We find ourselves in the same place at the end of the pandemic as we were at the beginning, doing really badly — but not as badly as some other western countries. As of a week ago, France had administered a grand total of 500 doses of the Pfizer vaccine compared to 270,000 in Germany.

No typo.

Meanwhile, America is picking up the pace:

* U.S. CDC SAYS ADMINISTERED 8,987,322 DOSES OF COVID-19 VACCINE AS OF JAN 11 VERSUS 6,688,231 DOSES ADMINISTERED AS OF JAN 8@Reuters

— Carl Quintanilla (@carlquintanilla) January 11, 2021

We’re inching up towards 800,000 new vaccinations a day, which is nice. But two million a day would be a lot nicer, particularly when you remember that we’ll need something on the order of 300 million people to be immunized before we reach herd immunity according to best estimates. Assuming that 100 million people will acquire immunity through infection, that means we’re looking at 400 million vaccinations. (Since, at least for the moment, all available vaccines require two doses per person.) Even at a rate of two million per day, we’d have to run full throttle into August to get where we’re going.

Biden has promised 100 million doses in his first 100 days, a number that *might* be achievable if everything runs well and we continue to build out capacity. But he’s already getting nervous that his first big initiative as president may fail because the people he’s put in charge don’t quite know what they’re doing. From Politico:

Biden has expressed criticism on multiple occasions to groups of transition officials — including one confrontation where Biden conveyed to Covid coordinator Jeff Zients and his deputy, Natalie Quillian, that their team was underperforming…

Zients, a business executive, and Quillian, who was until recently a partner at Boston Consulting Group, do not have public health backgrounds, and there’s been tension over their approach, which some people said was too broad-brush and not detailed enough for the complexity of the problem. Quillian had previously clashed with staffers on the campaign who felt the consultant-style mindset she tried to apply didn’t fit with a campaign operation, according to multiple staffers…

Biden on one occasion became exasperated with Zients and the team for not arming him with enough details on their planning ahead of a mid-December meeting between Biden and governors focused largely on the coronavirus response.

“They probably require some more practical doers with deep experience in navigating business and government,” the person who has been working with the transition said. “People who have actually made a bill become law or pulled together industries and understand what businesses are capable of and what they’re not.”

You can already see the partisan blame-shifting coming in February if Team Joe is slow off the mark. For Democrats: Biden inherited chaos from Trump. He had no idea how unprepared the federal government was to ramp up vaccinations. For Republicans: Biden’s supposed to be the “adult in the room,” the guy who would take COVID management seriously. Now here he is, already grasping for excuses. You can also tell how worried Team Joe is about not hitting its targets from the fact that they broke with Fauci’s advice last week and opted for a “first doses first” strategy on immunizing people. That strategy aims to partially vaccinate a great number of people rather than hold doses back to fully vaccinate a smaller number. (Ironically, Sleepy Joe received his second dose of the vaccine a few hours ago.) They’re prioritizing speed, and not just so that Biden can hit his numbers. The more Americans we can partially immunize in a short period, the more quickly we can slow the raging pandemic down.

Last week the Daily Beast reported that Trump’s team had also begun to prioritize speed by asking states to relax some of their priority rules when doses are at risk of expiring in order to encourage providers to dispense the vaccine more quickly:

As part of the conversations about how to quickly improve distribution, officials in task force meetings, in interagency phone calls and in a Camp David summit Tuesday suggested that states should distribute the vaccine—doses that may soon expire—to any individuals who want to get inoculated. These people would get the vaccine, even if they are not frontline healthcare workers, essential workers, over the age of 75 years old. There has been no formal decision to draft recommendations in this vein, officials said they are not against states pursuing this course of action and have transmitted to some local officials that they should embrace the idea. Health and Human Services Secretary Alex Azar and other top Operation Warp Speed officials met at Camp David Tuesday to discuss the next two weeks of the vaccination rollout and the transition to the Biden administration.

“We need to make sure that the critically ill and most vulnerable people are getting this vaccine first,” one senior administration official said. “But after that if there are doses that are just sitting in fridges expiring, we got to get them out there.”

If you think the scenario in which doctors simply stand by and let expiring doses go bad rather than dispense them to anyone within eyeshot is far-fetched, rest assured that it isn’t. It’s happening:

They were looking for unvaccinated employees

Most employees there had been vaccinated. Rest were unwilling

Found several EMTs & patients who were excited to be vaccinated

But hospital policy was clear: non-employees aren't eligible

My friend, ER Doc, incensed, intervened

2/4

— Ashish K. Jha, MD, MPH (@ashishkjha) January 11, 2021

But by then, vaccinators had left

He tracked them down. Their shift was over and per protocol, they had discarded the doses

Hearing more stories like this

No idea if these are one-offs or systemic

We aren't publicly reporting detailed data on state of vaccinations

4/5

— Ashish K. Jha, MD, MPH (@ashishkjha) January 11, 2021

Andrew Cuomo’s threats to levy heavy fines on any provider who bucked the prioritization become so notorious as a disincentive to speedy vaccination that he had to back off of them this past weekend, when even Bill de Blasio was dunking on him for being an idiot. That’s the good news, that he relented. The bad news is that New York’s new online vaccination hub is itself a Kafkaesque nightmare that’s going to end up discouraging the people who need the vaccine most urgently from signing up for an appointment:

not an exaggeration to say that the nyc covid vaccination website process is so overly long and difficult and broken that old people will die because they couldn't complete it

(source: me, after logging onto my mom's computer remotely and spending an hour getting her an appt)

— my pal andy™ (@andylevy) January 11, 2021

I talked to a friend last night who had the same experience. He was asked to create an account for his elderly parents on the website, then was asked to scan in their insurance cards. The questionnaire apparently involves up to *51 questions.* If you’re not Internet savvy and don’t know how to work a scanner, what do you do?

How is it not the absolute highest priority for bureaucrats to make the flow of information on both sides of the process as easy as possible? Create a centralized website with a widget to make an appointment and information on where to go, and simplify it to the point that a precocious six-year-old could figure it out. Name, time and date of appointment, that’s it. Or set aside some hours at the local pharmacy each day where seniors can just walk in. Instead:

All vaccinations are BY APPOINTMENT ONLY.

Due to limited supply from the federal government, all New Yorkers are encouraged to remain patient when scheduling appointments.

Do not show up to any vaccination site without an appointment—you will not get the vaccine.

— Andrew Cuomo (@NYGovCuomo) January 11, 2021

Thousands upon thousands of seniors in New York are going to give up on the process, exasperated that they can’t get scheduled. Another win for America’s worst governor.

I’ll leave you with Scott Gottlieb, insisting that it’s time to call an audible because the current pace is unacceptable.

"We need to acknowledge that it's not working, we need to hit the reset and adopt a new strategy in trying to get that out to patients" @ScottGottliebMD says of #VaccineStrategy pic.twitter.com/xalDjoZYKV

— Face The Nation (@FaceTheNation) January 10, 2021