To Immunise a Population, Make it Convenient, Duh!

As of January 1, 2021, the United States has 12.4 million doses of Covid vaccine distributed. There have been 2.4 million vaccinated out of a promised 20 million. Even if the nation can triple its current Covid  immunisation rate, it would take 3 years to immunise the 80% of Americans necessary for herd community and the resumption of pre-2020 behaviors. So while 2021 can still be a happy new year, don’t play on a that trip to Bora Bora let alone California soon.

Meanwhile the nation’s venerated Infectious disease expert Dr. Anthony Fauci is “disappointed”. In New York City where I live, Mayor Bill de Blasio has vowed to do “whatever it takes” to vaccinate 1 million New Yorkers in a month though his record in December was 88,000. The outgoing President has no comment while golfing. Common to all three leaders approach: Absence of a workable pandemic immunisation plan.

As a paediatrician of 20 years working mostly out of the Emergency Department and hospital ward, it occurs to me that after 20 million infections and 350,000 SARS Corona Virus-2 deaths that we in the medical and public health establishments still haven’t learned enough. When what is needed for different results is for us citizens to act differently, we persist with behaviours that hold American traditions and institutions paramount. This may seem heroic and in the 10 days before onset of Covid symptoms even fun, but as we have experienced again and again this pandemic, this is how we (continue to) die.

Let’s do this by analogy. To control the pandemic at its beginnings, there has to have been a mandatory mask in public edict. The CDC should have held daily public briefing on progress and challenges in the Covid infection fight. To minimise spread, health cadres should have gone to patient’s homes to test for Covid and the sick taken to mobile facilities set apart from the main hospitals. There was to have been robust contact tracing for all confirmed cases to ensure no American was taken by surprise. 

The state of covid testing in the U.S. 11 months into the pandemic

Instead, we Americans debated mask efficiency under the guise of liberty. The Administration made Covid the worse kept secret. Americans were asked to report to emergency rooms for diagnosis when rapid testing did not exist. The sick were brought into the ward and ICU infecting main hospital staff. Contact tracing was never sourced the necessary expertise, technology or enforcement to protect much of anything.

To control the pandemic now that there is a vaccine, the system has to make the process convenient— full stop. There should be universal covid vaccine access. Vaccination buses should pull up to where individuals most naturally congregate — Adults at home and at work; children in school. Registration within a universal electronic public database should take at most a minute. Patrons should be handed a cookie with application of bandaid and a high five when exiting the door.

Instead, getting vaccinated is hard as ever. Who is eligible and whether the vaccine is available is unclear. The country is sticking with a vaccinate in heath care facility strategy. Methods of registration feel like a lengthy standardised test. The system is promulgating yet another non-sensical health standard: A minimum 15 minute waiting period following injection. Just the math and logistics of this alone adds years to our herd immunity goal.

I chanced upon my own Covid vaccine opportunity through an email I rarely check. I was surprised the vaccine was being offered to me but signed up after 10 minutes on an on-line scheduling system. At the appointment in the hospital where I work, I was asked the same covid, risk and eligibility questions as during the sign-up. My injection was delayed 15 minutes because there weren’t enough chairs to handle the subsequent observation period. My nurse was awesome but I hoped so too would be the vaccine injected in my arm. As a rule, hope should never be uttered alongside descriptions of health policy.

Am I glad to have gotten the vaccine? Sure, but I realise the great many problems: It was arranged within a complex information system I happen to navigate daily, administered in the facility where I work, on a day I as the boss could arrange the 45 minutes of time. I felt both grateful and ashamed. The grateful part is obvious. But as someone who cares for children, I am actually at minimal risk. My shot would have been better allocated to any octogenarian, adult with obesity or diabetes, or household with medium income less than 45K. But this is not the story the system or doctors getting immunised on Facebook tell. And thus we return to the root cause problem in our All-American Covid response.