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
The original post and yours are both very interesting. In the UK for once our nationalised system probably came out better with getting hold of vaccines and effectively distributing them. (Something else which shouldn't get memory holed is various EU leaders trying to stop contracts from being fulfilled to send doses to the UK.)
However I do recall that at the start, Pfizer vaccines were kept at -70 degrees, which was colder than usual cold-chain. It was only some weeks (months?) later that they found out it was OK at normal freezer temperatures.
"America chose to care about the appearance of favoring approved groups over disapproved groups,"
I'm kind of bothered by this phrasing. "America" didn't do squat. VaccinateCA is no less "America" than the FDA. Pulling back so far that you just see a country throws away a lot of important data.
What we were looking at was a bureaucracy problem, and mostly a government bureaucracy problem, not an "America" problem. The people who care more about 'equity' than net results are a fairly small minority in this country. The problem is that they're a very well placed small minority, because they put most of their work into becoming well placed, rather than getting things accomplished.
We need to remove them from those strategic places, and replace them with people who want to get things accomplished. That's perhaps the critical task of your generation.
I say your generation, because I'm in my 60's. I'm of the generation that got us into this mess, by concentrating so hard on getting stuff done that we paid no attention to who was using our inattention to worm their way into positions of power over whether stuff would be allowed to be done. We left you a real mess, and I apologize for that.
Here in France it was next to impossible to find places with vacant vaccination slots. Then a lad (just a nerdy private citizen) created a website called Vite Ma Dose that let you search for availability. Of course he got plaudits from a government that should have made it unnecessary for him.
As a volunteer from very early days at VaccinateCA (I think Day 2?), I greatly enjoyed reading your reflections.
One amplification, with my own spin that I don't know that Patrick would agree with -- the experience of VaccinateCA was extraordinarily special, and the talent was extremely motivated, but there was nothing that we did that, in principle, the California National Guard couldn't have done by setting up a bunch of desks and phones in a hanger somewhere and calling up a small percentage of its total headcount to staff those desks.
As far as I can tell, the thought of throwing bodies at any part of the problem _other_ than staffing testing and vaccination centers (which, to their great credit, the National Guard was indeed called up for and executed competently) never occurred to anyone in government.
(The point applies to any government capacity, but I'm using the Guard here as an example because, well, for emergency response they _are_ supposed to be the "fast-moving state capacity" that Zvi mentions _by design and explicit organizational culture_, and in California likely have a decent number of e.g., FAANG programmers on their staff.)
Patrick notes this at some length, but it's worth emphasizing that the Governor of California has the ability to, essentially at will, call up arbitrary numbers of highly-skilled individuals who he can order to do almost anything for emergency response under the law, and _he used them to set up vaccination tents and direct traffic_.
The Governor could have, easily, cloned what we were doing with a few hundred Guardsmen and taken all the credit. He did not, despite strong incentives to do so, but rather waited on slow-moving IT projects from government contracting shops. I find that notable, and fascinating.
Um, reading this after RUSI report on the first few months of Russo-Ukrainian war, I cannot help but notice that this is a useful context for understanding observed level of dysfunction in the Russian army.
Around the time of the vaccine rollout I was one of the disfavored groups trying to snag leftovers. A friend of mine had succeeded, and I was plugged into a Facebook group where people shared information on where vaccines were available. I spent about a week trying and failing.
Then, the news story on the doctor in Houston, broke. The pharmacies around me changed their stance on leftovers. They were no longer for anyone that showed up, but just for those that were vaccine eligible and for whatever reason didn't bother making an appointment. I gave up at this point and ended up getting vaccinated about two months later when being fat made me eligible.
Prior to the pharmacies tightening their policies I observed some gaming of the system. Leftover doses were a result of pharmacists un-freezing doses and patients not showing up for their appointments. They weren't permitted to re-freeze the doses, they'd either be used or trashed. So, you could increase your odds of receiving a leftover dose by making an appointment for a fictional eligible person at the end of the day. When that person never showed up, you'd be there waiting for the leftovers. IIRC, I knew two people that pulled this trick. I didn't try it myself.
I read this post and then the whole document. (I had a free morning.) It was worth the read, and my take away (nothing new); Thanks goodness that this sort of individual action can still happen in the USA. (Even given all the government/ big business priority errors discussed.) To the author and anyone who worked on it... think not about lives lost, but lives saved. Well done! and thanks.
(Oh and knowing how to pull the right levers within Moloch, seems to be some of the reason for success, having a priority and working within the machine to make it happen.)
Although the narrative of systematic bureaucratic dysfunction is compelling, another narrative is being ignored. In the US, a volunteer organization was allowed to do good, wasn't shut down, the volunteers weren't harassed or jailed, and their story can be told and discussed, even though this makes officials look bad and government ineffective. To me this is perhaps more important in the long term and needs to be emphasized when talking about the very real brokenness.
The original post and yours are both very interesting. In the UK for once our nationalised system probably came out better with getting hold of vaccines and effectively distributing them. (Something else which shouldn't get memory holed is various EU leaders trying to stop contracts from being fulfilled to send doses to the UK.)
However I do recall that at the start, Pfizer vaccines were kept at -70 degrees, which was colder than usual cold-chain. It was only some weeks (months?) later that they found out it was OK at normal freezer temperatures.
"America chose to care about the appearance of favoring approved groups over disapproved groups,"
I'm kind of bothered by this phrasing. "America" didn't do squat. VaccinateCA is no less "America" than the FDA. Pulling back so far that you just see a country throws away a lot of important data.
What we were looking at was a bureaucracy problem, and mostly a government bureaucracy problem, not an "America" problem. The people who care more about 'equity' than net results are a fairly small minority in this country. The problem is that they're a very well placed small minority, because they put most of their work into becoming well placed, rather than getting things accomplished.
We need to remove them from those strategic places, and replace them with people who want to get things accomplished. That's perhaps the critical task of your generation.
I say your generation, because I'm in my 60's. I'm of the generation that got us into this mess, by concentrating so hard on getting stuff done that we paid no attention to who was using our inattention to worm their way into positions of power over whether stuff would be allowed to be done. We left you a real mess, and I apologize for that.
Here in France it was next to impossible to find places with vacant vaccination slots. Then a lad (just a nerdy private citizen) created a website called Vite Ma Dose that let you search for availability. Of course he got plaudits from a government that should have made it unnecessary for him.
As a volunteer from very early days at VaccinateCA (I think Day 2?), I greatly enjoyed reading your reflections.
One amplification, with my own spin that I don't know that Patrick would agree with -- the experience of VaccinateCA was extraordinarily special, and the talent was extremely motivated, but there was nothing that we did that, in principle, the California National Guard couldn't have done by setting up a bunch of desks and phones in a hanger somewhere and calling up a small percentage of its total headcount to staff those desks.
As far as I can tell, the thought of throwing bodies at any part of the problem _other_ than staffing testing and vaccination centers (which, to their great credit, the National Guard was indeed called up for and executed competently) never occurred to anyone in government.
(The point applies to any government capacity, but I'm using the Guard here as an example because, well, for emergency response they _are_ supposed to be the "fast-moving state capacity" that Zvi mentions _by design and explicit organizational culture_, and in California likely have a decent number of e.g., FAANG programmers on their staff.)
Patrick notes this at some length, but it's worth emphasizing that the Governor of California has the ability to, essentially at will, call up arbitrary numbers of highly-skilled individuals who he can order to do almost anything for emergency response under the law, and _he used them to set up vaccination tents and direct traffic_.
The Governor could have, easily, cloned what we were doing with a few hundred Guardsmen and taken all the credit. He did not, despite strong incentives to do so, but rather waited on slow-moving IT projects from government contracting shops. I find that notable, and fascinating.
Um, reading this after RUSI report on the first few months of Russo-Ukrainian war, I cannot help but notice that this is a useful context for understanding observed level of dysfunction in the Russian army.
Around the time of the vaccine rollout I was one of the disfavored groups trying to snag leftovers. A friend of mine had succeeded, and I was plugged into a Facebook group where people shared information on where vaccines were available. I spent about a week trying and failing.
Then, the news story on the doctor in Houston, broke. The pharmacies around me changed their stance on leftovers. They were no longer for anyone that showed up, but just for those that were vaccine eligible and for whatever reason didn't bother making an appointment. I gave up at this point and ended up getting vaccinated about two months later when being fat made me eligible.
Prior to the pharmacies tightening their policies I observed some gaming of the system. Leftover doses were a result of pharmacists un-freezing doses and patients not showing up for their appointments. They weren't permitted to re-freeze the doses, they'd either be used or trashed. So, you could increase your odds of receiving a leftover dose by making an appointment for a fictional eligible person at the end of the day. When that person never showed up, you'd be there waiting for the leftovers. IIRC, I knew two people that pulled this trick. I didn't try it myself.
I read this post and then the whole document. (I had a free morning.) It was worth the read, and my take away (nothing new); Thanks goodness that this sort of individual action can still happen in the USA. (Even given all the government/ big business priority errors discussed.) To the author and anyone who worked on it... think not about lives lost, but lives saved. Well done! and thanks.
(Oh and knowing how to pull the right levers within Moloch, seems to be some of the reason for success, having a priority and working within the machine to make it happen.)
Although the narrative of systematic bureaucratic dysfunction is compelling, another narrative is being ignored. In the US, a volunteer organization was allowed to do good, wasn't shut down, the volunteers weren't harassed or jailed, and their story can be told and discussed, even though this makes officials look bad and government ineffective. To me this is perhaps more important in the long term and needs to be emphasized when talking about the very real brokenness.