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Unsanitized: The COVID-19 Report for Nov. 23, 2020

We've Given Almost Nothing to States and Cities for Vaccine
Distribution

This breakthrough relies on rickety, underfunded local health systems

 

Getting several billion of these suckers around the world is one of the
only things we should be thinking about right now. (Hendrik
Schmidt/picture-alliance/dpa/AP Images)

First Response

The day that the COVID-19 vaccines are approved for emergency use by the
FDA-likely December 11, based on the timing of their meetings-will
be a great triumph for science and public investment. The Moderna and
Pfizer vaccines, for the first time based on messenger RNA, herald a new
scientific breakthrough that could unlock a host of new therapies and
palliatives. (AstraZeneca's vaccine, which announced some positive
results today
,
could also be approved in short order.) And the rapid timing from
discovery of the virus to a vaccine, pushed along by public dollars and
guarantees, should also become a model, though if we collaborated with
the world instead of going it alone

we would have dispensed the vaccine even faster and saved a lot of
lives.

But these innovations, which will have wide-ranging effects into the
future, collide with the near-term block and tackle of how you get a
drug manufactured, stored, and shipped to every corner of the globe, to
be administered, twice, to virtually everyone on the planet. At some
point the science gives way to a logistics operation on a scale nobody
has ever seen before. Compounding this difficulty is the fact that Joe
Biden's transition has no access to the vaccine data

and is frozen out from the decision-making process.

The infrastructure we currently have for vaccine distribution is by
definition weak, because the scale of what's needed with this is so
massive. The Vaccine for Children program provides something like 3
million shots a year. We need 600 million in a matter of a few months,
just for the U.S. And the big, glaring problem is that, in our federal
system, the primary role in actually getting the vaccine delivered to
people goes to states and localities. And incredibly, there's
practically no money for this purpose right now.

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Here is how this has been explained to me. There are 64
"jurisdictional immunization programs
,"
which includes 50 states, D.C., eight U.S. territories, and five large
cities. They ask for an allocation and the government, through Operation
Warp Speed, will fill that. But at that point it's up to the
jurisdictions to determine vaccination sites, transport the vaccine to
those locations, and make sure there's enough demand at each
particular site so the vaccine doesn't go to waste. Pfizer's vaccine
in particular has a short shelf life
,
just five days in a refrigerator, so it has to get out immediately once
it reaches the last leg of the journey.

There's also prioritization for who gets the initial supply of shots,
staffing for how administers them and how the health system can
integrate it, and just a mountain of other details. We already know
about the freezers
;
many locations just don't have this capability.

So how much money has been allocated for this, the largest logistical
project in the history of mankind? $200 million
.
That's all the jurisdictions have received thus far. Biden has
promised $25 billion for vaccine distribution, but that's tied up in
the moribund stimulus talks. There may be some smart person devising
some way to unlock emergency funding along the lines of what Trump did
on the border wall, but at the moment, you need Congress to issue some
dollars. "[W]e absolutely do not have enough to pull this off
successfully," said the state health officer of Mississippi

to the New York Times.

We Can't Do This Without You

This is absolute madness. The economic and public health effects of
efficient delivery of a vaccine are almost incalculable. It will unleash
pent-up demand

across the country and return the country to something resembling
normalcy. This multi-trillion-dollar, multi-tens-of-thousand-life action
is resting on a couple hundred million distributed across the country?
What?

This case study of preparations in my home county
,
Los Angeles, is instructive. They've bought the ultra-cold freezers,
which is more than a lot of places can manage. But there aren't any
plans on how to ship the vaccine from one freezer to another. The
decisions on where to distribute the vaccine haven't been made. All of
these decisions cost money, and making the wrong one and having to
change plans cost more money. That money doesn't exist without federal
assistance.

As Olivia Webb reports
, with
states largely unable to act, HHS is going through CVS and Walgreens to
deliver to long-term care facilities. Other large chain pharmacy
partnerships are being put in motion. Distribution, in other words, is
being privatized. "There are huge potential failure points," Webb
notes, common to the idea that scale can magnify disruptions. If one of
the thousands of little nodes in the jurisdictions have a refrigeration
problem, that can be managed with some other part of the network. If CVS
fails, that could affect a much larger population.

Of course, this is just the national response. Global vaccine
distribution is a whole other can of worms, one that's incredibly
necessary to prevent future outbreaks and mutations. There's a global
consortium called Covax that is dedicated to this task, but this Times
takeout

on Bill Gates' role with the organization and the use of a bunch of
McKinsey consultants is not very satisfying. In particular, the
lingering effects of drug company intellectual property fights hangs
over the whole enterprise.

In the immediate term, cities and states have to have the funding to
distribute the vaccine. Otherwise, this gets wrapped up with big
business in ways that could have disastrous effects on global health.

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Look at Me

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.

I was on The Intercept's Deconstructed podcast, also talking about the
Day One Agenda. Listen here
.

Days Without a Bailout Oversight Chair

241
.

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Today I Learned

* Fed chair Jerome Powell has (I think, it's ambiguous) agreed to give
back

most funding for credit programs to the Treasury. (Federal Reserve)

* Up to 325,000 excess deaths this year
,
well above the official coronavirus mortality statistics. (New York
Times)

* Hong Kong giving $645

to anyone who tests positive for coronavirus, to encourage testing.
(Bloomberg)

* The monoclonal antibodies from Regeneron

that President Trump used got FDA authorization. (CNBC)

* Incredible: 20 percent of downtown businesses

in Madison, Wisconsin, have closed up due to the virus impact. (WKOW)

* Sen. Kelly Loeffler (R-GA), who has her own runoff election in Georgia
to campaign for, is in quarantine

after inconclusive COVID tests. (Axios)

* $15 billion in direct bailout support for the fossil fuel industry,
according to a new report . (Bailout
Watch)

* Racial disparities on COVID are the consequence of existing health
disparities
,
and can be overcome with effort. (Mother Jones)

* Plenty of ventilators but not enough people

who know how to use them. (New York Times)

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