As winter descends on a country ravaged by the coronavirus pandemic, life unfolds on a split screen. On one side, the picture is bleak: Every 30 seconds, another American dies of COVID-19. The number of people infected or killed in the United States keeps outstripping the common analogies we use—a hurricane, a daily 9/11 attack, a tsunami—to express the magnitude of our national catastrophes. On Wednesday, CDC Director Robert Redfield said that the death count could reach nearly 450,000 Americans by February.
On the other side of the screen, though, the news is startling: The pandemic is beginning to end. On Wednesday, the United Kingdom granted emergency authorization for the widespread use of the first vaccines, and in the United States, the FDA is expected to do the same soon. A day earlier, the CDC finalized recommendations that would direct the first shots to health-care workers and seniors in long-term-care facilities. On Friday, states submitted their requests for vaccine doses based on the CDC’s criteria. State officials have been finalizing their plans for the vaccine’s so-called last mile—that is, how it gets from distribution sites into Americans’ arms. Some people will be vaccinated very soon, and most by the summer or fall of 2021.
The moral imperative now is to get vaccination done quickly. The new year will usher in a rolling recovery, in which relief will move in waves across the nation. The entire time, Americans may struggle to maintain their composure—as the inevitable snafus happen; as healthy working-age adults who are eager to resume their pre-pandemic lives realize that tens or hundreds of millions of people are ahead of them in the vaccine line; as the pandemic goes on killing, day after day.
The United States is about to undergo a vaccination campaign at a speed never before attempted, and Americans aren’t used to seeing public policy scale up this quickly. In the short term, the rollout of the vaccine will be constrained by how quickly pharmaceutical companies can manufacture it. Public policy will have to address four other distinct challenges: the need for public agencies to determine which groups get the vaccine first; varying demand for it, due to deep misgivings about it in some quarters and outright propagandizing against it in others; the difficulties of mass-distributing vaccines that need to be kept at temperatures as low as –70 degrees Celsius; and the data-management challenge of keeping track of who has and hasn’t been vaccinated.
All year, well-meaning health experts have urged Americans to follow the science. But in the year ahead, science will have little to do with our pandemic response. Vaccine distribution is all about logistics, and government officials must level with an impatient public: Bulk delivery is often imperfect, so manage your expectations accordingly.
President Donald Trump minimized these challenges before the election. His insistence that the military would distribute the vaccine was a Trumpian deus ex machina—a very complex problem would have an easy solution that just reveals itself in the final act of the drama. In reality, the military and National Guard can assist with delivery, makeshift public-health capacity, and security. But they won’t run the operation, which will primarily be a hometown effort. State public-health systems will manage the stockpile delivery, working in coordination with the federal government, private business, health-care facilities, and volunteers.
Nothing will be simple. That health-care workers need the vaccine first seems largely uncontroversial. But such a broad priority contains the seeds of disagreement. Should back-office administrators who seldom interact with patients or medical staff receive priority over teachers or grocery workers? Seemingly low-risk individuals will fall into priority categories, and higher-risk people out of them, based on the sheer necessity of simply drawing a line somewhere.
Even good planning may not survive contact with reality. Trucks will break down. Vaccine batches will be recalled. Some deliveries will include too many or too few boxes. Supply chains will be stretched. Detailed planning, including how to assemble and manage stockpiles of syringes, needles, and other necessary products, will likely have to wait for the new administration to come in. The entire process will often look disorganized; the public and private bureaucracies necessary to carry out a mass-vaccination campaign for a country of more than 300 million people will look unfeeling and unforgiving.
This year, Americans have seen what can go horribly wrong in the realm of public health. But we can now give ourselves permission to be hopeful. The overall picture, or at least the one on the right half of the split screen, looks far brighter than most had reason to expect even a month ago.
Two vaccines have proved successful. Efforts by Trump’s Operation Warp Speed—by providing an advance commitment to buy promising vaccines—meant that the vaccine has been manufactured before approval, waiting for the go sign. Airlines are pre-positioning the vaccine across the nation in order to satisfy a global supply chain. DHL, FedEx, and UPS are surging capacity. The three most recent former presidents have offered to get vaccinated in public to show their commitment and confidence in the vaccine. CVS and Walgreens are prepared to begin taking patients or deliver shots to senior-care facilities. The same supply-chain-management techniques and information technologies that allow you to order a 2020 Sucks novelty T-shirt and have it appear on your college roommate’s doorstep two days later can be mustered to save countless lives and begin to pull this economy out of a slump. Demand for the vaccine will often exceed supply, but it will eventually arrive.
This is the month when the pandemic began to end, but until the middle of next year or longer, Americans need to get used to the split screen—and to a series of mixed messages: Some people may scheme to get to the front of the line, while others will be too hesitant to get vaccinated. The distribution will be messy, but the officials overseeing it can correct its course as it goes along. The vaccination campaign needs to happen quickly, but your shots might not happen right away. You need to keep taking precautions as you wait your turn—but be ready to come forward soon enough, with your sleeves rolled up.