Listen: How Badly Is Vaccination Going?

Operation Warp Speed pledged to vaccinate 20 million Americans by the end of 2020. We fell far, far short of that. How worried should we be?

Juliette Kayyem, a former assistant secretary of homeland security and an Atlantic contributor, joins staff writer James Hamblin and executive producer Katherine Wells on the podcast Social Distance. She explains what’s going on, what the problems have been, and why we shouldn’t be too concerned (yet).

They’re also joined by a listener named Craig, who’s seeking advice on a tough situation: When can you travel to see an ill family member?

Listen to their conversation here:

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What follows is a transcript of the episode, edited and condensed for clarity:

James Hamblin: Juliette, you had to coordinate planning between federal, state, and local governments for issues of disasters, including those involving health, like the H1N1 pandemic. So planning vaccine rollouts like this is right up your alley. Can you explain how this is supposed to work, what’s happening right now, what’s not working, and what needs to change?

Juliette Kayyem: People need to separate what Trump and the White House have failed to do and what we’re seeing on the local and state level. We’re seeing a little bit of what we anticipated, which is: It’s really hard. It’s really big. Numbers are not clear. Supply and demand are off, depending on where you look. Some places are plowing through their stuff. Others seem to have stuff waiting. Data systems are falling apart. Phone lines aren’t being answered. I’m not forgiving, but all of this seems in the fixable realm.

People say the federal government needs to take control. None of that would work, and it shows a real lack of understanding of crisis management. You want a public-health emergency to be intimate, to be local, to be able to pivot based on what you’re seeing on the ground.

And the feds are absolutely necessary. The Trump administration did fall behind in terms of providing support and money and best practices and even resources. That will change on January 20, so I’m reluctant to mess with the science and the protocols—one dose, two doses, half a dose—until we can really see what the problem is.

Katherine Wells: How would you describe how the rollout is going? Is this going well?

Kayyem: Oh, no. But is it inexcusable? That’s where I won’t go yet. In other words: There are lots and lots of challenges. One is that it was the holidays. That’s always a difficult time to ramp things up in terms of initiation. We want to wait for seven to 10 days in January to see if the numbers ratchet up.

That was always going to be a challenge. The other is, the allocations were off. States were told certain things and only got, sort of, half allocations. So they have to reconfigure who comes first based on these allocation waves. In some places, they thought first come, first served would be good, not because they want old people to sit outside for eight hours, [but] because they were really worried about vaccine hesitation. That ended up not being a good idea.

And some of it is just data-management issues and data-buildup issues. Things crash. Information is not shared. And then finally, a personnel issue. We’ve got to go 24/7. We have to get nimbleness. And that’s where the new money will likely go. Nine billion dollars was just authorized; [there will] probably be more under the Biden administration. That should go to people to help the processing of vaccine distribution.

And then the final thing is, when I look to the end of January and early February, I think we can’t quite grasp how game-changing, if it works, the Johnson & Johnson vaccine will be. Because that’s an old-school vaccine: single dose, no cold storage necessity. You’ll start to see this look a bit like the flu vaccine, where we can walk into CVS and Walgreens. All of it takes time. It will have its blips and course corrections, but it is going to look better, because I’ve seen it start like this before and then things get worked out.

Wells: So Craig had called us with a question. He said he would like to visit a family member, and one of the things he’s trying to figure out is when are things going to get better?

Kayyem: I have plans to travel abroad in August. So I feel like the world will start to move well before then, unless something happens. To your point, Craig, it’s very dependent on two criteria. One is that we get more money to the states and localities under the Biden plan, which I think we’ll do. And the other is that more vaccines are offered.

Okay, normal-ish this summer. Do we have any understanding of what happens between now and normal-ish, or is it really hard to say? Are there just too many variables to say things will be better in X state or for X type of person by March or April?

For the high-risk pools and the high-potential infection pools—that’s your first responders, teachers, etc.—I think life will be very different. [Vaccination] can happen relatively quickly so long as we keep up manufacturing and supply, but each state is going to be different.

Hamblin: Yeah, people are waiting overnight outside pharmacies to get it in one state, and in other states, there are first responders who don’t have it yet.

Kayyem: Right, and I think a new administration will tighten that up. We’ve gotten nothing from this president on the rollout.

Wells: But since it’s being driven by the states, how much does the federal government matter? How much is a new administration going to be able to change?

Kayyem: A lot, and relatively quickly. In crisis management, we say: The locals execute, the states coordinate, and the federal government supports. And that support is cash—to pay people, to train volunteers ... Lots of people want to help, but all of the infrastructure costs money. And so that’s what you’re going to see. And that can move relatively quickly.

Wells: Craig, is this helpful? Does this answer your question?

Listener Craig: It definitely sounds like the answer is: Summer is when we can expect things to get better. For my personal situation, that may be too long. And so it’s telling me maybe that there’s not much of a difference between January or February or March.

Kayyem: Yeah, don’t think of it as a light switch though. So when I say summer as normal-ish, I mean that you’re going to feel like it’s 2019 in many ways. You will go to restaurants. If you have the vaccine, we’re going to have ID systems—apps or cards that show that you’re protected. I think between March and June, as more people get vaccinated and we start to get towards herd immunity, [we’ll see a rolling recovery]. Life will feel different in the post-winter phase.

Craig: So my father was recently diagnosed with late-stage cancer. His prognosis is somewhat uncertain, but not particularly promising ... I don’t feel like I can wait until even May. Visiting him in March versus now—you’re telling me there will be a progression and the risks will be lower. The more time I can wait, probably, the better the pandemic will be?

Hamblin: Yes, [things] should be getting better. The vaccines are going to be widespread. But if people start to get complacent, if we don’t wear masks and distance, we could still see rates rising. And if your family is outside of that pool of available vaccinations, you don’t want to travel in February if [case] rates are actually higher then. So there are variables here.

Craig: None of this is certain at this point. I need to make plans and weigh risks. It does sound like the most probable outcome is that, as vaccines start to roll out heavily in February, case counts go down [and our] risk of infection continues to get lower.

Hamblin: It should.

Kayyem: It should. Not a lot, but some. And that’s how to think of it. Each day adds to that risk reduction. I know you want to visit your dad specifically, and I think that will look very different in March and April for you.

Craig: Thank you.

Kayyem: Thank you, good luck.