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Vax and the cities

Makes sense.

Mayor Sylvester Turner

A group of mayors representing some of the United States’ most populous cities — including Austin, San Antonio and Houston — is asking President-elect Joe Biden to give them direct access to coronavirus vaccines.

In a Wednesday letter, the 22 mayors urged the Biden administration to establish a national vaccine distribution plan for cities, instead of allocating all available doses to state governments.

“Cities have consistently been on the front line of our nation’s COVID-19 response,” San Antonio Mayor Ron Nirenberg wrote on Twitter. “I’m proud to join my mayoral colleagues in requesting that the Biden Administration prioritize a direct line of vaccines to our communities. We must do all we can to expand and improve access.”

Direct shipments of the vaccine would allow local leaders to plan and connect directly with their constituents, including disadvantaged communities, and help distribute vaccines more swiftly, the mayors argue.

“While it is essential to work with state and local public health agencies, health care providers, pharmacies, and clinics, there is a need to be nimble and fill gaps that are unique to each local area,” they wrote. “Very few cities are receiving direct allocations, and as a result, the necessary outreach needed to lay the groundwork for your vaccination goals are not being met.”

It’s basically an argument for streamlining the supply chain. I favor this because I don’t have much faith in the state’s apparatus, but I’ll listen to your counterargument if you have one. President Biden is proposing a big COVID relief plan that includes a bunch of money for “community vaccination centers”, which kind of sounds like vaccination hubs to me. We’ll see what kind of response this gets.

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8 Comments

  1. Jason Hochman says:

    Not a counter argument, but again, you have to say that Texas is the first state to vaccinate one million people, and leads all of the populous states in percentage of people vaccinated. Texas government is doing a great job, yet Texas has not received as many doses as the other big states that Trump loves much more, for example, New York (his home state) and California.

    The counter argument is the city’s comprehensive annual audit. The city once again had a big deficit in the general fund. The pension problem is as bad as ever. Meanwhile murder rose by nearly 50% in 2020, while the police reported a huge drop in arrests. The fire department is undermanned and underfunded. As Turner said, “it is what it is,” and the fact is that the city is just incompetent to manage the vaccination program.

  2. Lobo says:

    Re: “the fact is that the city is just incompetent to manage the vaccination program.”

    Hochman: I’d say the comparative incompetence is an opinion, not a fact, and should therefore not simply be assumed

    On the merits of alternative distribution channels and agents, what about the County?

    For starters, Lina Hidalgo understands the mismatch of supply and demand, and that you have to be up front and transparent about it, not stimulate demand that is already way too high, or sing your own praises and cast aspersion on those on the front lines (as Abbott in his vaccine news conference).

    Second, there is a dire need for the people at large to understand that the vaccine is not a miracle cure ex machina, at least not in the short run, and that therefore, precautionary measures remain the only effective means to contain the pandemic (and protect one’s own health). The fact that an effective vaccine exists is not a viable alternative at this time. Person responsibility for good health behavior remains imperative.

    STATE VS. LOCAL

    Generally, speaking, the vaccine distribution has to be implemented at the local level because the state doesn’t have the infrastructure or wo/manpower to handle the one-on-one inoculation transactions (unless the program can be administered through a state-level and state-covering institution, such as National Guard, where direct command and control could in theory be an advantage, perhaps in the first stage).

    Big cities have to be the focal points (by whatever name) because that’s not only where the most people are (which lends itself to greater efficiency), but where you have the highest density. The same dynamic that applies to pandemic spread also applies with respect to “spreading” the vaccine (albeit in reverse, by reducing the number of available hosts for the virus to invade and replicate in), and ultimately achieving herd immunity.

    ELECTION ADMINISTRATION ANALOGY?

    Inspiration might even be taken from organizing elections, which pose similar logistics problems, albeit with the smaller population of those both eligible to vote and intent on voting. But the key problem with the mass inoculation is the scarce supply, and the concomitant need to ration, prioritize (i.e., “discriminate” as who gets it and who doesn’t), and how to best queue those given priority designation.

    Election administration is a dubious analogy, though, in at least one respect: The analogue for rationing (which is currently unavoidable) would be voter suppression by the Republicans by making it harder to vote (which is avoidable, at in theory).

  3. Jason Hochman says:

    Lobo, you make a good point. Indeed comparative incompetence is an opinion, but, let’s look at what we have: a state doing the best job of vaccination distribution, so why put it in the hands of the city, which is an unknown?

    More to it, the city has its hands full. It needs to address the murder demic, and the arson demic. It needs to do a better job of funding the police and fire departments that can help with that situation. The city needs to figure out the pension disaster. The city has a lot of infrastructure work to do.

    I also marvel at the mayors who wanted a national strategy, in spite of the fact that the US has a federal system, but now, they want to run the vaccination distribution. And Turner, especially, who was not in any hurry to take on more responsibility. When I asked him about what the city planned to do about the kids failing in school at an unprecedented rate, he said “It is what it is, that’s up to the 17 independent school districts within the city. Ask them, why don’tcha?”

    I didn’t see Abbott’s vaccine news conference, so I don’t know what aspersion he cast, but again, the state leads the other populous states, so something is being done right.

  4. Bill Daniels says:

    Wolf,

    I’d have to disagree with you about Dora la Exploradora’s self awareness in not hyping the vaccine when there’s a limited supply at the moment, but I do agree with you that that’s an opinion, and we all have one. My opinion is she’d do better giving hair and makeup tips on a Youtube channel.

    Next, there’s this:

    “Person responsibility for good health behavior remains imperative.”

    Personal responsibility is great, but anathema to liberal thinking. Personal responsibility would have been to pass information to the public, and then let the public make it’s own decisions. Don’t force businesses to close and thus go bankrupt. Let businesses, and consumers, make their own decisions. Enlightened self interest, eh Wolf?

    As to the vaccine distribution conundrum, Team Trump has largely already worked that out. Remember early on, before there were even vaccines ready to go, Team Trump met with Walgreens, CVS, and other national retailers to plan for testing and vaccination centers using the existing footprint of those retailers?

    So we have Operation Warp Speed, Trump’s doing, to wipe out time killing regulations to speed the vaccines to market, coupled with Trump’s pre planning the distribution scenario and…..if there’s problems, as Creepy Uncle Joe says, getting needles into arms, that’s on local governments.

    Personally, I know several people here in the Houston area who have already gotten the first vaccine. I think the hospitals are doing a pretty good job with distribution….orderly patient scheduling is in their wheelhouse.

  5. Bill Daniels says:

    Also, kudos to Kuff for the thread title excellence. I laughed when I read it.

  6. Lobo says:

    Re: Walgreens, CVS, and other pharmacies

    Bill: Sure, intuitively, that makes sense: a medical service is involved, and they are already providing it (on a pay as you go basis). Think flu shots. The problem is the massive volume, and getting the vaxxing done fast for close-to the entire population (assuming adequate supply), not just the pre-existing pharmacy customer base.

    There are lots of people – healthy people, and people with no ready access to MD – that don’t set foot in a pharmacy all year long (or rarely), and all that extra volume (non-customers) would be in excess of the regular foot traffic. If pharmacy locations had much spare capacity, they would have been closed, and many did as would have noticed if you got around town a bit over the last few years.

    In short: Insufficient infrastructure/capacity. There are both facility (store occupancy limits) and wo/manpower constraints that are not that flexible. Even parking lot capacity would be an issue.

    That said, part of the job can/could be done by piggy-backing (or -packing, if you will) onto the existing customer base in the initial stage involving the priority groups. Many people with pre-existing conditions are also people that regularly visit “their” pharmacy (which takes care of the problem of matching individuals to many small facilities, i.e. physical allocation of capacity), so you can give them that COVID shot at that time without creating too much of a surge that would strain store and staffing capacity. This could even be formalized through a rule that links access to vaccine to pick-up of some other prescription (for queuing purposes and management of the flow of vax customers through the facility).

    But the principal problem right now is the scarcity of vaccine, not yet the mechanics of the logistics. The really serious logistics issues will come to the fore when the supply is vastly increased, assuming Biden invokes the Defense Production Act and/or the persuasiveness of federal money and the expressed willingness to invoke the DPA if need be, to get production ramped up.

    Regarding Judge Hidalgo’s public messaging on the matter, she has recorded video on her twitter, which speak for itself. She also explains how Harris County is going to avoid the mistakes in Florida, were seniors lined up for hours to no avail (CNN’s Dr. Gupta even mentioned it with respect to his own parents).
    Here is Lina: https://twitter.com/HarrisCoJudge/status/1349891551149740033

    I will grant you that Abbott looks more regal on this flag-flanked mobile throne (and some folks like that), but in terms of substance, he can’t hold a candle to Hidalgo (opinion). — Congratulating yourself for the achievement of others (scientists, pharma industry) and blaming others for the failures of your own administration (vaccine distribution and prioritization scheme) are not the marks of good leadership.

  7. Bill Daniels says:

    “Congratulating yourself for the achievement of others (scientists, pharma industry) and blaming others for the failures of your own administration (vaccine distribution and p”rioritization scheme) are not the marks of good leadership.”

    Can I just remind everyone that we are STILL waiting on a vaccine for AIDS? The vaunted Dr. Fauci, back in the 80’s, was a hated pariah for his mishandling of that issue by the same people that love him now. What’s different? Fauci hates Trump, so that overshadows his lack of competency. Feels > Realz.

    Note that Reagan didn’t REALLY intervene and demand that an AIDS vaccine be created back then, and there still is not one today. Compare and contrast with the Wu flu. In less than a year, after Trump’s intervention, we’ve got TWO vaccines, with more in the pipeline headed this way. In fact, wasn’t Joe Biden in charge of Obama’s ‘Moon shot’ to cure cancer? What happened? What did Joe do? Have we cured cancer with that ‘Moon shot?’ Got a cancer vaccine? Seems like the answer is no. We got a nice SOTU speech sound bite, and that’s about it.

    Trump said we’d have a vaccine in record time, and we got not one, but two, with several more on the way.

    As to the limitations of Walgreens, et al, yes, there are obviously going to be staffing challenges. Nurses will have to be hired locally to administer the shots, but the infrastructure, the store footprints, heck, even the store parking lots, were already pre-planned as sites where inoculations were to be given.

    Staffing is obviously going to be an issue, but that’s not something that we can really hang on Trump or the federal team. Every hire can’t be worked out at the top level. Trump’s team has gotten the Trump vaccine out in record time (this can not be disputed), and, with a few hiccups, has a solid plan to distribute the vaccine to the states, using FedEx and UPS, and I think there was some military involvement as well. Trump put military guys, and delivery guys on the team to figure out distribution….he put logistics pros on the problem, vs. picking a team to carefully reflect each of the 57 genders and a Roy G Biv color sampler.

    Do you care about the color and sexual orientation of the people involved in creating and distributing the vaccine, or do you just care that it’s out and people are getting it?

  8. Bill Daniels says:

    Edit: I concede there is an HPV vaccine, but that was created during the W. years, not the Obama years. Joe shouldn’t get credit for that.