An Rx for vaccine distribution

Or, "If I were Queen of the Universe"...

An original illustration of the Queen of Hearts by John Tenniel for “Alice’s Adventures in Wonderland.”

As a young girl, whenever my mother issued a unilateral edict I thought was unreasonable or unjust, I distinctly remember thinking (though certainly not vocalizing), “Who died and made you Queen of the Universe?”

The Queen of the Universe had the power to carry out commands and make things happen, even when the mandates she put forth might seem unenforceable or unfeasible.

The Queen of the Universe could insure there would be no dessert for someone who did not eat their lima beans. She could withhold allowance from anyone who failed to execute the required household chores. And she could make good on her threat that anyone who said “Shut up!” to their sibling in a moment of pique would live to regret it.

As I’ve watched the disastrous roll out of COVID vaccine distribution taking place in Sarasota County and elsewhere in Florida in recent weeks, I’ve had occasion to wish I had inherited her mantle. I’m just presumptuous enough to think that, if I were Queen of the Universe, I could come up with a better system. (Let’s face it, it would be harder to come up with a worse one.)

What’s bothered me most about the county’s initial online-only, first-foot-in-the- digital-door approach is how iniquitous and unfair it has been to so many: those who don’t have Internet access or technological savvy; those whose employment or other schedules prevented spur of the moment sign up action; those teachers and retail workers who’ve taken risks for almost a year to serve the needs of the rest of us; and those whose preexisting conditions have put them in heightened danger for contracting, suffering and possibly dying from the virus.

The Eventbrite site the county chose to use resulted in the ability to obtain an appointment being almost entirely contingent on luck, with a decided advantage to those with fast reflexes, clever strategies and time on their hands.

Inadvertently, it ended up pitting neighbor against neighbor, with those who succeeded in getting a coveted spot crowing about their good fortune and those who didn’t feeling miffed and resentful. (You could see that from the comments on social media alone.) Even more distressing, I got wind of several cases where people were able to pull strings, fudge facts or use positions of influence or wealth to jump to the head of the line.

To make matters worse, those who did succeed in getting their first vaccinations soon learned that there was no way to schedule or reserve an appointment for their required second dose 28 days later. And, at least as I write this, that remains the case, though that second dose deadline is rapidly approaching for many.

Let me be clear that I do not place the blame for all this (as many others have) on our local Department of Health employees, who have been doing their best to figure out a practical process without guidance or assistance from the state or federal government, without reliable or adequate information about forthcoming vaccine shipments and with no experience in managing a public health effort of this magnitude.

And while the signup process may have been botched, from all accounts they’ve been doing a bang up job of funneling people through the actual vaccination process. (Other than the congregation of too many people in one building, which in itself could be considered a super spreader event.)

At any rate, all of this has made me think about how I would have handled the distribution if I were Queen of the Universe.

First off, I would have set categories of prioritized vaccination for particular groups, in the following order: Frontline health care workers. Teachers working in brick and mortar schools. Frontline retail workers in essential businesses like grocery and drug stores. Those over the age of 75 with high-risk preexisting conditions.

For the rest of us, I would set up a lottery similar to the one Manatee County has instigated, with easy-access registration by phone or online, as well as outreach efforts to sign up people in communities and populations that have been disproportionately impacted by the virus. It would not be a first-come, first-served “waiting list,” but rather a giant pool from which names would be randomly drawn and residents notified when vaccine and appointments were available.

Then I’d set up a drive-through process (such as was implemented for COVID testing), to insure that those coming for an appointment would not be exposed to greater risk by standing in line or congregating with others (even distanced) within a building. And I’d figure out some way to insure that your first dose would not be administered without an assurance that a second would be available when it was due.

That means a lot of people would wait a long time to get their shots. It would mean months more of restricted activity, mask wearing, social distancing and hand washing, as well as the inevitable resulting economic impact. Even if you are Queen of the Universe, with the sheer number of people who must be vaccinated to provide herd immunity, I’m afraid that is inevitable. But at least there would be an orderly process that made sense and delivered some semblance of impartiality and equity.

Please don’t ask me how I would make all of this happen. I’m figuring that as Queen of the Universe, I would have the power to get it done. After all, Mom always did.