Look to Israel for a Measure of How the US Vaccine Supply Chain Has Failed
In mid-December 2020, the US bumbled into one of the biggest leadership failures in the modern era. After heroic science and astute government funding delivered new vaccines in record time, the US botched the Covid-19 vaccination campaign’s roll-out.
To put the scale of the debacle into context, let’s compare the US performance to that of tiny Israel.
After a slow start at the end of December 2020, the US geared up to vaccinating 500,000 people per day, according to Dr. Moncef Slaoui, the chief science adviser to Operation Warp Speed, a figure described as “hopeful” by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Even this “hopeful” objective involves vaccinating a scant 0.16% of the population daily.
By comparison, Israel was vaccinating 150,000 people a day or about 1.7% of its 9 million people since the end of December 2020 — over 10 times the US rate per capita. At these vaccination rates, Israel may need a little over 80 days to achieve herd immunity (when 70% of the population are vaccinated twice). In fact, this month, Israel announced that every Israeli citizen over the age of 16 will be vaccinated by the end of March 2021.
The US may require about two-and-a-half years full of chaos, death, and economic ruin to reach herd immunity.
Many of the problems that plague the US are embedded in the country’s vaccine supply chain, especially the “last-mile” segment that delivers serum to Americans. As any practitioner will quickly discern, this supply chain is poorly prepared and managed.
Vaccine supply chain management hard but not impossible
Supply chains are built around three flows: product, money, and information. And to achieve the highest levels of performance the participants must plan and coordinate these three flows. To minimize delays and maximize vaccination rate — true Warp Speed — planners need to coordinate manufacturers, logistics providers, local governments, healthcare providers, and citizens to ensure everyone knows what to do and has the tools they need when vaccines are approved.
US government officials knew for more than seven months (since they announced Operation Warp Speed) that millions of citizens would need to visit one of numerous inoculation centers to receive doses of the vaccine. While the Israeli administration planned for such a vast and complex operation, the current US administration failed in this crucial planning and coordination phase.
In addition, a lack of information hampered the US effort. States and health care providers did not know when they would get which vaccine in what quantities ahead of time. Consequently, mayors and governors were unable to inform the public about the roll-out. This information vacuum created suspicion among citizens and dread among local hospitals and clinics.
Here are some examples of where these failures undermined the vaccine supply chain.
Leadership. Israel’s Prime Minister Netanyahu spent several months prior to the vaccine program’s start talking to CEOs of pharmaceutical companies, buying vaccine doses, cajoling stakeholders, and using personal connections as well as economic incentives to ensure vaccine supplies. President Trump played golf during this crucial preparatory stage, and tweeted fake facts about the election he lost.
Planning for vaccinations. Israel imported the first shipments of the Pfizer vaccine before the US FDA approved it. The Israelis judged the costs and risks associated with buying an unapproved vaccine to be much lower than the costs and risks incurred by delaying orders for the drug and vaccinations. Israel’s months of pre-planning included training volunteers to man extensive phone banks, developing management systems, enlisting army medics and retired healthcare professionals, preparing and qualifying vaccination centers.
Conversely, in the US, Operation Warp Speed apparently did not include vaccination drives in its planning. The country missed the distribution portion of its original year-end goals by 30%. It distributed only 14 million of the 20 million doses targeted. The operation’s performance on inoculations was even worse. Only 2.73 million people were vaccinated by the end of 2020 — a shortfall of more than 85% from the original goal.
Coordinating with patients. Israel created an appointment system to maximize the rate of vaccinations while minimizing the further spread of Covid-19 when citizens visited inoculation centers. The country’s planners understand that vaccination is a “numbers game” when the goal is to inoculate the highest number of people as fast as possible. Like other governments, the Israeli government established priorities designed to minimize the future number of deaths, burden of cases, and economic consequences of the ongoing pandemic.
In parallel, the Israeli administration issued a call to every citizen 62 years of age and older to contact their primary care physician clinic. Phone volunteers assigned each caller a pre-planned time and place to get the vaccine. Once a person arrives for their appointment, they wait only 3–5 minutes to get inoculated. Due to the vaccine’s critical cold-storage handling requirements, there may be doses left over in some locations at the end of each day. If so, neighborhood residents, regardless of age, are invited to receive the vaccine without an appointment. No vaccine goes to waste.
In contrast, the US was concerned about the “right” priorities when creating its vaccination program. This prioritization is already failing because, for example, many healthcare workers who were not exposed to Covid-19 patients were assigned a high priority. And when a clueless state tried to vaccinate a large number of people, the result was endless lines of elderly Floridians waiting many hours for vaccination, with brawls erupting as people cut the line, creating, in effect, virus superspreader events. Appalling photos from Florida show the lack of planning and systematic organization.
Eliminating paperwork. In Israel, vaccination is entirely free. In the US, only the vaccine itself is free but administering it is not (administering the vaccine costs about $45 per jab). This latter system raises health insurance coverage issues, imposes deductibles and co-pays, and adds paperwork to the process.
Moreover, US recipients must sign a legal waiver absolving vaccine administrators and makers of liability. The extra paperwork means potentially life-threatening delays in vaccine administration, less productivity at centers, and reduced inoculation rates.
In Israel, the rule is: “If you showed up for the vaccination, you automatically agreed to take on the risk.”
Fighting anti-vaccine rumors. After spending months undercutting medical experts’ assessments of the pandemic, President Trump created an anti-institutional culture in the US. Further, as the vaccines neared approval, the President appeared to be more concerned with defeating the Democrats than defeating the disease.
The Israeli leadership took a different approach. Officials recruited Facebook to remove content that spread erroneous information or falsehoods about the vaccine. This effort was part of a massive marketing campaign to get citizens vaccinated. And given the rate of vaccination in Israel, it is likely that the Palestinians in the West Bank and Gaza may get vaccinated well before most Americans.
Country size no excuse
Some commentators may dismiss comparisons between Israel and the US as hopelessly inconsistent given the huge disparity in the sizes of respective countries. The simplest counterargument is that the US is massively richer and can bring more per capita resources to bear. Also, perhaps a small country is nimbler and able to vaccinate faster than a much larger nation — but over 10 times faster?
The more compelling counterargument is that modern supply chains eliminate most of the challenges associated with geographic size when moving goods, information, and money. Management directives, training instructions, citizen education, marketing, cloud-based tools, and operational data can travel at the speed of light to anyone who needs them. Moreover, such is the efficiency of modern airfreight and trucking services that the extra time it takes to deliver vaccines to inoculation centers across a vast country such as the US should be no more than a few hours or perhaps a day compared to smaller nations. Express parcel services have been delivering almost any kind of package “next day” to any US address for decades. If Amazon.com can deliver a plain brown bag of ordinary groceries within two hours in most cities, surely a life-saving vaccine can reach people in less than a day with proper planning and coordination.
(Some) light at the end of the tunnel?
The incoming Biden administration promises to administer 100 million vaccines in its first 100 days in office. This amounts to doubling the rate of vaccinations in the US to 1 million/day. Unfortunately, even this improvement means that the US will not reach herd immunity until sometime in the second quarter of 2022. To match the Israeli rate, the US has to vaccinate 5.5 million people per day — 10 times more than the current rate and more than five times the rate the new administration is pledging.
My sincere hope is that the new government will quickly identify the weak links in the US vaccine supply chain and fix them. As the new mutant virus accelerates infection rates throughout the world, every day of delay increases the number of sick and dead Americans.