Saving lives with the world’s least impressive inventory-tracking system

December 10, 2022 11:43 PM

In early 2021, in the richest area of the world's richest country, in the home of the world's largest technology companies, the best way to find a COVID-19 vaccine was to go to a website which relied on a small army of volunteers making phone calls every morning to every single pharmacy. This is the story of VaccinateCA, and the United States' bungled vaccine distribution. (warning: very long)
posted by meowzilla (28 comments total)

While VaccinateCA was taken down in August 2021, the official California vaccine website, MyTurn, still exists and shows a tiny fraction of available sites compared to Vaccines.gov.
posted by meowzilla at 12:15 AM on December 11, 2022 [2 favorites]

It is long and I'm only partway through reading it, but it is well-written and interesting.

We were only able to get our first doses of vaccine when we did because of another volunteer, decentralized effort -- those Facebook groups that popped up that both provided general information (like, posting that the RiteAid locations in such and such neighborhoods are showing lots of openings on Tuesday and Wednesday) and where people who were higher risk or from a vulnerable population could be matched with a volunteer who was experienced in working through all the various online and phone systems.

I don't know if anyone has tried to estimate how many people in total got helped by the kinds of volunteer endeavors like in the article or the ones that helped us, plus the existing NGOs and community groups that pivoted to this, but it must be millions of people. There was a desperate gap for information and people stepped up and filled it.
posted by Dip Flash at 6:06 AM on December 11, 2022 [6 favorites]

I left a sentence out of my comment:

We were only able to get our first doses of vaccine when we did because of another volunteer, decentralized effort -- those Facebook groups that popped up that both provided general information (like, posting that the RiteAid locations in such and such neighborhoods are showing lots of openings on Tuesday and Wednesday) and where people who were higher risk or from a vulnerable population could be matched with a volunteer who was experienced in working through all the various online and phone systems. We are highly-educated people who are comfortable with technology and self-advocacy, and at the time we found the system completely opaque and frustrating, and couldn't navigate it without help.
posted by Dip Flash at 6:46 AM on December 11, 2022 [9 favorites]

As I commented on Mastodon (and then got a comment from someone who worked on VaccinateCA and has different takeaways):

this piece, telling the story of an ad hoc effort that became crucial, is one of the most emotionally provocative pieces of nonfiction I have read this year.

It pushes me to ask myself:

what biases make me less effective at making change?
why didn't I leap on the opportunity to volunteer in pandemic response given many opportunities to do so? were those good reasons?
and more.

The article doesn't mention them (and I think they wouldn't be McKenzie's cup of tea) but it reminded me so many times of "The Revolution Will Not Be Funded" and of Rebecca Solnit's writings on the self-organizing strengths we often underestimate we can have in the face of disaster.
posted by brainwane at 6:58 AM on December 11, 2022 [14 favorites]

I haven’t gotten past the first part yet. I would not say the article is well-written: erudite yes, but it seems to be attempting a slightly snarky tone in describing what has to come together to get vaccines to actual people, to emphasize how that shouldn’t be as complicated as it was made to be. But that seems to have led to an overly complicated explanation, which somewhat undermines what appears to be the thesis so far. I suspect (speaking from personal experience - my first drafts are also always far wordier than necessary!) that a good editor would be able to shorten it down to at least 2/3 the length without losing important detail or impact. But it does look like an interesting story, and definitely an important one to review so that the US can do better next time!
posted by eviemath at 7:34 AM on December 11, 2022 [3 favorites]

McKenzie works at Stripe, which produces Works In Progress. I think they're unlikely to edit him for length. Stripe also produces or produced books via Stripe Press which - based on the one book I read that they published - they do not/did not edit for "Wait, hold on, that doesn't make sense".

McKenzie has a sort of elliptical style sometimes (like, posit a system that has the following attributes) and in this case I infer that a lot of that is because he wants to balance saying what he observed with not burning bridges.
posted by brainwane at 7:46 AM on December 11, 2022 [4 favorites]

I tried really hard to read this. But it was very wordy, repetitive, sarcastic, and desperately needed editing. Then I got to the part where he ranted about California's attempts at healthcare equity and justice in vaccine distribution. I tried to find a pull quote, but he is so verbose and obfuscatory in his language I just gave up--it would take an entire page of block quote to set up the context.

Referring to people traditionally not served well by government, healthcare, or society, i.e., BIPOC communities, as "favored by the government" and people who are privileged in every axis, i.e., wealthy white people, as "disfavored by the government" is just gross. The section heading is "In which California institutes a policy of redlining for justice" and that tells you pretty much everything you need to know about the concerns about "reverse racism" here. Yes, I know he said his real concern was about the inefficiency of the system's attempt at correcting historic inequities. No, I don't really believe that he actually cares about correcting historic inequities at all.

I absolutely agree that the initial vaccine distribution was a clusterfuck. It was absolutely due to a combination of Trump administration nonsense, federal to state nonsense, state to county nonsense, and most of all capitalism. Like a lot of folks not from California, I wasn't familiar with his project and instead found out where to get my first vaccine and those for my loved ones from word of mouth and social media in my community. The closest I saw to this was a bunch of local folks (mostly Boomers looking out for their peers) made a Facebook group in January and would help anyone who needed it find vaccine sites whose criteria they met. Pretty low tech. Worked fine for that initial couple months. By late March, that was all over and anyone over 16 who wanted a shot in Georgia was getting them. It looks like that happened in California by mid-April. I know it felt like forever at the time, but the few months when every young, wealthy, healthy white person in California couldn't get vaccinated were really not that long.
posted by hydropsyche at 7:51 AM on December 11, 2022 [11 favorites]

This is a thinly veiled tech-libertarian screed and shouldn't be taken at face value.

I suffered through all the part glorifying "startup-infused derring-do", but when I got to the part saying racial equity "is classic bikeshedding", I had to stop reading.

There's no reason to trust this essay or consider it an accurate account. It's not fact-checked, it's not an investigation, it's not a report, it's not journalism, it's just another techbro ranting about things outside his field of expertise.
posted by splitpeasoup at 8:28 AM on December 11, 2022 [14 favorites]

The argument being made here, implicitly and explicitly, is that California’s progressive desire for equity in healthcare came at a sacrifice of getting vaccines in arms. The empirical question is—is that… true? Was California actually slower at vaccine administration than red states with no compunctions about equity? Were terminal vaccination rates and death rates worse in California than in red states? I’m pretty sure I know the answer, and I’m pretty sure it disproves his thesis.
posted by rishabguha at 8:30 AM on December 11, 2022 [7 favorites]

It was absolutely due to a combination of Trump administration nonsense, federal to state nonsense, state to county nonsense, and most of all capitalism.

Not putting this entire thing in the context, from the start, of the previous administration dragging its heels WRT the pandemic, promoting arrant quackery, attacking its own members who were trying to do something constructive, and finishing by trying to not only delegitimize the incoming administration but literally trying to overthrow the results of the election, just discourages me from even trying to skim this bloated piece.

[ctrl-f trump]

[0 results]

Yeah, that's what I thought.
posted by Halloween Jack at 8:46 AM on December 11, 2022 [6 favorites]

McKenzie works at Stripe, which produces Works In Progress.

Ah, that explains it.
posted by splitpeasoup at 8:59 AM on December 11, 2022

Also: a weird little aside about voting against Obama three times? And he thinks we should respect his opinion about matters of public health? Sure.
posted by rishabguha at 9:06 AM on December 11, 2022 [3 favorites]

"just another techbro ranting about things outside his field of expertise" -- I think this is not accurate, given that many news sources do indeed credit McKenzie with a leadership role working on VaccinateCA.

I got a lot out of this piece and found it usefully challenged my assumptions about how vaccine equity went/should have gone. I am inclined to give more credibility to McKenzie than I would to a random tech worker, since he actually worked on the effort to get more shots into more arms, faster.

There was also the moment where I put together that McKenzie was implying strongly that he had voted for Alan Keyes (instead of Barack Obama) in that 2004 Senate race in Illinois, thus making him one of the 27% in the classic formulation, which was quite a trip.

Part of what I get from this piece is how a person I disagree with did useful work that I could learn from.
posted by brainwane at 9:08 AM on December 11, 2022 [7 favorites]

For a somewhat less obnoxious/irritating person who worked on a similar project, here is the story of Huge Ma (aka Vax Daddy), who brought automated vaccine site searching to NYC. He has also been a strong supporter of anti-Asian hate efforts in the city. I don't think he's written an overview of his own efforts like this, but I wish he would; his decision to pull the site for a brief period to protest anti-Asian attacks in the city was highly controversial but brave.

(I got my own first shot appointment via a Twitter alert from his TurboVax, speaking of other tech in the news lately.)
posted by praemunire at 10:24 AM on December 11, 2022 [5 favorites]

I also gave up reading this after the author's obvious biases become too overwhelming for me to parse out what was fact and what was opinion. I'm glad that he did meaningful work on improving vaccine access in California and genuinely applaud that effort. But he is clearly not a reliable narrator for an objective assessment of what was and wasn't working at the time, and what VaccinateCA's overall impact was relative to other efforts. I would be interested to read an account of the same thing by a journalist who was not directly involved in VaccinateCA and is able to assess it relative to government-led efforts with greater objectivity. But so much of this casts aspersions on other efforts to provide vaccine access on the basis of unsourced or poorly-sourced claims that it's just too hard to know what's true and what's ax-grinding by someone with an anti-government bias.
posted by biogeo at 10:26 AM on December 11, 2022 [7 favorites]

The argument being made here, implicitly and explicitly, is that California’s progressive desire for equity in healthcare came at a sacrifice of getting vaccines in arms. The empirical question is—is that… true? Was California actually slower at vaccine administration than red states with no compunctions about equity? Were terminal vaccination rates and death rates worse in California than in red states? I’m pretty sure I know the answer, and I’m pretty sure it disproves his thesis.

I can think of a few confounding factors, here!
posted by atoxyl at 10:48 AM on December 11, 2022

I mean I don’t love his general attitude, either, but I’m not sure that specific empirical comparison is going to be too enlightening, as far as that specific question.
posted by atoxyl at 10:51 AM on December 11, 2022 [1 favorite]

I know it felt like forever at the time, but the few months when every young, wealthy, healthy white person in California couldn't get vaccinated were really not that long.

Except the rules didn't work. Most people I know were vaccinated far ahead of their 'official' eligibility. Everyone knew that if you just drove far enough inland, there would be a pharmacy with vaccine shots and no line. If you could waste hours on the phone and spend a few more standing in line, you could get the 'leftover' shots from some other priority group. The only people who had the time and connections to do this were the wealthy or connected.
posted by meowzilla at 10:52 AM on December 11, 2022 [3 favorites]

I see this as a book rather than an article, and one that could do with editing. But then he is a software engineer, not a professional writer. Which incidentally prove the point that writing well is an actual skill that needs to be learnt.

It reminded me of the debacle over the HealthCare.gov website back when Obama Care was launched. A friend of mine was involved in the rescue effort for that site, and this seems like a version of that story on steroids.

For me the value of this article is that is illustrates quite how pervasive and ingrained corruption is in the US. Corruption is a not only a problem of occasional bad actors handing over brown envelopes (although the US has those). Corruption is the rampant petty power plays that occur at ever damn level. Corruption is the total cynicism that voters and politicians alike have in the whole system: the expectation that nothing will work, that public services will fail, because everyone is on the graft. It's the whole fragmented and fragile structure of the health care system, the badly written laws that are made in bad faith. What looks like incompetence is revealed to be the system working as it is meant to do: but what it is meant to do is capture power and money in a small number of hands, rather than actually solve any public problems.

I read this and thought of Sarah Chayes book On Corruption In America. (Btw Chris Hayes has an excellent interview with her on his long-form podcast).

The failure of the vaccine roll out is a result of the US not having a functioning government anymore (if it ever did); of the gangsters having won. I mean, I'm admittedly a little obsessed with this topic -- I have a whole podcast on it! But to me that's the take-away, not the clumsy writing.
posted by EllaEm at 11:34 AM on December 11, 2022 [1 favorite]

I was working as an academic epidemiologist in California at the time -- there are many things he gets wrong as mentioned upthread, and I suspect he's overstating his group's contributions (I'd never heard of them before, and their solution doesn't really align with the actual bottlenecks I perceived), but I'd like to focus on my positive takeaways from the piece.

So, ignoring the middle-schooler-level trashcan political takes in the article, there's an interesting playbook here about how to get a nonprofit off the ground quickly, and with decent funding. I hope more people will feel empowered to volunteer their time and effort during the next crisis, whatever it may be -- this time, there were so many ways to help, and not nearly enough hands helping out. Imagine what a group of people without trashcan political views could accomplish with the same level of resources, connections, skills, etc that this guy had. One particular takeaway is how a small nonprofit or group of volunteers can swiftly navigate logistics without having to deal with all of the red tape or political whims that govt agencies or providers are subject to.

And calling up pharmacists everyday is a simple but extremely effective strategy. I knew a guy who would call up pharmacies from his dorm room back in the early '00s to get leftover HIV medicine sent to Haiti. When the next crisis happens, what will the bottlenecks be, and what are similar simple but effective strategies that small volunteer groups can employ? I think there's always a lot of people who want to volunteer and help, but just aren't sure how. A lot of different volunteer groups did great work filling data gaps re: covid that govt agencies failed to address, and I hope that's an area that can grow in the future.
posted by bongerino at 11:43 AM on December 11, 2022 [14 favorites]

The failure of the vaccine roll out is a result of the US not having a functioning government anymore (if it ever did); of the gangsters having won.

This simply isn't true, and the failures of government are largely thanks to the fact that we keep putting people in charge of it who want you to think that our government can't function. Despite the very real problems with corruption, inefficiency, and incompetence that we read about in the news all the time, we have an incredibly potent set of federal, state, and local governments that, when mustered properly, can and routinely do achieve amazing things. The fact that we hear regularly about failures of government is how things are supposed to work; it is part of the immune system of democracy working to identify threats.

The idea that the US government is irreparably corrupt and ineffective is a lie that the far right has been systematically pushing for over 50 years. Don't buy it. The US government is flawed, in some areas deeply flawed, both structurally and morally. But it is better than the alternatives that have been offered so far. The highest levels of the CDC administration may have botched its duty in providing clear, evidence-based public guidance during the first two years of the pandemic, but the civil servants at the CDC also dutifully collected and reported the data that was essential in tracking and responding to the pandemic, both for organizations and individuals. The FDA may be relatively slow in getting vaccines onto the market, but it also ensures that they are safe and effective, which is, in historical terms, an absolute triumph of medical development and administration.

Yes, it often feels like our government is rotting from the head. But this is only because voters have systematically been depriving it of a brain. Nevertheless its body remains powerful and vital, and ready to serve the people if only we will let it. The "failure" of the vaccine roll out, to the extent that the weeks of delays and confusion during the most massive vaccine distribution effort in history can be said to be a "failure," are due not to the lack of a functioning government, but due to Fox News and other right-wing media outlets poisoning peoples' minds into rejecting basic public health measures like masking during vaccine development and distribution, and convincing them that vaccine denial is an intellectually and morally defensible position.
posted by biogeo at 3:45 PM on December 11, 2022 [20 favorites]

The one memory of the pandemic that I will eagerly share for the rest of my life is how efficient actually getting the vaccine in my arm was. I showed up and gave them my name. The intake person asked me some questions then directed me to another line. Five minutes later I was called over to a station where I was quickly stuck. Then I was given my vaccine card and sent over to a chair in a monitoring section where I had to wait the requisite fifteen minutes. And then it was done.

The whole vaccination site was like something out of the final act of a disaster movie when help has finally arrived and things were getting done. There were dozens of nurses from local hospitals mixed in with military personnel dressed in camo. It was clear that everyone had gone through a lot and there were a lot of weary faces, but you could cut the excitement and anticipation of getting the vaccine with a knife. There was one soldier doing a bit of a dance to direct people to the many, many, many different locations where the needles were meeting arms.

What I won't share is how "meh" signing up was. I waited several weeks until I could squint enough to maybe possibly qualify when it opened to one precondition and even then it was a lot of reloading the browser window. Thankfully the boosters have been much easier to obtain.
posted by RonButNotStupid at 5:14 PM on December 11, 2022 [10 favorites]

> Was California actually slower at vaccine administration than red states with no compunctions about equity?

FWIW here in (very red) Missouri our governor decided the first thing they were going to do with their first quotas of vaccines was to get the national guard and organize huge vaccine-a-thons in various rural parts of the state.

The idea here is that the rural folks are always left behind and get things last and no one cares about them much blah-blah-blah so we're going to very obviously put them at the front of the line and get'er done there first.

(Also Gov definitely thinks of rural Missouri as his base of support - and he is, indeed, from rural Missouri himself.)

So, this was something of a debacle. This was about the time it was becoming clear that there was going to be a pretty big conservative backlash against the vaccine and the people in these rural areas - who we had all previously imagined, would be rushing down to get their vaccine at the very first opportunity - were instead going to lag and wait and show some pretty considerable resistance.

So anyway they had 10 or 15 of these big productions around the state in various small podunkvilles, and pretty predictably, not many people showed up to any of them.

This was a predictable outcome of a couple of (predictable) factors:

- If you want to have a giant event vaccinating many thousands of people in a short time, you need to put the event in a place that has many, many thousands of people located closely nearby. This kind of place is, by definition, called "a city". "A BIG city" would be even a better such place.

- Rural populations are indeed often overlooked and lag behind in health care availability, etc etc etc. This isn't because we are mean people who hate rural Americans but because reaching 3 million people spread over a vast, sparsely populated landscape is really, really HARD.

You're not going to reach those people with like 15 giant highly publicized events.

It's going to take more like 1500 small community events - or even more realistically, 15,000 such events. You've got to be at every community potluck and church activity and quilting bee and place of employment, senior center, and 10,000 other such gatherings, and then at a bunch of other places, too.

Having said all that, the vaccine rollout here was not so terrible, all told. Within the space of just a few months, every single person who WANTED a vaccination was able to get one.

Vaccinating 330 million people is not all that easy.

I'm sure it could have all been done a little better. But it sure as hell could have been done A LOT WORSE, too.

The failures really have not been in the arena of the logistics of vaccine production and distribution. Those have, quite honestly, been something of a big success.

The failures - and the reason something like 32% of the U.S. population are still not fully vaccinated, even now - have come from a far different place.

Someone should write a snarky article about that situation, I suppose.

Back to logistics, though: Even at this late date, no one has ever bothered to take the time/effort/money to show up at those 15,000 local events across rural Missouri to talk about the vaccinations and offer them to people - or the similar 15,000 (or more) such events it would take to reach out to underserved populations in the cities and suburbs, either.

It's like we spent an infinity of money and time and effort to reach point X, but after that there was nothing but a big shrug - the vaccine is AVAILABLE at every corner drug store, to anyone who wants it, and there is nothing more we can do beyond that.

Pro Tip: There is literally A TON you can do beyond that. In fact, in this type of project, it is precisely at that point that the real hard work begins.
posted by flug at 11:00 PM on December 11, 2022 [5 favorites]

Slight derail, but it's all relative. As an American living in Japan, I watched as the American vaccines were rolled out with seeming lightning speed, whereas in Japan the government and their byzantine bureaucracy hemmed and hawed and shuffled their feet and didn't do jack shit for months and months. Most people in Japan couldn't get a vaccine until late summer 2021, a good six months after the U.S. It doesn't sound like a big gap now but at the time it was really frustrating, with my family back home all with their second jabs done, with no wait times for vaccines in the U.S. anymore, and there I was in Japan, no vaccines even on the horizon.
posted by zardoz at 2:36 AM on December 12, 2022 [5 favorites]

The argument being made here, implicitly and explicitly, is that California’s progressive desire for equity in healthcare came at a sacrifice of getting vaccines in arms. The empirical question is—is that… true?

Even if it is true, COVID hit minority populations way harder than white people, so assuming that more minorities got COVID vaccine shots (since the system is only about providing access, not actually delivering actual arms) then it was probably very successful at preventing COVID spread and getting vaccines to the people most likely to be seriously sickened, hospitalized, and killed.
posted by The_Vegetables at 7:52 AM on December 12, 2022 [2 favorites]

As an American living in Japan

Amazingly enough, so is the author. Who spent time doing ESL teaching.

Which incidentally prove the point that writing well is an actual skill that needs to be learnt.

IMO, it proves the value of editors as a separate role. Not that I'm trying to excuse any verbosity in the article.
posted by pwnguin at 11:18 AM on December 12, 2022

I was part of a local WA State effort to help those who could not deal with the technology find open appointments. My particular skill was being able to quickly navigate the online resources and figure out patterns of when/where vaccines would become available. Others would sit on the phone with the person to get all the personal information that needed to be entered. It was time consuming and required a lot of trust on the part of people who required help.

King County, where Seattle is located, had an exemplary outreach effort using established community resources to reach every part of the city, every micro-culture, and every language group. They achieved a >80% vaccination rate while the rest of WA State lingered around 60%. If I was going to emulate anyone, it would be King County Public Health. Their website is still one of the best around for finding vaccines, getting assistance with Covid-19 information, and generally being useable by non-technical people.
posted by drossdragon at 4:03 PM on December 12, 2022 [2 favorites]

A thread on Twitter (a nitter view so you can avoid Twitter) about McKenzie's piece: "some commentary on this article on this from my time as a COVID data officer at a California health system". Some agreement and some disagreement.
posted by brainwane at 8:24 PM on December 25, 2022