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Why has vaccine distribution been so challenging?

Question: Why has vaccine distribution been so challenging?

Answer: To summarize, I would say that the problems are these: 

  • We don’t yet have enough vaccines to go around. 
  • Vaccine administration has been overly decentralized with each locality, sometimes each provider, left to create their own vaccine implementation system.
  • In the context of limited supply and decentralization, localities are straining to plan and implement their vaccination campaigns– especially in light of limited funding, limited human resources, and health care and public health systems already overstretched responding to COVID patients and community spread. 
  • This strain is compounded by lack of timely data from the federal government to states and from states to localities on how many doses to expect and when to expect them. 
  • The lack of timely data seems to be a product of an overly complex vaccine information system in which different government entities “own” different components:
    • HHS/BARDA maintains the manufacturing/production information system (e.g. how many doses to expect from vaccine production); 
    • The Operation formally known as Warp Speed maintains the transit logistics data system and state allocations planning tool (Tiberius); 
    • The CDC maintains the vaccination administration data system (VTrckS) and provides technical assistance to states to help plan allocation needs; and
    • Commercial partners (like CVS), States and Territories, and Federal partners each feed information (e.g. vaccines administered and doses on hand) into various data streams, making the reporting cumbersome, complex, and lagged generally 3+ days.

The new Administration is working to resolve these problems.  For example, yesterday, President Biden announced that the number of doses going to states would increase to 10 million/week for the next 3 weeks, up from 8.6 million/week currently.  He also announced the plan to purchase 200 million more doses of vaccine with the aim of having enough doses for all adults to be vaccinated by this summer.  The Administration’s $1.9 trillion American Rescue Plan  includes a good deal of funding to states and localities to fill gaps in COVID response, including vaccine implementation with a promise to hire 100,000 Americans to support the public health response effort (hello, Health Force!).  And his National Strategy for the COVID-19 Response promises to “improve the allocation process by providing states and their localities with clear, consistent projections to inform their planning.” The Strategy also promises that the Administration will “fully leverage the Defense Production Act to fill any distribution gaps” and commits the Department of Health and Human Services to “release guidelines for redistribution within states as needed and where appropriate.”  
If you’d like to read more, this article published last week in Time, The U.S. Fumbled Its Early Vaccine Rollout. Will the Biden Administration Put America Back on Track?, provides more detail.