patient data (like name, contact info., and scheduling data), but with networking of its recorded data to central hubs. Of course, those hubs would then have accurate data to assure overall coordination of vaccine delivery with Federal supply centers and of immunization progress within the communities they serve. If planning would have begun in September, the Trump Administration would have been prepared with a systematic approach to deliver vaccines where needed, on time for scheduled immunizations, and with trained staff ready to immunize in communities of appropriately sized density. Overall coordination and tracking would have allowed for immediate recognition of problems—such as over or under supply—and quick recovery.
America has begun to ship vaccines but without a plan for success. Within just a couple of weeks, we have already received reports of seniors waiting in long lines at central vaccination hubs. Only 25-35% of the vaccines shipped have been administered. Manufacturers are producing more vaccines than are being used. And we find vaccine shipments placed in temporary storage, at the risk of expiration of their effectiveness. Meanwhile, there appears to be no assured scheduling of the follow-up dosage. Unfortunately, incompetence always has a price. In this case, that price is chaos, waste, and, potentially, many avoidable deaths.
When President Trump announced his “warp speed” approach to vaccine development, he effectively gave this scientific endeavor a political brand name and, at the same time, took credit for its scientific achievement. His announcement reminded me of one Senator’s recent statement describing the difference between politics and the law. The former, he stated, is often unfair. The latter is how a democratic republic assures justice and fairness. Applying his distinction to governing, it is imperative that an elected President not play politics in administering his/her responsibilities. Whereas those in Congress must compromise their politics to assure their constituents are served fairly and justly, a President “shall take care that the laws be faithfully executed” (Section 3, Article II, the Constitution). A President may be the leader of his political Party. But his actions must subordinate his political well-being to the public he serves. The Constitution and his oath of office require as much and have the force of law. But President Trump has been running a political campaign from his very first day in office. Of course, his Administration deserves credit for paying in advance for vaccine production while still in its trial phase. But politicizing the speed of vaccine production in this manner made many question—unfairly—whether the vaccines developed were thoroughly tested and not rushed to market. When he disclaimed “Covid, Covid, Covid” as a fake news obsession, he was playing politics with Americans’ health and safety—what the Constitution framed as “the general welfare.” Perhaps, his discrediting of the pandemic’s threat, his blaming the States for its unrestrained spread, and his dumping vaccines on the States without a plan to assure timely and effective vaccinations are all emblematic of a basic ineptitude. Nevertheless, his response to Covid-19 remains a dereliction of duty. We have been treated unfairly, and he has violated his oath to the Constitution. “Warp speed” implies some manner of efficiency where none was ever evident. There was never a plan.
National disasters, like raging fires or violent hurricanes, occur on their own timeline. They pass over us, then leave us to plan our recovery. But pandemics pass through us. It can only be mitigated by personal safeguard measures. And vaccines can further mitigate its deadliness, reducing its effect to something akin to a common cold. But those mitigation efforts coexist with the virus’ rampant contagion through our population. Have we Americans fought back effectively? Has our government supported mitigation efforts consistently and insistently? Our President, instead, chose a destructive path, downplaying the virus’ threats and required mitigation efforts. In his personal conduct and at his rallies, he managed to model and encourage reckless behavior, leading us into a national disaster. No general fights a war without a plan to end it. But this lame duck Presidency has done so for nearly a year while hospitals were overrun and morgues, overwhelmed with corpses.
The second paragraph above is just a commonsense outline of what could have started a planning effort months ago. While it only required a few minutes to compose, it could have been the start of multiple projects to build a vaccination delivery system. At a minimum any plan would have required (1) identification of delivery hubs in variable sized communities, (2) the assignment of local coordinators in these hubs, (3) the training of suitable personal—like medical students, national guard, senior caretakers, and others to deliver the vaccines, (4) creation of tracking and scheduling software, (5) identification of the networking mechanism required to implement and track the overall vaccination program, (6) and an ongoing collaborative planning effort with the States to resolve problems as they arise.
Given these planning deficits, the new Administration will be left with the task to vaccinate millions “on the fly” with no pre-existing plan but with the need to recover from the ensuing chaos. Vaccine shipments have not been delivered as promised. Vaccination schedules have not been met or coordinated with shipments. As a result, many have waited in lines for vaccines that have not been delivered. And, on the reverse side of this equation, a large quantity of vaccines has been stored in remote locations awaiting vaccinations. Those delivered and unused vaccines are at risk of expiration. Meanwhile, the pandemic that initially went undeterred is now raging forward at a pace wherein hundreds of thousands are being infected every day and the death count is rising well past any previous catastrophe. This one-year Covid death count will shortly surpass America’s death count for all of World War II. Every day we lose as many Americans to Covid as we lost in the 911 tragedy. If President Trump was not impeached for criminally inciting insurrection, he should have been removed from office for gross incompetence. In either case, he is guilty of dereliction of duty.
Recently, President-Elect Biden admitted this reality. But he also proposed a remedy. His plan is comprehensive, requires hundreds of newly hired personnel, collaboration with the States, expert and decisive leadership, transparency, and a large financial investment. The management requirement will be akin to fighting an invasion with day-by-day adjustments to the unexpected. His plan will have to recover from the deficits left by the previous Administration and evolve its implementation in concert with a system and network that can only be built in stages—not before availability of vaccines, but as vaccines become available. No systems developer would choose to solve a problem before it is sufficiently analyzed. But, often, he/she must begin to act before the path ahead is definitively known. When so confronted, the emphasis must be on the expertise of the players, their collaboration, and their leadership.
Our nation has faced many challenges. President-Elect Biden has not only noted as much but reminded us that we have proven our ability to overcome them. One hundred years ago we fought a pandemic without the science and resources we have today. Regardless of our planning deficit, we now can begin to take the informed and diligent steps necessary to defeat this pandemic. And, unlike other threats, such as insurrection, global unrest, the dismantling of our institutions, systemic racisms, elected reprobates—like a rogue President, and a dysfunctional Congress, every American can participate and effectively mitigate the horrors of this pandemic. We just need to act in each other’s interests and care as much as our new President for our collective well-being. Or we can heed the words of our new Vice President, spoken just moments ago before the Lincoln memorial: “Tonight, we grieve and begin healing together. Though we may be physically separated, we the American people are united in spirit.”
Let us call this one small step for patriotism and a leap forward for our health and well-being.