Cuomo, after threatening to fine vaccine providers: Why aren't these vaccines being given out more quickly?

I don’t believe that the biggest problem with New York’s vaccine rollout right now is that providers are too scared of being fined to administer the vaccine in a timely way. But the juxtaposition of yesterday’s post with the clip below is irresistible. You can prioritize speed in dosing out the vaccine or you can prioritize the most vulnerable citizens receiving it first, but it gets tricky when you try to prioritize both.

I’m thinking a bigger problem with the rollout is the fact that … providers appear to be taking weekends off, per the sharp dips in daily doses in this graph:

Good thing the coronavirus doesn’t spread on Saturdays and Sundays or else we’d really be falling behind.

Having threatened to fine providers who give out the vaccine to people who are ineligible, Cuomo’s now threatening to fine them if they don’t give it out fast enough:

New York state will begin fining hospitals that do not administer allotted COVID-19 vaccines within a week of receiving their supplies and will decline to provide them with further doses, Governor Andrew Cuomo said in a news conference on Monday…

“I don’t want the vaccine in a fridge or a freezer, I want it in somebody’s arm,” [New York Health Commissioner Dr. Howard Zucker] said. “If you’re not performing this function, it does raise questions about the operating efficiency of the hospital.”

There’s only one way to ensure that every last dose is used and that’s by … defying Cuomo and giving the vaccine to people who are ineligible. Once a pharmacist removes a batch of doses from a freezer, the clock begins to tick; the doses will expire in a number of hours. If there’s not enough demand by eligible recipients in that timeframe, the pharmacist is left to decide whether to risk a gigantic fine by dosing out the remainder to ineligible people or to let it go to waste. An example from D.C.:

David MacMillan is not a first responder or health care worker. So he was surprised when a pharmacist at a Giant Food in Washington, D.C. asked him and his friend if they wanted to get the Moderna vaccine…

“She turned to us and was like, ‘Hey, I’ve got two doses of the vaccine and I’m going to have to throw them away if I don’t give them to somebody. We close in 10 minutes. Do you want the Moderna vaccine?” he said in the video.

That’s the way to do it, and that’s how Israel is doing it. But if you’re a provider in New York, Cuomo’s threats about fining people might make you reluctant to take that risk.

As for a national scheme on speeding up vaccinations, how about this? For all of January and February, from 7 a.m. to 7 p.m. each day, senior citizens get exclusive access. From 7 p.m. to 7 a.m., anyone who queues up is eligible. If, during senior hours, business is slow and the pharmacist has doses on the counter that are at risk of going bad, they’re encouraged to administer those doses to anyone they can find regardless of age. Then, starting on March 1, all age restrictions are lifted and it’s first come, first serve for the whole population.

Not a perfect scheme, obviously: What about people who are disabled or who have other comorbidities? What about essential workers? The need for speed requires that we simplify, though. Age is the easiest way.

The key, though, is making sure that providers are dosing it out around the clock, 24/7. Can we make that happen? Sure, says Scott Gottlieb: The sooner we get 24/7 chains like Walgreens and CVS into the game, the sooner the process will ramp up.

Aren’t we going to run out of vaccine if we start round-the-clock dosing at big chains, though? Ah, not likely, Gottlieb says. We have a lot of doses coming:

We also have, or will soon have, an epidemic driven by the new, more contagious strain of COVID that’s brought the UK to its knees in the span of about six weeks:

The U.S. does very little genetic sequencing of the virus relative to other countries so we’re in the dark about the extent to which the British variant is already circulating here. But it’s hard to look at the breathtaking spread and horrendous toll of the virus in southern California despite severe social distancing restrictions there and not wonder whether that’s the UK virus’s handiwork, coming soon to the rest of America. The UK has also been under heavy restrictions but somehow hasn’t managed to avert frighteningly rapid spread. The only thing that’s going to save us, it seems, is mass vaccination as quickly as we can do it.

Which brings us to a question about the stockpile we’re amassing: Should we continue to distribute it proportionally by population or is it time to flood California with extra doses to try to put out the inferno there? If I were Gavin Newsom, I’d be begging for as much of the vaccine as I can get and sending the National Guard into cities to set up 24/7 vaccination areas where seniors can get immunized ASAP. We’re facing a runaway crisis at the very moment that we finally have a brake on it. Whatever money it takes to find the manpower to pull that brake is worth spending. It’s a bona fide national emergency and it’s getting worse by the hour.

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