COMMENTARY

Let Experts Do What Experts Do

Christopher Moag, PA-C

Disclosures

March 09, 2021

The development of a vaccine through Operation Warp Speed (OWS) was a success by all measures. OWS partnered with the pharma industry leaders, the experts in vaccine development, and prepaid them to develop a vaccine in record time, regardless of the efficacy of the vaccines developed. And this public-private partnership worked; an effective vaccine was developed in less than a year, an accomplishment just shy of a miracle. But OWS wasn't just about developing a vaccine. It was also about "delivering 300 million doses of a safe, effective vaccine for COVID-19 by January 2021." For that, it was a failure — and by more than 250 million vaccines.

We are distributing the vaccine throughout the country, which is a wonderful thing, but it is complicated, unorganized, and nearly impossible to predict. The vaccinators are in the dark about when they're getting vaccines, how many, and who they can be given to. The general population is in the dark about where to get vaccinated, when they'll qualify, and whether they'll be able to get their second dose. To further complicate matters, every state is approaching the vaccine rollout with a different strategy. The governor of Connecticut, in addressing his state's simple approach to vaccine priorities, explained very well that "a lot of complications result from states that tried to finely slice the salami."

The fact that this is happening on a nationwide scale for one of the most important challenges the United States has ever faced is shocking and, frankly, embarrassing. Given the amazing success of the vaccine development, it begs the question: Why didn't the government use the same public-private partnership strategy for the vaccine rollout that was used for the vaccine development?

The vaccine rollout is arguably one of the highest-stakes logistical puzzles the US government, or any government, has ever needed to solve. Every resource on the planet was up for grabs to solve it: virtually unlimited funding, technology, expertise — you name it. Yet, it was decided to use the US healthcare system to figure out a way to vaccinate 330 million people as quickly as possible. This is the same US healthcare system that has been ridiculed for decades for its inefficiency, overcomplexity, and delays in adopting new technology. The same healthcare system in which it takes an average of 24 days to get a first-time appointment with a doctor, one of the most basic needs of its consumers.

Meanwhile, in 2019, UPS shipped 4.7 billion packages across the world, FedEx shipped 3 billion, and Amazon shipped 2.5 billion. These American companies are experts at getting things where they need to be, quickly and accurately. The vaccine effort is the exact type of problem that these companies have been designed to solve. Yes, the vaccine rollout requires more than just getting a box from A to B quickly. But if healthcare systems struggle with scheduling and organization when not already under immense stress from a pandemic, they can't be expected to suddenly figure out how to handle a far more logistically complex situation. These private companies are experts in logistics; they could put together an effective plan and figure out the resources needed to execute it.

The US government has the legal ability to pull these companies into the distribution process. The Defense Production Act, which is already being used to secure supplies during the pandemic, could also have been used to call in logistics companies and contract them to develop and execute the distribution plan. That being said, the Act most likely would not have even needed to be used; if the government had reached out to these logistics companies, they probably would have agreed to help. Amazon has already come forward and offered assistance in the vaccine distribution, stating that they are "prepared to leverage our operations, information technology, and communications capabilities and expertise to assist.". Yet, Amazon is still on the sidelines, watching the US government and healthcare system flounder through the vaccine rollout.

In no way is this an argument that healthcare professionals should not play a role in the vaccine rollout. They are the medical experts. It is an argument that we should be using the medical experts for the medical part and the logistical experts for the logistical part. To be fair, FedEx and UPS were enlisted to ship vaccines from A to B. But this was simply to move vaccines to new locations, not to manage logistics beyond that. And logistics is the main issue we are facing.

Bringing in for-profit companies to manage the vaccine rollout would not have been free. The federal government gave over $10 billion to pharma companies for developing the vaccine — a small price to pay for all the lives saved and the long-term impacts of ending the pandemic. But that $10 billion solved only half the problem; more funding to the right resources is needed to solve the other half of the problem: how to get the vaccine into people's arms. That funding, which is being argued over in the House and the Senate, should in part be going toward making sure that experts are managing vaccine distribution.

Christopher Moag, PA-C, is an emergency medicine physician assistant and the medical team lead at GYANT. For more insights like these, check out his free newsletter, Translational Medicine.

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