That said, it is clear that many states and cities could be doing much better than they currently are. It has been obvious since January 2017 that the Trump administration would provide little help in a crisis. States and cities have had months to lay out a plan, and scrounge up the relative pittance needed to get shots into arms — cannibalizing every other department if necessary, for there can be nothing more important than getting that vaccine out.
Yet a great many states and cities are whiffing it. It appears that the culprit here is some combination of authorities getting tangled up over who deserves the vaccine the most, snarling the process with elaborate eligibility requirements (a classic American neurosis), and the blistering incompetence that has characterized nearly every level of the American state response to the pandemic. As Dr. Ashish K. Jha writes in the Washington Post, the public health departments that are at the center of distribution have been starved of resources for decades, particularly after 2008.
It isn’t hard to think up a simple set of rules that would ensure shots are going into arms as quickly as possible. First, vaccinate all the health-care workers interacting with COVID patients, then everyone in nursing homes (as is conventional wisdom, to be fair). Then distribute shots to hospitals and pharmacies, or set up temporary distribution sites, and instead of trying to prioritize people according to some complex need calculation, do simple age cutoffs so only a driver’s license or some other ID card is needed.