The plan, insofar as there was a plan, made nominal sense. Given the high demand for newly approved COVID vaccines and their relative scarcity, this precious material would have to be initially allocated in the most economical fashion possible. Inoculations, therefore, must be given to the most vulnerable and exposed populations first. This seemed to be an equitable distribution plan with the potential for reducing the most serious infections. Although such a schedule would silo the vaccine, it would also produce the most immediate public health benefits—at least, it would, so long as it could be competently administered. You can already see where this is going.

The ongoing debacle in New York is indicative of the plan’s conceptual flaws. As of Monday, only about 300,000 of the 650,000 doses allocated to New York had been administered. But the restrictions on who can receive the vaccine are so strict that they’ve mostly been administered to hospital workers. That has produced the perverse condition in which hospital employees with little exposure to the pandemic, such as, say, radiologists, are more likely to be immunized than unaffiliated frontline health-care professionals like pediatricians.

“This is a management issue,” said Gov. Andrew Cuomo in his own defense. He insisted that the state’s hospitals have fallen down on this urgent job, but Cuomo has put plenty of stumbling blocks in their paths. This week, the governor decreed that hospitals would be fined up to $1 million if they were found to have vaccinated anyone outside the state-mandated list of priority recipients. But, amid controversy over the slow rollout of the vaccine, he appeared to contradict himself when he also decreed that hospitals would be fined $100,000 if they failed to administer all of their vaccine supplies to the eligible recipients within seven days of their receipt. Thus, hospitals might be more inclined to allow their unused vaccines to expire rather than risk their licenses.

If the governor was more concerned with public health than his own image, the most sensible course of action would be to expand the categories eligible for immunization. Indeed, New York City Mayor Bill de Blasio has called on Cuomo to do just that: open access up to all New Yorkers who are 75 or older—an egalitarian approach that cannot be gamed or manipulated by the well-connected. But the governor has so far resisted these entreaties, and the results of this policy have been underwhelming. For example, in New York City, the vaccination campaign takes weekends and holidays off, and this past Monday saw fewer vaccinations recorded than the week prior. This is not the sort of urgency you might expect to see amid a paralyzing global pandemic.

The situation isn’t much better in Chicago. There, Mayor Lori Lightfoot blamed a similarly glacial rollout of COVID vaccines on the federal government, and she’s not entirely wrong. The Trump administration promised to distribute at least 20 million doses of the vaccine by the first of the year, but only 14 million found their way to the states. And yet, only about 4 million doses have been administered so far. “If you look at Illinois as a state,” which had received about 400,000 doses by the end of 2020, said Northwestern University Professor Hani Mahmasssani, “it’s about 42% of the vaccine delivered to Illinois has actually be administered.”

Like many other municipalities around the country, Chicago has provided frontline healthcare workers with priority access to COVID vaccines. But not every healthcare worker has taken advantage of this incredible opportunity. National Public Radio spoke to Dr. Nikhila Juvvadi, the chief clinical officer at Chicago’s Loretto Hospital, who justified this phenomenon by contending that minority groups have general and historical mistrust of vaccines. “I’ve heard ‘Tuskegee’ more times than I can count in the past month,” Juvvadi said, “and, you know, it’s a valid, valid concern.”

No, it’s not. The press has spent weeks heaping mountains of deserved scorn on Republicans whose paranoia is damaging civic health, but only to legitimize and validate paranoia that might do real damage to the nation’s physical health? That’s unconscionable, particularly since it seems that Juvvadi’s experience isn’t atypical. As NPR noted, a Kaiser Family Foundation poll found that nearly one-third of surveyed health-care workers won’t get vaccinated, many of whom are minorities. But rather than aggressively dispel unsubstantiated concerns about COVID vaccines, which are contributing to the bottlenecking of supplies, this outlet chose to legitimize them.

The plan, though well-intentioned, isn’t working. And some municipalities are beginning to face that fact.

In Southern California, hospitals are acknowledging that they have had no choice but to violate Sacramento’s mandates regarding vaccination eligibility. When these facilities were left with half-depleted vials and no new recipients for a jab, they were compelled either to allow these vaccines to expire or to inject them into any willing recipient. But because distribution remains limited to hospital workers, those willing recipients were mostly drawn from the family members of doctors and hospital staff. To some, that might seem like an abuse of privileged access to this inoculation. But when the only other alternative was to allow vaccine supplies to perish, it should be clear to any reasonable observer that there was no alternative.

A Sacramento hospital recently experienced similarly adverse circumstances and turned that adversity into a trial run for an effective policy aimed at vaccinating a critical mass of the public in short order. On Monday, a Mendocino County medical center discovered that one of their freezers housing 830 doses of the Moderna vaccine had failed, and all their doses would expire within hours. So, hospital staff fanned out, exhausting priority recipients and eventually flagging down anyone willing to receive the vaccine before it expired. Within two hours, before the imperiled vaccines succumbed to the elements, every drop had been administered to someone.

This improvisational approach to mass vaccination is all but policy in Washington, D.C. In the District, the Department of Health’s official guidance allows extra doses of the vaccine to be distributed to anyone willing to take them. And there has been no shortage of takers. Likewise, Florida has opted to provide hospitals and long-term care facilities autonomy to determine how they distribute the vaccine after priority populations had been targeted. This has produced a somewhat chaotic situation in which individual counties have resorted to using private event-coordinating platforms on the Internet to organize the distribution process. And although this has produced great consternation in the press, it’s better than having a centralized, government-run portal that doesn’t work (which has been New Jersey’s woeful experience to date).

An all-of-the-above approach isn’t just desirable; it is an urgent necessity. If the country’s objective is to achieve herd immunity as fast as possible—a condition that will protect both the aged and frontline health-care workers as much as their own vaccination would—expanding access to immunizations seems like the logical way to get there. Unfortunately, like the vaccine, logic is in short supply.

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