“Gen. Perna is no longer in charge” -- STAT News
If Katelyn says “here’s a link” I’m going to watch. This was an exceptional presentation by General Perna. The right person, in the right place, at the right time during a crisis. Very refreshing to watch if you are tired of listening to the endless blather from politicians. His take on leadership, and the collection and use of actionable data, is truly inspiring.
No doubt to say the logistics of the 2021 roll out were gargantuan would be an understatement.
As for today, as you put it, "This is due to a massive shift: vaccines are now commercialized." This reminds me of your other recent post about being careful comparing the US to other countries and how the CDC (or as it has come to be known in my social circles, Center for Disease Creation) made vastly different recommendations than the rest of the modernized world. In that post, you indicated it was because in every measurable metric the US ranks dead last in terms of quality and outcome of healthcare. The US is also the only one that relies of insurance for funding (more on this in a second) in a healthcare for profit industry. So, it is not surprising that this for-profit care industry would do an equally spectacular job with a mass vaccine roll out. Color me shocked, I tell you. Prior to 2020, the political right wing used to crow about how the US had the best healthcare in the world. Thankfully they've gone silent on that one.
As far as insurance, I have long said that it is the wrong financial vehicle for healthcare, especially routine healthcare. Using oil changes as an analogy, which can be considered a form of routine health maintenance for your vehicle, if we were to fund oil changes like we fund healthcare, you would buy a policy with a $100 per month premium to get an oil change every three months. The mechanic would bill the insurance company $500, and they would negotiate it down behind the scenes to $50. While this may sound absurd, if you look at how much most insured people are paying, either directly or through their employer (compensation not seen in their take home) versus how much the care they receive costs ... the parallels should be apparent.
We have met the enemy and he is us.
The vaccination rate in 2021 was mediocre. The booster uptake in 2022 was abysmal.
For profit companies order exactly as much vaccine as they think they'll be able to flip, and not a microgram more. And if they see a crummy uptake now, because people are trying to "optimize" their boosters for a winter surge - they'll tighten up even more, because that's how these companies work, because they don't give a shit about people who write blogs on substack, just about making bank.
Thank you, Dr. Jetelina. Not only a mess but a sad and frightening mess. And what about Novovax? I can't take the mRNAs. Novovax given in Europe and Canada, I believe. Must I drive from New York to Montreal to get it? (I don't know that I even could get it.) Thanks for all the info you provide.
Ha! How timely to receive this post now. Just got off the phone with a local Walgreens pharmacy. I had an appt yesterday morning, but they sent me away because they couldn't get through to Medicare to process the claim. Medicare was 'down' (their words). Called yesterday afternoon and again this morning, the pharmacy still cannot get through to Medicare to start my claim. They blame Medicare and the fact that thousands are trying to process claims all at once but I have my doubts. Perhaps this particular pharmacy's link with Medicare has gone down and they are so swamped they have no time to troubleshoot. Or, perhaps it's true that tens of thousands of Medicare recipients across the country are unable to get their COVID vaccinations this week because Medicare is 'down'. This is the first time I've attempted to get my COVID shot from a national chain pharmacy - in the past I have used local pharmacies, but they have not received a supply yet. What a mess.
On a completely different note, thank you so much Dr. Jetelina for all that you do to keep us informed and safe.
Thanks for sharing this speech by Gen Perna. I volunteered with our local health department to administer vaccines and they system was quite amazing. Not perfect, sometimes frustrating, but overall so very efficient.
Feeling this so hard right now! Also good luck finding kids covid vax-- there is ONE pharmacy in our area that has them, but they are requiring a Rx from our doctor to give the covid vax to kids. And the doctor has no idea what they are talking about-- OMG- it shouldn't be this hard and I want my kids to get it-- imagine someone who is on the fence about getting it themselves or getting it for their kids! There should not be this many hurdles- it means reduced vax uptake! Sigh...
Your headline - "Vaccine rollout is a mess today, but wasn't during the pandemic” - suggests that we are no longer in a pandemic. Aren’t we still in one?
In addition to the rollout being a mess, with all due respect to the FDA, why do they delay approval of Novavax? Why did they restrict who could receive it last time?
People want an alternative to mRNA. I feel like a sitting duck, waiting.
Wow, thank you so much for posting this. I was at the receiving end of the vaccine and supplies at the local level, working with the state. We had to plan and select the locations where the distributions would go, taking into consideration the capacities of those locations to manage and deliver to patients' arms the different types of vaccine (diluting vaccine, cold storage capacity, utilizing multidose vials with minimal waste of vaccine, etc). We also had to consider epidemiology of the disease in our local area guiding us to prioritize the populations that were most affected and at risk. It was stressful and frustrating, but now I can appreciate just how bad it could have been had it not been rolled out so well at the top level.
I was excited to watch this presentation and then read your statement of it being "apolitical" - which I'd like to remind everyone - there's no such thing as "apoliticism" on any topic, especially not public health. I also wondered why it was mentioned - is this something we value now? Sanitized, neutral, "no sides" public health? I personally don't, because the minute that you try to "dial down the politics," you end up taking a neutral position - like passively watching the public health emergency end, sayings "it's really no big deal, it's fine" as millions are kicked off Medicaid in 2023, masks are pulled out of healthcare, and now we have the commercialization of healthcare for the COVID boosters. It's all politics. As public health professionals I think it's important to figure out where we stand in the midst of it.
I watched, and in the first few minutes the speaker shared his extensive military background and experiences. That's political. Sitting in Somalia as a captain, and relying on young male bravado at getting information that's "close enough" for the general is political. I respect his accomplishments, and definitely think he was a good fit for the task of the vaccine rollout, but to say this talk is "apolitical" is like saying public health is apolitical. It's not. Every side we take is a political one, even passive neutrality.
I have to say, re the rollout in 2021, that how well it worked seemed to depend on a number of factors, including where you lived. We were living in the Hudson Valley, and the roll-out where we were was a massive pig’s breakfast. Older people were consigned to sitting hunched over computers in the middle of the night trying to grab available slots, mostly to no avail. A group of us sent out emails soon as we spotted places with open slots, but it was like a pyramid scheme, with only the first few netting an appointment. Our two-person household ended up logging 400 miles back and forth to the nearest open mass vax site to get our primary and first booster shots. We had a 90 year old friend on the east end of Long Island, where the problem was similar; she only ended up finding an open slot through a weird serendipity--a friend who learned a local fire station, catering only to public employees, had a couple vacant slots. It was an absolute, ongoing nightmare that lasted for weeks. What ended up saving the day for many folks in our area in the Hudson Valley was an independent pharmacy in Woodstock, NY, the Village Apothecary. Smoller and his staff are continuing to do an excellent job, sending everyone on their list updates of availability and what to expect.
Thank you for making this available! Love when he said (talking about critical elements of successful rollout) "Everybody checked their egos at the door."
I can't disagree more about it's a mess now, but wasn't during the pandemic. By the time you younger folk needed your vaccinations, it was organized. But when we seniors tried to get vaccines early when it was our time, there weren't even appts to be cancelled. Sites would say they are getting in vaccine next week and will put up appts on, say , Tues. You go to their site- and either the appts weren't up yet, or they already all taken. Then we got clever and would stay up till after midnight trying to snag an appointment. Eventually we'd fine one within a hundred mile radius of home, fill out the form, only to find by the end of the lengthy process of filling out the form, that the spot was now already taken, and there were no other slot left. It was awful, frightening and stressful. I say we, because every senior I knew was going through this. It was our only topic of conversation- leads on where there might be a vaccination available. You younger guys missed this. It was weeks of this., And remember, there were trucks acting as morgues then. No, I'll take this roll out any day. At least every day there are appts available. And many more places with appts.
Right now I’m waiting in an understaffed Walgreens. There’s a line half the length of the store, and traffic backed up outside. People masked and unmasked are coughing sneezing and hacking, and I’m unsure how safe it is for me or anyone to stay and wait. I’ve been here for 45 minutes, and it could be at least that long til my name is called. I’m “high risk”. This is the privatization of Covid 19.
Unbridled capitalism is a many-splendored thing. Efficiency and operational optimization just automatically emerge from the unregulated marketplace. Like magic.