Long before the coronavirus pandemic began, New York state had a carefully-crafted mass vaccination plan, developed in part with federal grants, which was centered around county public health departments and had been practiced regularly for years. But since the coronavirus vaccine has been approved, Cuomo has seized control of the process without explanation, ignored the plan, and is running distribution through hospitals.

Cuomo is so possessed by conservative desertist ideology, the idea that government benefits should only be allocated to people who deserve them, that until recently hospitals were supposed to use a Byzantine “matrix” to determine precisely who needs shots the most. The New York Times reports: “The state had advised clinics and other facilities to rank employees through a matrix that takes into account age, comorbidities, occupation, and the section of the facility where the person works.” Cuomo threatened that any hospital caught ignoring prioritization rules would be fined $1 million. But then, because people were criticizing him about the slow pace of vaccination, he also said hospitals that failed to distribute their allotments within a week of receiving them would not get any more. The rules were loosened somewhat on Monday, but reportedly New York City still can’t get approval for inoculating anyone in the general population over 75.

As a result, the rate of vaccination is pitiful: New York state had only used a third of its supply as of Tuesday morning, and New York City less than a quarter.