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.
I would really hope that this community would have higher standards for discourse. If you are going to make claims like #1, please provide evidence. I tried to do a google scholar search for impacts on maternal/fetal health of the vaccines and the small number of papers I found were basically saying "we don't have good data and it will likely take years to collect post-hoc, since pregnant women weren't included in the initial efficacy studies".
One thing we _do_ know is that fever and the diseases that cause it are one of the worst things for pregnant women. Preventing fever and fever causing illnesses (like with the COVID vaccine) is almost definitely a good thing, and there would need to be pretty large downsides to outweigh it.
While fetal stem cells in the mothers blood serve various diagnostically useful purposes such as determining sex or identifying chromosomal abnormalities early and non-invasively, I'm not aware of any health-supporting functions they provide (and in fact I believe they can sometimes cause problems for the mother), that is so large that we would be extremely concerned even if we _did_ have evidence that they were being "destroyed" by the vaccine.
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.
Yeah, this seems key, and it's weird to me that the posts don't talk about it. I feel like the post comes across as "we mysteriously sucked at distribution"; I don't understand *why* we had the wrong sense of storage temps, but if you go into fixing this problem thinking the issue was "CVS was so nervous about liability they were more cautious than the instructions said to be about temperatures" or something, your solutions are going to be *wildly* wrong.
(I'm definitely curious about whether we became less risk averse for dose spoilage, or Pfizer et al just somehow didn't think to do this research until later, or it required doing another massive efficacy study and you can't do that ethically until after the phase 3 clinical trials, or what. My impression was that this *significantly* contributed to the logistics issues, and it feels like we should maybe try to avoid it next time we have a pandemic...)
"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.
In 'fairness' to the governor, I would be surprised if he or anyone on his team had any notable ability at doing what you describe.
The binding constraint still tho was probably that what VaccinateCA did didn't and doesn't 'make sense' for a governor, or almost any politician, to do, i.e. organize an ad-hoc group to do work nominally the responsibility of other 'official' organizations.
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.
Yep, I ended up waiting for my technically-eligible moment as well.
Note that that trick transforms the play entirely - from 'get a dose that would go to waste' to 'make a dose be about to go to waste in hopes of getting it.' Pretty big difference.
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.
I don't think the 'other narrative' was ignored – certainly not by Patrick or Zvi, both of whom explicitly mentioned it as a critical reason why the effort was possible or feasible at all.
But I'm not sure which 'narrative' is "more important" overall, i.e. in all relevant circumstances. There are certainly (very very roughly) similar efforts that are just flat out illegal.
You are right, there is a key passage highlighted from the report by Zvi. I missed that on first reading, being sort of tucked into an inconspicuous pause in the argument. It's worth highlighting in the summary: men with guns protecting people in power from losing face is a real problem for many countries.
I would really hope that this community would have higher standards for discourse. If you are going to make claims like #1, please provide evidence. I tried to do a google scholar search for impacts on maternal/fetal health of the vaccines and the small number of papers I found were basically saying "we don't have good data and it will likely take years to collect post-hoc, since pregnant women weren't included in the initial efficacy studies".
(See here: https://jamanetwork.com/journals/jama/fullarticle/2776449
and here: https://www.mdpi.com/2076-393X/9/11/1351
for examples)
One thing we _do_ know is that fever and the diseases that cause it are one of the worst things for pregnant women. Preventing fever and fever causing illnesses (like with the COVID vaccine) is almost definitely a good thing, and there would need to be pretty large downsides to outweigh it.
While fetal stem cells in the mothers blood serve various diagnostically useful purposes such as determining sex or identifying chromosomal abnormalities early and non-invasively, I'm not aware of any health-supporting functions they provide (and in fact I believe they can sometimes cause problems for the mother), that is so large that we would be extremely concerned even if we _did_ have evidence that they were being "destroyed" by the vaccine.
(for example, see the section on inflammation and auto-immune diseases in women here: https://news.asu.edu/content/fetal-cells-influence-moms-health-during-pregnancy-%E2%80%94-and-long-after)
#2 really serves no purpose and immediately lowers my opinion of you and makes my already skeptical view of statement #1 even more dubious.
I think it's just past time that the commenter to which you replied be banned.
I am not there yet, I strongly prefer to avoid such actions, but it wouldn't shock me if we get there not that long from now.
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.
Yeah, this seems key, and it's weird to me that the posts don't talk about it. I feel like the post comes across as "we mysteriously sucked at distribution"; I don't understand *why* we had the wrong sense of storage temps, but if you go into fixing this problem thinking the issue was "CVS was so nervous about liability they were more cautious than the instructions said to be about temperatures" or something, your solutions are going to be *wildly* wrong.
(I'm definitely curious about whether we became less risk averse for dose spoilage, or Pfizer et al just somehow didn't think to do this research until later, or it required doing another massive efficacy study and you can't do that ethically until after the phase 3 clinical trials, or what. My impression was that this *significantly* contributed to the logistics issues, and it feels like we should maybe try to avoid it next time we have a pandemic...)
"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.
Well said!!
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.
In 'fairness' to the governor, I would be surprised if he or anyone on his team had any notable ability at doing what you describe.
The binding constraint still tho was probably that what VaccinateCA did didn't and doesn't 'make sense' for a governor, or almost any politician, to do, i.e. organize an ad-hoc group to do work nominally the responsibility of other 'official' organizations.
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.
Yep, I ended up waiting for my technically-eligible moment as well.
Note that that trick transforms the play entirely - from 'get a dose that would go to waste' to 'make a dose be about to go to waste in hopes of getting it.' Pretty big difference.
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.
I don't think the 'other narrative' was ignored – certainly not by Patrick or Zvi, both of whom explicitly mentioned it as a critical reason why the effort was possible or feasible at all.
But I'm not sure which 'narrative' is "more important" overall, i.e. in all relevant circumstances. There are certainly (very very roughly) similar efforts that are just flat out illegal.
You are right, there is a key passage highlighted from the report by Zvi. I missed that on first reading, being sort of tucked into an inconspicuous pause in the argument. It's worth highlighting in the summary: men with guns protecting people in power from losing face is a real problem for many countries.