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How vaccine distribution failed in Washington State

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The short version is that the state invested too much time in drawing fine distinctions about how distribution should be prioritized and far too little on logistics, with the result being a vaccination process that was both slow and inequitable:

In the months leading up to the first COVID-19 vaccine shipments, Washington state health officials agonized over which residents should be vaccinated before others. They surveyed 18,000 people and convened focus groups, debating race, age and essential occupations.

But unlike some other states, the state Department of Health (DOH) neglected to plan for basic logistics that would have allowed for quick vaccination of those most vulnerable to the disease.

They didn’t enlist the National Guard. They didn’t centralize vaccine appointments. Key scheduling and reporting software arrived late. Providers were given vials but no strategy to process patients.

Then, despite a constrained federal supply, the state opened up vaccines to everyone 65 and older. Chaos ensued. Some wealthy hospital donors and those able to navigate a labyrinth of websites have secured shots. Trust in the system frayed.

After two months and more than a million doses administered, the state has struggled to vaccinate some of the people at highest risk for disease, including home care workers, Hispanic residents and homeless people eligible for vaccine.

The state was not wrong to make equity an important consideration. But in addition to neglecting the logistical questions, decision-makers forgot one of the most common lessons of studies in law and society: on the ground, complexity generally defeats equity. The more byzantine the rules, the bigger the advantage for sophisticated players ceteris paribus. The lessons seem clear: keep priority categories simple, accept that there’s going to be some leakage if you act to vaccinate as quickly as possible, affirmatively seek out vulnerable groups, and don’t sanction people for stepping out of line unless the conduct is truly egregious (like selling access.)

Washington has generally competent government officials, and the situation has improved considerably. These were difficult problems! But hopefully trust can be restored and the process continue to improve.

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