The Israeli system is slow. It's centrally-planned, and even with central-planning taking advantage of pre-existing distribution networks and patient record digitization, the planners still make mistakes with dose distribution. There are four HMOs in this country, one of them has too many doses for the current age tranche and hands them out to younger walk-ins in peripheral areas, two of the HMOs don't have enough and are slowing down the progress of the age tranche for everyone else.
As bad as the Israeli system is, honestly, it's about the best that can be done considering that vaccine distribution in Israel is supply-constrained. They had to stop giving out first doses for about a week until they could negotiate with Pfizer to move up the shipments. What shipments do come in are quickly distributed. As of yesterday, 45+ can make appointments.
The US healthcare system is a nightmare. But for all of the US healthcare system's many, many, many weaknesses, vaccine distribution is supposed to be a strength. Doses are mass-manufactured and cheap, about $15/dose. Private providers are supposed to be able to make their own dosage orders through their own pre-existing suppliers and be distributed through ordinary private logistics networks. Intense competition insures a minimum of dose wastage. The state can minimally regulate to ensure that supply chain participants have adequate refrigeration etc. If the state wants to prioritize frontline workers, the elderly, fine. The state is more than welcome to buy as many (cheap) doses as it wants on the open market, and distribute for free to whoever the state deems to be a priority. But if the state cannot adequately take advantage of the relative supply glut, and efficiently manage the total supply that is available, then the state shouldn't freeze out the private market on the excess!
What's the goal here? The goal is not to immunize the elderly, or frontline workers. The goal is to end the pandemic. That means getting R under 1.0, and that means mass immunizations. That frontline workers or the elderly represent theoretical optimizations in pursuit of that goal is clearly demonstrating to not work out in reality. Let the free market work!
100-150k a day is not that slow in my opinion, especially when you consider the yearly flu shot mess. Honestly, the fact we reached ~2 million in a few weeks is insane. I thought vaccines would be delayed, then deployment would lag behind, then HMO systems would absolutely crash for weeks on end, but they didn't (except the first 2-3 days) and we indeed started in December.
If the current schedule holds, I could be vaccinated in March. Given my friends' experiences in the US and UK, I consider that very fast and fast enough, at least. Would I be happier if supply sped up and we doubled vaccinations per day? Of course, but given other countries, this is very acceptable.
Look, I think that it's acceptable considering the fact that the whole system is supply-constrained. Prioritizing healthcare workers, teachers, the elderly isn't just a theoretical optimization in Israel - it's a working one too. The only way it would be faster is if there wasn't a supply constraint. The fact that the whole world is mucking up doesn't mean that our model is some kind of ideal, and I certainly don't think that it's the right model for the US, for the reasons I listed.
Right, I agree. If countries had no supply issues I would definitely agree with opening it up for everyone, with maybe a subset of reservations for specific risk populations (or with the option of bumping someone back in their place).
Yeah I know that. Israel can be, at the same time, both the relatively fastest vaccinating country (relative to everyone else) and still be, in objective terms, slow.
The Israeli system is slow. It's centrally-planned, and even with central-planning taking advantage of pre-existing distribution networks and patient record digitization, the planners still make mistakes with dose distribution. There are four HMOs in this country, one of them has too many doses for the current age tranche and hands them out to younger walk-ins in peripheral areas, two of the HMOs don't have enough and are slowing down the progress of the age tranche for everyone else.
As bad as the Israeli system is, honestly, it's about the best that can be done considering that vaccine distribution in Israel is supply-constrained. They had to stop giving out first doses for about a week until they could negotiate with Pfizer to move up the shipments. What shipments do come in are quickly distributed. As of yesterday, 45+ can make appointments.
The US healthcare system is a nightmare. But for all of the US healthcare system's many, many, many weaknesses, vaccine distribution is supposed to be a strength. Doses are mass-manufactured and cheap, about $15/dose. Private providers are supposed to be able to make their own dosage orders through their own pre-existing suppliers and be distributed through ordinary private logistics networks. Intense competition insures a minimum of dose wastage. The state can minimally regulate to ensure that supply chain participants have adequate refrigeration etc. If the state wants to prioritize frontline workers, the elderly, fine. The state is more than welcome to buy as many (cheap) doses as it wants on the open market, and distribute for free to whoever the state deems to be a priority. But if the state cannot adequately take advantage of the relative supply glut, and efficiently manage the total supply that is available, then the state shouldn't freeze out the private market on the excess!
What's the goal here? The goal is not to immunize the elderly, or frontline workers. The goal is to end the pandemic. That means getting R under 1.0, and that means mass immunizations. That frontline workers or the elderly represent theoretical optimizations in pursuit of that goal is clearly demonstrating to not work out in reality. Let the free market work!