Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Key Mostly Outward-Facing Facts From the Story of VaccinateCA, published by Zvi on December 14, 2022 on LessWrong.
I had the privilege of getting an advance draft of Patrick McKenzie’s very long story founding and running VaccinateCA, an organization dedicated to providing Americans information on where and how to get vaccinated against Covid-19.
It is an amazing document. Despite its length, I am going to flat out say to Read the Whole Thing if you have the capability of doing that. It is full of things worth knowing and understanding. I benefited from reading it twice, once as a draft and again as a finished document.
Since the VaccinateCA post remains very long and difficult to navigate or draw reference from, this post is an attempt to pull out the most long-term-important passages and facts and give an outline of the events and insights that reflect the world outside VaccinateCA, to keep this bounded. I have a short bullet point section on the inside lessons as well, but to keep this bounded am focusing elsewhere.
A central theme is the author, Patrick McKenzie, being surprised and confused by how dysfunctional were government operations, and how deprioritized was the cause of having less citizens get sick and die. As you read, notice these repeated surprises and confuses, and notice that the correct model would not be so reliably surprised in the same directions.
Similarly, he notes that he believes some of his statements present the situation as so dysfunctional that they sound crazy. The statements do not sound crazy to me at all. They sound accurate, and like the type of thing one would expect. It seems important, if we want things to improve, to realize that such statements are accurate, normal and expected.
Again, seriously, read the original if you can, at least the parts about how government systems (largely didn’t) track the vaccine and ensure it was distributed to citizens.
The Logistical Problems With Distribution Were Unnecessary
For some reason we decided that our standardized cold chain, sufficient to keep the vaccines good for ten weeks, was not good enough, despite that obviously being good enough. So for no real physical reason, we didn’t use our existing infrastructure.
The Pfizer vaccine keeps for ten weeks when transported or stored unopened between two degrees Celsius and eight degrees Celsius (36°F and 46°F), which is the exact same range as the flu vaccine and overlaps that of milk.
Transportation was easily achievable via cold-chain logistics, abundantly commercially available in the US and already used pervasively in the pharmaceutical industry.
The product rollout for the vaccine should have been approximately as logistically straightforward as any product rollout in the United States. It was not, principally because it did not use the US’s formidable advantages in coordinating product rollouts.
The Hyperlocal Information Problem
The core problem that VaccinateCA was created to solve was that our vaccine distribution system:
Took some vaccine doses.
Distributed them to various places.
Did not track how much was distributed to which places when.
Did not track how much vaccine was available at which places.
In practice, let each place decide what subset of the people legally eligible was eligible to get their particular vaccine shots. Some restricted by geography, some were more strict about age or condition, others less so.
Individuals were left to call various places to see who had vaccine shots.
Good news is calling pharmacists and asking ‘do you have the vaccine?’ works.
In California this system managed, in the face of overwhelming demand, to administer only 27% of delivered vaccine shots into arms by mid-January.
The remaining 73% were sitting there. In a freezer. Waiting.
Had no plan to remedy the lack of information. Did not much ...