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Expert Vaccine Allocation Panel

We need to up our vaccination data game

As noted before, it gets harder from here.

As the initial mad rush for COVID-19 vaccines wanes, Texas is shifting its distribution strategy to focus on smaller providers, setting up a crucial test for the state as it attempts not only to get shots in arms but also to track that information accurately.

Over the past five months, Texas health officials have focused on allotting vaccines to mass vaccination sites, pharmacies, hospitals and local health departments that distribute thousands of doses a week — introducing a mammoth data collection effort that stressed the state’s already troubled reporting system. Officials say the new strategy will help target communities that have so far been hesitant to get shots by working with local pharmacies and public health organizations.

“Vaccination has slowed,” Imelda Garcia, the chair of Texas’ Expert Vaccine Allocation Panel, said during a Thursday news briefing. “It seems we’re getting to the point that most people eager to get vaccinated have gotten at least their first dose, so the next phase will be about helping ensure that vaccine is more easily available to those folks who are not going to go as far out of their way.”

The effort will be supplemented by a $1.5 million ad buy targeting vaccine hesitancy, alongside an in-person push in Walmart parking lots to tout the benefits of the vaccine. The state will host about two dozen pop-up events over the next several weeks; the first took place Thursday in south Austin.

“We’ve seen a reduction in vaccine requests coming from our big hub providers, and that means continuing the shift from the mass vaccination sites to regular providers like doctor’s offices and pharmacies,” Garcia said.

[…]

As vaccine allocations ramped up dramatically over the past month, agencies administering the shots have reported glitches or other issues with the state’s vaccine tracking portal, ImmTrac2.

“We feel we’re getting the data in an appropriate amount of time,” said Patti Foster, chief operations officer of Texas Emergency Hospital in Liberty County. “We’ve just been very frustrated with the ImmTrac system.”

The ImmTrac portal works with the state’s Vaccine Allocation & Ordering System, which providers use to request doses. While the VAOS program runs relatively smoothly, ImmTrac has repeatedly undercounted the number of people who have been vaccinated.

The errors threatened weekly vaccine allocations. State officials would look at the bad data and think that the provider was not using its entire vaccine stockpile, potentially deciding to allocate fewer doses the next time around.

Providers said they usually receive a call from the state when that happens, and they’re able to work it out. Still, it’s a frustrating and time-consuming problem, especially as providers sometimes have to tell several different state employees the same problem again and again.

“It’s been a very cumbersome process, and you have to really stay on top of it,” said Jennifer Harrison, the senior director of clinical operations at UT Health Austin.

The state’s vaccine administration numbers have also been unreliable. For nearly two weeks, the state’s dashboard has indicated that Cochran County — with a population of 3,100 people just west of Lubbock — had vaccinated more than 95 percent of its 16-and-over population. That error occurred because of a coding problem, state officials said, but it has yet to be fixed.

State health officials say they are dealing with “hundreds of thousands of doses from thousands of providers” and are getting to the bottom of problems as they arise.

See here for the background. I don’t have any insight to offer here – this story was my introduction to ImmTrac2 and the Vaccine Allocation & Ordering System – other than to say data is often messy, and big IT projects always have kinks in them. The state could certainly allocate more resources to these projects, but in the end the implementation is going to have its share of bumps. How we handle them over the next couple of months will help determine where we end up in percentage of the population vaccinated.

When the vaccine problem becomes more about demand than supply

Or to put it another way, what are we gonna do with the people who refuse to get vaccinated?

Low vaccination rates in counties that are whiter and more conservative could be impairing Texas’ ability to quickly reach herd immunity for COVID-19.

Texas counties that are poorer, whiter, less-educated and where former President Donald Trump won a larger than average share of the vote have vaccinated a smaller share of their population than the state average, a Houston Chronicle analysis found.

In the 144 Texas counties that meet these criteria, about 28.7 percent of people aged 16 and older have received at least one dose of the COVID-19 vaccine. Statewide, the average is 32.2 percent.

In Liberty County, fewer than 20 percent of residents have received at least one dose of the vaccine, one of the lowest rates in the state. What’s more, as Harris County residents have begun flocking to rural counties for easier access to vaccines, state data shows that providers in Liberty County — a rural patch between Houston and Beaumont — have put 27 percent more shots in the arms of Harris County residents than they have in residents of their own county

Meanwhile, in the 22 counties where Joe Biden won a majority of the vote — places that tend to be both more diverse and educated — an average of about 44 percent of eligible Texans have received at least one dose of the vaccine.

The vaccination gap between whiter, more conservative counties and the state average may not be cause for concern for the state’s vaccination efforts yet, said Rice University health economist Vivian Ho, but there is a potential for it to widen over the next two to three months.

“As more vaccines become available, that gap is going to widen, because there’s still excess demand for vaccines in our cities, where the majority of the population lives,” she said. “If, for instance, only 50 percent of people in these outlier counties are vaccinated, they will continually be subject to superspreader events that will overwhelm the weakest components of the state’s healthcare infrastructure.”

[…]

Across the state, health officials are searching for ways to reach and vaccinate people who are reluctant to do so.

State health officials are trying to think through the “last mile”, said Dr. David Lakey, a member of the Texas COVID-19 Expert Vaccine Allocation Panel. People who are hesitant to get vaccinated may not go to mass vaccination sites or hubs, but may go to providers they trust.

In Public Health Region 4/5 North — a group of counties in the northeastern part of the state, around Tyler — officials are working with faith-based communities and hosting vaccine fairs to vaccinate more people in the region with the state’s lowest average rate. They have also been conducting home visits as part of these efforts to bring vaccines to homebound people.

Ron Nichols, emergency coordinator for Chambers County, said having well known, local paramedics dole out doses has helped assuage some residents’ concerns. Nichols said demand for vaccines was initially high, but has begun to plateau in recent months because people are either waiting on the single-shot vaccine from Johnson & Johnson, or because of distrust rooted in misinformation.

“There are a lot of people who just don’t understand, don’t know or don’t trust the process,” he said. “The Facebook misinformation machine has been running rampant.”

I suppose there may be fewer Houstonians taking vaccination road trips now that there’s more doses available. Be that as it may, the approach being outlined here makes sense. It’s largely the same strategy that has been advocated and used for communities of color and immigrants, and for the same reason – people trust people they know. It’s more arduous, but it has to be done. It would be nice if more of the state and federal elected officials who represent these areas stepped up and took some of the responsibility for convincing their constituents to get vaxxed, but I’m not holding out much hope for that.

(I am going to attempt to exercise some grace about the hesitancy in these parts of the state, even as we know that lies and propaganda are the main reasons for the fears that many of these folks have, and the risk that their hesitancy may help give rise to a stronger and more vax-resistant strain of the virus. For now, at least. We’ll see where the numbers are in a few months.)

The vaccination eligibility list is about to be wide open

Go ahead and get on it, though be prepared to wait as the supply issues work themselves out.

Everyone age 16 and older, regardless of occupation or health status, will be eligible for the COVID-19 vaccine in Texas starting March 29, state health officials said Tuesday.

The Texas Department of State Health Services is still asking providers to prioritize appointments for people who are 80 and older, and to prioritize walk-ins from anyone in that age group who shows up without an appointment. The vaccines are not limited to Texas residents, and citizenship is not a requirement for the vaccine.

“We are closing in on 10 million doses administered in Texas, and we want to keep up the momentum as the vaccine supply increases,” said Imelda Garcia, DSHS associate commissioner for laboratory and infectious disease services and the chair of the state’s Expert Vaccine Allocation Panel.

Until now, eligibility for the vaccine was mainly restricted to a few groups: health care workers, people ages 50 and older, those with certain underlying health conditions who are 16 or older, and employees of schools and day care centers. Texas began receiving vaccines in mid-December.

The vaccine is still in short supply as the announcement makes about 22 million people eligible on Monday. The state has been allocated more than 14 million doses since distribution began in December — far short of the supply needed to fully vaccinate everyone right away.

[…]

The state is also launching a website next week for people to sign up for vaccines at public health centers and state-run clinics. The Texas Public Health Vaccine Scheduler will alert participants to upcoming events and available appointments. For those who do not have access to the internet, the state will also be creating a hotline for appointments by phone, officials said.

The DSHS has more on Twitter. Great news for those who have not yet been eligible, though as we have previously discussed it’s not necessarily great for the distribution effort or for vaccine equity. All states were mandated by President Biden to make the vaccine generally available by May 1, so this is just getting a one-month head start on that.

County Judge Lina Hidalgo calls this a milestone moment.

“Opening vaccine eligibility vaccines to every adult is a key milestone in our fight against COVID-19,” Hidalgo said. “The onus is now on each adult to do their part. This vaccine is safe and effective, and the faster we all get a vaccine the sooner we’ll be able to pull through this crisis, get our economy running at full speed, and get life back to normal.”

Many experts have continued to raise concerns about unequal access to vaccines, particularly among low-income communities.

Rice University health economist Vivian Ho said the opened eligibility could help on that front because public health agencies will be able to, for example, vaccinate all workers at a grocery store.

“Now you can say we are going to go to workplaces, because there’s no age limit,” she said.

Conversely, Ho said, the announcement will do little to convince people who have already decided not to get vaccines, namely in communities outside of major cities.

Opening eligibility criteria will clear confusion for many communities who have hesitated to get a COVID-19 vaccine because of constantly changing age and medical condition restrictions, said Luis Torres-Hostos, dean of the University of Texas – Rio Grande Valley School of Social Work.

Torres-Hostos, who has worked with his university to get the message out to Latino communities, is hopeful public health officials will have more luck with immunization with these changes.

“Where are the vaccine deserts? Where are the places where it’s really hard for members of the community to get their vaccine?” he said. “We’ve got to do something to make sure that the vaccine is being given there.”

However, even his optimism comes with a caveat. Expanded criteria will only fix inequities if it comes with increased vaccine supply.

Communities of color and low-income communities are not hesitant to get the vaccine; a recent poll by the Kaiser Family Foundation finds 7 in 10 Hispanic people surveyed have received or want to book an appointment for a COVID-19 vaccine.

“If we build it, they will come,” Torres-Hostos said.

I sure hope this will help with the inequity issue, and I agree it will clear up any lingering confusion. We’ll look for that DSHS website when it’s up (and hopefully doesn’t crash). Y’all get yourself – and anyone you know who might need some assistance – in line for the vaccine.

Vaccine progress

Good news.

Texas will surpass more than 7 million COVID-19 vaccination doses administered today, top public health officials told the Texas Senate as Gov. Greg Abbott lifted all capacity limits for businesses and ended government-imposed mask mandates in the state.

At the same time, the health officials also offered a strong defense of the previous mask mandates, saying they reduced the chance of asymptomatic people spreading the virus and resulted in a record low year for influenza in Texas.

The speed with which vaccinations are being distributed is one of the keys to Abbott’s new order removing all mask mandates and allowing all businesses to re-open to 100 percent of their occupancy. Still, Texas has one of the lowest vaccination rates in the country, with 15.8 percent of residents having received at least one shot.

“We have come a long way in a very short period of time,” said Imelda Garcia, a top official with the Department of State Health Services, as she testified before a committee in the Texas Senate on Wednesday morning.

Garcia reminded lawmakers that Texas didn’t get its first vaccine shipments until Dec. 14. She lauded vaccine providers around the state for stepping up to administer so many shots in such a small window.

“They have been busting their butts in order to get shots in arms as fast as they physically and possibly can,” Garcia said.

Harris County alone topped 1 million doses on Tuesday.

Because the majority of vaccines in Texas require two doses, the number of people fully vaccinated is just over 2 million statewide.

Yes, there has been a lot of great work done, and everyone involved should be praised and thanked for it. There have been plenty of obstacles to overcome, that’s for sure. Because I’m a numbers nerd, I feel like I have to say something about the totals and percentages cited in this story, because as is they’re making me twitch. Seven million people would represent about 23% of the total state population. Given that the vaccines are only being given to those 16 and up, that makes the denominator in that fraction smaller, and thus would make the percentage higher. The only way this works if that total of “seven million doses administered” counts all shots given, both first and second. That would put the number of people that have had at least one shot at almost five million, which is closer to that 15.8% (it’s now higher on that NYT page, as it updates in real time). I’m just a little annoyed that I had to think it through like this to make sense of it all.

Not so good news.

The Texas Medical Center, in partnership with the city, is now administering 232,000 COVID-19 vaccine doses per week, and experts expect that number to ramp up as more vaccines are shipped to the state.

While vaccination rates are increasing and COVID-19 cases are trending downward again, medical officials said the public shouldn’t get too comfortable. Texas Medical Center leaders said there is currently no strong correlation between vaccination and hospitalization rates.

Experts are anxious that there could be another surge as students go on spring break this month. There’s more virus in Houston, and it’s spreading faster as more infectious variants circulate in the area.

“We’re not seeing the rapid decline we want to see,” Bill McKeon, president of the Texas Medical Center, said at a Wednesday webinar on the state of COVID-19 in Houston.

Part of the reason for this is that it takes time for the vaccine to take full effect – this is true of both the one-shot J&J vaccine and the two-dose Pfizer and Moderna vaccines – and it is eminently possible to continue to carry the disease after getting your shots. You will be much less likely to get sick, but you can pass it on to others, who may not be so lucky. This is why everyone who cares about keeping people alive and healthy are continuing to urge everyone to wear masks and maintain social distancing. We are approaching a point where those things will not be vital, but we are not there yet.

Good news for some, just news for others.

Texans ages 50 and older will be eligible for the COVID-19 vaccine starting March 15, state health officials announced Wednesday.

“We’ve seen a remarkable decrease in the number of hospitalizations and deaths since people 65 and older started becoming fully vaccinated in January,” said Imelda Garcia, the chair of the state’s Expert Vaccine Allocation Panel. “Expanding to ages 50 to 64 will continue the state’s priorities of protecting those at the greatest risk of severe outcomes and preserving the state’s health care system.”

Currently, the state is vaccinating members of priority groups 1A and 1B, which include health care workers, Texans 65 and older, and anyone over age 15 who has a pre-existing condition. Last week, state officials also made educators and child care employees eligible for a dose.

Those 50 and older will be included in priority group 1C. More than 93 percent of Texans who have died from the virus have been at least 50 years old, health officials said in a press release.

One can certainly argue that some other folks should have been next in line, but this is where we are. On the plus side, thanks to President Biden, everyone will be eligible for the shot in a few weeks. Until then, get yourself signed up at your first opportunity. And keep that mask on until someone other than Greg Abbott tells you to take it off. The Trib has more.

We should be vaccinating grocery workers

The only disagreement I have with this is that we should have more broadly classified “essential workers” from the beginning, and it should include more people who do not have the ability to work from home.

Nearly a year into the pandemic, Ryan’s experience that day reflects the challenges that grocery store workers across Texas are facing in their stores every day. For months, workers have risked their health to keep shorthanded grocery stores open, all while dealing with increased hours and customers refusing to wear masks.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices urged states to include front-line essential workers in Phase 1B of vaccine allocation. But Texas decided not to include any essential employees like grocery store workers in the state’s current vaccine priority groups. Without any guarantee of vaccine prioritization, grocery workers now find themselves overwhelmed and continually exposed to the virus with no end in sight.

[…]

Back in April, when people made a rush for essential supplies like toilet paper and soap, Gov. Greg Abbott tweeted a message of support for grocery store workers, saying that “everyone across our state appreciates your hard work to help Texans respond to the #coronavirus.” Since then, workers say they have felt forgotten and abandoned by the state government.

In December, the Texas Expert Vaccine Allocation Panel, in charge of designating each population currently eligible to receive vaccinations, decided against including front-line essential workers in Phase 1B. The Department of State Health Services said that the panel wanted to reserve vaccine doses for those at the highest risk of death, which includes people over 65 and anyone over 16 with a chronic medical condition that puts them at higher risk.

At least 8 million Texans currently qualify for Phase 1A or 1B of vaccine allocation, but the state has received fewer than 4 million doses thus far. The panel is currently considering potential priority groups for Phase 1C of vaccine rollout, and its decision will depend on epidemiological data about virus transmission, according to DSHS Director of Media Relations Chris Van Deusen.

However, at least 11 states and the District of Columbia followed CDC recommendations by deciding to put front-line essential workers, including grocery store employees, in the their latest rounds of vaccine allocation, according to The Washington Post. New York allowed grocery workers to start getting the vaccine last month. Arkansas has also started vaccinating teachers and educators in the first round of essential workers to receive doses, and the state plans to expand distribution to other essential workers later this month.

“You feel like you don’t matter when your own state goes against every recommendation that there is out there,” said Dawn Hand, who works at a Kroger in Houston. “Why don’t we matter? What’s your answer to that?”

I personally feel that prioritizing people who had to do in-person work, as some states have done, was the better choice than making group 1B open to the over 65 crowd, and I say that even knowing quite a few people who have gotten their vaccine as a result of that choice. Big employers, like grocery stores and big-box retail – plus all of their delivery workers – could have been brought in to help distribute and administer the shots. This would target people who are clearly at risk, and as the story notes would also have helped with the equity problem. Another group of essential workers that should have been prioritized are meatpacking plant employees, who have not only been extremely hard-hit by COVID (due in large part to the inhumane practices of their employers) but are also lower-income, often non-English-speaking people who are harder to reach for the vaccine. In their case, I’d want to send clinicians to their locations, and use whatever threats and incentives are needed to make sure their bosses give them the time and space to get vaccinated. We could still do all of this in round 3, but I don’t blame any one of these folks for thinking that they were left behind.

The COVID vaccine wait list

Good idea, and about time.

Judge Lina Hidalgo

Harris County Judge Lina Hidalgo announced Monday afternoon a new COVID-19 vaccine waitlist, in an effort to ensure those who are high priority don’t get overlooked and make for a smoother process.

Hidalgo explained the basics of how the waitlist will work. Hidalgo was joined by Dr. Sherri Onyiego, the interim local health authority for Harris County Public Health.

The waitlist is said to be weighted and randomized, meaning the website won’t necessarily favor whoever has the quickest internet connection. Once the portal opens Tuesday, everyone will be able to register.

If you fall under the 1A, 1B or seniors groups, then your registration will be weighted for priority, and it will then be randomized within the priority list.

The launch of this new portal and waitlist expands the previous process by allowing eligible residents to sign up for vaccines on their own directly, according to a press release from the county.

Eligible residents without internet access can also call 832 927-8787 once the portal is live to be placed on the waitlist.

The new system starts today:

That’s a good approach, and honestly it’s how we should be doing this nationwide. I’ve heard plenty of stories of people with good Internet skills or just the right about of persistence and life-hacking who have helped people sign up for vaccines, but it really can’t and shouldn’t be this hard. And honestly, even for the folks like me who are closer to the back of the line, just being able to register now and then wait to be called when it is our turn would likely relieve a lot of anxiety out there. This starts today and if it works as well as I expect it will, I hope other counties will follow suit. The Chron and Houston Public Media have more.

Meanwhile, on a related note.

Lt. Gov. Dan Patrick is pushing the state to refine its criteria for COVID-19 vaccination eligibility, saying that whittling down the list may better prioritize vulnerable Texans and clear up confusion over when shots will actually be available.

The state is currently offering the vaccine to frontline workers and vulnerable Texans, a group of more than 9 million people — even though the state is only receiving about 300,000 doses a week. That numerical reality has made for a confusing and frustrating process for Texans eligible for a shot, with many unable to find available doses or unsure where to look with demand far exceeding supply.

“Texans need to have a better understanding of the time it will take for everyone to be vaccinated in order to reduce lines, confusion and frustration,” Patrick wrote in a Thursday letter to the state’s Expert Vaccination Allocation Panel.

It will probably be May at the earliest before all members of that first priority group have been immunized, said Dr. David Lakey, a member of the state’s vaccine panel, in an interview this week with Hearst Newspapers. The Texans currently eligible are included in groups 1A — health care workers and nursing home residents — and 1B, those over 65 and anyone 16 or older with certain pre-existing medical conditions.

[…]

Patrick suggested creating subgroups within 1B over the next several weeks — perhaps by first taking two weeks to vaccinate those 75 and older, a group of about 1.5 million. Then, he said, a subgroup of roughly 65,000 teachers and school staff over 65 could become eligible.

“This would help give people an idea of reasonable expectations and reduce wait times and frustration each week,” Patrick wrote. “Right now, in many cities and counties when an announcement of available vaccinations is made, website sign-up pages crash and phone calls go unanswered.”

Seems reasonable, and as above it makes you wonder why no one had thought of this before. Including and especially Greg Abbott, who did not come up with this idea despite being the immovable object on everyone’s COVID plans. We’ll see what happens with this.

Next in line for the vaccine

Attention will shift to more vulnerable populations.

Texans who are 65 years old and older, and those who are at least 16 with certain chronic medical conditions will be next in line for the COVID-19 vaccine, the Texas Department of State Health Services announced Monday.

“The focus on people who are age 65 and older or who have comorbidities will protect the most vulnerable populations,” said Imelda Garcia, chair of the state Expert Vaccine Allocation Panel and DSHS associate commissioner for laboratory and infectious diseases. “This approach ensures that Texans at the most severe risk from COVID-19 can be protected across races and ethnicities and regardless of where they work.”

The vaccine, which arrived in Texas on Dec. 14, has been available so far only to front-line health care workers and residents of long-term care facilities. There are nearly 1.9 million Texans in that group, so it will likely take a few weeks before the state transitions to the next phase, state health officials said.

The state expects to receive 1.4 million vaccine doses by the end of the month. Eligible facilities under the current phase include hospitals, pharmacies, nursing homes and Texas Department of Criminal Justices facilities.

The city of Houston will also receive 6,000 doses that are ticketed for firefighters and health care workers, so that’s good. A list of comorbidities that would get you onto the eligible list for the vaccine is in the article, so click over and check it out if you think this may apply to you or someone you know. But do keep in mind that bit about it taking a few weeks to transition into that next phase, because it will take awhile to get through the first phase. We need to continue to practice prevention so as not to sicken and kill many more people needlessly.

Indeed, for those of us in Houston, the next few weeks are looking rough.

The spread of COVID-19, steadily increasing in Houston and Texas since the beginning of November, is expected to accelerate in coming weeks, according to the latest modeling, a trajectory that could make the city and state one of the nation’s next hot spots.

The models project COVID-19 numbers — cases, hospitalizations, deaths — to continue rising in Houston and many other parts of Texas before likely peaking sometime in January. Parts of the state at crisis levels the past month have peaked.

“There’s a lot of concern about the Houston area as we enter the Christmas season,” said David Rubin, a pediatrician and director of The Children’s Hospital of Philadelphia’s PolicyLab, which produces one of the models. “If I were to say what areas in the country still have the potential to surge, the Houston area definitely would be one of them.”

Rubin and others urged everyone to hunker down over the coming holiday period in an attempt to limit the damage from the coronavirus’ seeming last onslought before gradually deployed vaccines can begin to shut down the pandemic. He noted widespread deployment won’t be in time to affect Houston’s winter peak.

[…]

“What’s concerning is that so many regions of Texas look to be hit about the same time,” said Spencer Fox, associate director of the UT COVID-19 Modeling Consortium. “It’s a sad trend at a time when the vaccines are almost within reach.”

The Houston-area trends are worrisome in two of the models. Fox’s group projects 2,121 COVID-19 hospitalizations in the area on Jan. 15, for instance, an increase of 36 percent over the 1,561 such admissions for Dec. 17.

In addition, the CHOP PolicyLab modeling shows the number of Harris County COVID-19 cases should nearly double by the end of the first week of January. The model projects 2,919 cases on Jan. 7, up from 1,478 on Dec. 14.

A third forecast, by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), projects the number of deaths in Texas will peak Jan. 5 at 292. The model, the only one of the three that projects more than a few weeks out, says daily deaths would total 280 on that date assuming universal mask wearing but reach 345 by late January if mandates are eased.

Thanks partly to the vaccines, the IHME model projects the number of daily Texas deaths will decrease dramatically after the Jan. 5 peak — 138 on Feb. 1, 55 on March 1 and 17 on April 1. The vaccine’s most immediate effect is expected to be more of reducing severe illness and deaths than cases.

The IHME model does not project past April.

In all, 28,134 COVID-19 Texas deaths are expected as of Dec. 31, according to the IHME model. All but 2,700 of those came after June 30.

“That’s a devastating loss of lives in just a six-month period,” said Dr. Peter Hotez, a Baylor College of Medicine infectious disease specialist and vaccine scientist. “Has Texas ever lost so many lives in such a short time?”

The CHOP PolicyLab foresaw the June/July spike, though they were more alarmist than the situation turned out to be. But between the holidays and the colder weather that makes outdoor dining less feasible, the conditions are certainly there for an uptick. We all know what to do about this, it’s just on us to actually do it.