The vaccination rollout, like the virus itself, has laid bare the failures of leadership all over the world. Politicians at every level of government, in just about every locality, state, and nation (with a few exceptions, such as Israel), have fallen down in spectacular ways. Philadelphia outsourced part of its vaccination campaign to a group of enterprising students, with disastrous results. The E.U. let itself get taken by surprise and finds its freezers empty of vials. Italy has gotten bogged down in a plan to deploy temporary vaccination pavilions designed in the shape and colors of a primrose. They promise to be pretty, and also to cost as much as luxury apartments and accommodate about the same number of guests. New York is struggling with a cocktail of scarcity, panic, confusion, skepticism, and misinformation. Put them all together and what you get, as City Councilmember Mark Levine put it, is The Hunger Games.
Nobody expected a worldwide mass-vaccination campaign without friction and screwups, but we have compounded inevitable problems with innovative self-defeats. Among them is a misconceived conception of how to distribute the vaccines equitably. The goal should be to prevent death and limit more infections, not to correct the inequities that the pandemic has exposed. Of course, those at greater risk of contracting the disease or dying from it need to be vaccinated first. Beyond that, though, we should stop treating an inoculation as a form of privilege, a right, or a reward: It is a public-health measure. We have spent nearly a year trying to promulgate the notion that protecting your own health is a public service to others. The same is true for the vaccine. We need everyone to get jabbed, and every day of delay is another day of shared grief and collective loss.
Giving hundreds of millions of injections of a new vaccine is a complicated task. But in the absence of a centralized federal system, unprepared and underfunded states, cities, and health providers have thrown together a jumble of websites that have tossed that complexity into the laps of individuals. You want a jab? Fine, first determine what eligibility category you’re in (1B-C? 1C-A?) by scrutinizing a dizzying variety of color-coded charts that vary from state to state and county to county. Then create an account at one — or, to hedge your bets, all — of the local websites. In New York, that would be the state portal, the city’s vaccine hub, the city’s Health and Hospitals portal, private urgent-care networks, individual hospitals, community health organizations, pharmacies, and so on — each representing a different team trying to guess how many doses they’ll have on hand weeks from now. A successful hunt for an appointment, if any, yields an email with instructions to arrive no more than five minutes early, but on Inauguration Day, at the city-run vaccination center at the Walton Educational School in the South Bronx, people waited for several hours in the cold, the appointment schedule was abandoned, and first-dose recipients were told to begin the whole rigmarole again in order to obtain the second dose. If you were trying to design a system to discourage participation and slow distribution to a creep, this would do the trick. The half-hearted but wholly bureaucratic pursuit of equity has produced its opposite.
Millions of New Yorkers are left feeling that they are uniquely incapable of navigating the system — that it is rigged against success. Some battle through, others try an end run on the process, many probably give up. Far too many may never bother trying, convinced that the whole program is a government con, an attempt to foist experimental concoctions on a population of sheep, to collect private information, or to lure undocumented immigrants into the arms of ICE. In a polyglot metropolis like New York, the whole inoculation battle is taking place in a language that many don’t speak.
We have been here before — as recently as last summer, when the city was frantically trying to get its entire population to respond to the Census, a crucially important process that many New Yorkers initially treated as someone else’s problem. “There are a number of obstacles we need to overcome when we are trying to convince people, especially Black and brown people, to take an action that the government is telling them they have to take,” says Amit Bagga, the former deputy director of the city’s Census effort, who is now running for City Council. “For many immigrant communities, one of the biggest barriers is the ability to comprehend not just what’s being said but also why it’s being said. Some have fled places where government is repressive or nonexistent. More recently, mis- and disinformation are real problems. The only way to get past that is to have trusted, valued partners brokering that information.”
The good news is that we have a tool that works. During the Census, under the city’s auspices and with city funding, Bagga and his colleagues created the Complete Count Fund, a network of 157 community-based groups whose members could explain to their neighbors (in Mixtec, Quechua, Tlapaneco, Bangla, and a dozen other languages) why it was in their interest to fill out the form. Even in the midst of a pandemic and a ceaseless assault on the Census by the Trump administration, nearly 62 percent of the city’s (estimated) population completed the questionnaire, a higher response rate than a decade ago, or than in any other major city.*
That quick-deployment corps of civic messengers could be mobilized now, with clipboards and fliers, in every neighborhood. “I had in mind the idea that we were setting up a civic-engagement infrastructure that could be activated in challenges such as this,” Bagga says.
Instead of reaching into communities, we’re pitting them against each other. After The City reported that suburbanites were sneaking across the city line and hogging slots at the Fort Washington Armory, the hospital that runs the location announced it would start earmarking all appointments for city residents and set aside 60 percent for residents of the largely Latino neighborhood that surrounds it. That’s fine, if those quotas don’t cause more bureaucratic fussing, complications, frustrations, delays, and discarded unused doses — which they likely will. Equity means making sure that everyone gets vaccinated as quickly as possible, not squabbling over who gets vaccinated this week.
And yet inequity is baked into a system that puts the onus on the public to figure it out. The minute you demand that individuals compete for a scarce commodity, those with more resources and better information will win. Instead, let’s use a model we already have. Everyone gets called for jury duty, given a date, and instructed to show up. Yes, jurors can get postponements and choose dates that suit them better, but we don’t have a pool of millions, all haggling over scheduling at the same time. We should ask everyone simply to register for a vaccine, then contact them with assigned appointments, a system that would be reassuring and foster patience.
We know how to do this: We have a whole economy based on the urgency of getting mass-produced products to individual consumers at high speeds. The blitz development and manufacture of multiple, highly effective vaccines is a triumph of Big Pharma. Maybe it’s time to call in Big Logistics. I can order plant food from Amazon by following an exquisitely simple procedure, and several hours later it materializes at my front door. Apple somehow manages to supply a hungry planet with millions of copies of each new product on the same day. Lettuce makes it from greenhouses thousands of miles away to my local bodega before it’s had a chance to wilt. Credit-card companies manage millions of simultaneous transactions, alert customers to possible fraud, and answer questions round the clock. Certainly, federal funding is needed, but we should also appeal to the civic sense of corporations that have made fortunes from the movement of goods at a time when the movement of people has been restricted. They want the economy humming again, too.
The job, after all, is not just to ensure and distribute this week’s quota of doses, but to plan a six-month (or longer) campaign. The more smoothly it goes, the sooner we can get kids back to school and start to claw back our futures. We should stop doing the equivalent of building Italy’s primrose pavilions, reinventing systems we already have.
*Editors’ note: Steven Romalewski, from the CUNY Graduate Center’s Mapping Service, contests the city’s claim that the response rate in 2020 was higher than in 2010.