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This is a photo from May 1962, outside a junior high in Denver, as hundreds lined up for the polio vaccine. According to the Denver Post archives, more than 350,000 people received their dose of the vaccine that weekend, the second event in a series of “Stop Polio Sundays.” By the end of the month, more than 70% of the ten counties surrounding Denver had been vaccinated.
It’s weird, first off, to see people waiting in line for a vaccine without masks. And I’m sure people got very tired of waiting in that line. But here’s the thing about the people in this line: they all got a vaccine, and none of them had to navigate a Ticketmaster-like online system that stymies all but the most tech-savvy in order to do it. (Edited to add: they were also receiving doses via sugar cube, which was easier to administer — distribution technology matters!)
This past week, my text threads have been filled with friends’ figuring out how to sign their parents up for a vaccine appointment. They were trading tips, websites, and strategies: log-on at this time, keep hitting refresh, make sure you have this information ready, keep checking back every five minutes.
What’s the secret to getting an appointment? It’s the same secret to navigating any American system: have a tech-savvy English-speaking person in your life with ample time on their hands.
The interfaces, everyone agrees, are terrible. There are very, very limited options for non-fluent English speakers. In Georgia, like a lot of states, the vaccine hotline is overloaded. One woman got an appointment for her parent at a pharmacy by logging on between 5 and 6 am and searching counties in the surrounding area — but how would anyone know to do that, or that it was even a possibility? Rumors of “secret” unadvertised phone lines — some real, some not — abound. What works in one area of the state is fruitless in another: several of my friends’ found appointments for their parents in Seattle, but there’s not an appointment to be found, at least at the timing of this writing, in Bellingham or in the Eastern half of the state.
In California, the distribution and communication has been so poor that a group of volunteers have come together to crowdsource the task of calling hospitals and pharmacies to see which ones have a supply. One woman described getting her mom signed up in the state after a full week of “chasing down backdoor tips” about local grocery store pharmacies with appointments. In Florida, another woman said signing up, at least through their provider, required her parents to sign their signatures, onscreen, with a mouse — an incredibly daunting task for something with arthritis or limited mobility. Other states require the ability to scan an insurance card. “We had two sisters, a grandson, and me all on multiple screens trying to get my mom an appointment in Florida,” one woman told me. “One of my sisters got the golden ticket a few weeks ago.”
“Golden Ticket,” “gaming Ticketmaster,” “backdoor tips,” “like dealing with Black Friday sale” — this is not the language to describe a functioning vaccine distribution system. But who’s surprised? The current mess is what happens when a broken COVID response slams up against a broken healthcare system. The result is even more fragmented, ever more unequal access to care — by state, by region of state, by health care provider, and, of course, by privilege.
When you leave knowledge and access to something as valuable as a vaccine to be distributed organically, it will not distribute equally. It pools at the top, and it takes months for enough supply to accumulate for it to trickle down below. If you don’t have a family member with the time, wherewithal, and generalized knowledge to help you navigate the system, where does that leave you? Unvaccinated — at least for several months — and isolated. Or: unvaccinated and, depending on your age and situation, still at high risk of exposure. Imagine getting this far through the pandemic, being eligible for the vaccine, not getting an appointment, and then catching COVID and dying or having long-term side-effects. Statistically, that’s going to be the case for thousands of Americans.
Part of this clusterfuck can be and certainly should be blamed on the Trump administration, which, big surprise, had no vaccine distribution plan in place outside of getting doses to nursing homes. The Biden Administration has pledged to distribute 100 million doses of the vaccine over the next 100 days, yet that will leave just 14% of the country vaccinated. Who will be amongst that 14%? A significant number of the nation’s most vulnerable, yes. But who’s getting left behind? If you’re reading this on a Sunday during some downtime and struggling to get yourself or your parent an appointment, what about all the people who don’t have the time or text groups to tell them how to make this happen?
In the short term, distribution needs to be, above all else, funded — but if it’s going to continued in this hodgepodge manner, it should at least take advantage of available resources. Meals on Wheels, local Mutual Aid societies, religious organizations, bible studies, libraries (but vaccinate and fund the librarians for the work), farmer’s markets, Elks Clubs, neighborhood associations, grassroots and labor advocacy groups — states should be partnering with all of this existing infrastructures to reach those struggling to navigate the system. There’s a way, in other words, to at least try and rescue this capsizing ship of a vaccination effort, and I hope it happens.
With that said, it’s hard to envision the continued vaccination effort as anything other than a slow-rolling shitshow. And for that, I don’t blame the specific policies or personnel of the Biden administration so much as the ongoing national resistance to rethinking our healthcare system. All of the “golden ticket” rhetoric might sound overblown, but it’s the language of a country where healthcare is treated as a capitalist commodity, subject to the whims of the free market, instead of a right.
It’s worth noting, for example, that five of the top seven states in vaccine distribution — Alaska, North Dakota, South Dakota, New Mexico, and Oklahoma — have some of the highest percentages of Indigenous population in the United States. Alaska, which tops the state distribution list at 10%, also has the most veterans per capita in the country.
These states are rural, yes, with smaller populations, often concentrated in a handful of larger cities. But for Indigenous and veteran populations (which often overlap — Indigenous Americans have the highest per capita participation in the armed forces) their health care has been centralized and systematized. Alaska, for example, received 115,000 vaccine doses in the original distribution. 36,800 of those were for tribal members, to be distributed through tribal health clinics. (The Alaska VA also received its own allocation of the vaccine, and is working to distribute it to veterans).
The Alaska tribal distribution is slightly different than what’s happening in other states, which have worked in tandem with IHS. But it’s liberated clinics to communicate and allocate according to local tribal needs. Last week, one of those clinics, which serves tribal members in Anchorage as well as 55 small villages, opened up vaccinations to those 18 and older. In the Yukon-Kuskokwim region, which has had the highest COVID rate in the state, the local clinic is vaccinating those 16 and older.
There’s a few lessons you could take from all of this. First and foremost: the tribes take all of this very seriously. One out of 595 Indigenous Americans has died from COVID over the past year, including thousands of elders, many of whom were amongst the last living speakers of Indigenous languages. It’s impossible to overstate the devastation of the disease — which, despite concentrated tribal efforts that, in most cases, far outstripped the actions of the state and nation — spread quickly through intergenerational households where isolation was difficult if not impossible. In Alaska, in particular, the memory of the 1918 flu, which wiped out entire villages, is still fresh; earlier this year, the Iditarod was significantly rerouted in order to protect villages along the route from potential exposure. The tribes are wasting no time on unnecessary bottle necks.
The second lesson is that this sort of distribution works effectively at the granular level — but only when it is well-funded and well-organized. The tribal clinics are in control. They get to make decisions about priority and roll-out. They’re able to avoid bottle necks because they know how many doses they have and how to reach the people who are next in line. Even though doses needed to be distributed by bush plane and snowmobile, they’ve been able to make it work by collaborating with the state.
The third lesson is that this distribution is possible because health care is treated as an Indigenous right. This was codified in the treaties that tribes negotiated with the United States government as it unlawfully seized Native land, and despite all the other ways the United States government has gone back on those treaties, that right has remained, with ratification from the Supreme Court. It functions similarly to the agreement forged with veterans, and like that agreement, and it has been plagued by underfunding and mismanagement. But still: the right remains.
When you treat healthcare as a right, you begin to strip away the barriers between the individual and care that capitalism has purposefully allowed to accumulate and rust in place. As the cases of the VA and IHS make clear, you still need to fund it, and you still need to manage it as if the people for whom you provide care are precious and worthy, not sources of profit or opportunities for savings and budget cuts. But the first step is conceiving of of healthcare as a fundamental right — not a privilege.
If you’re struggling right now to get a vaccine appointment for yourself or your parents, the frustration and unfairness you’re feeling, that’s what millions of Americans experience everyday — and have been experiencing for years — when it comes to navigating our healthcare system. You might have felt it yourself, or felt some corner of it. Regardless: remember this feeling of helplessness. Keep it close. Know that no matter how much tinkering and funding the Biden administration directs into the system won’t actually address the root of the problem. If you hate this, if you’ve hated all of this, if you authentically never want anything like this past year to happen again, start thinking now about the systems and beliefs that allowed it to get this bad in the first place. Right now, we need fixes. But for our future, we need foundational change.
Things I Read and Loved this Week:
Liars lie about everything
I read a lot of interviews with Amanda Gorman this week and this one was my favorites
Toward a patient gamer
Red-pilling as “radicalization without substance”
A bookstore organized by feelings
This week’s just trust me
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Our county is one of the best in Washington State for vaccinations. We just got our jab yesterday, but the big problem is still lack of vaccine. One nearby clinic opened on a first come, first served basis and turned away about a thousand people waiting in line. Yes, the local tribes are involved. The Jamestown, the local machers, as we Jews call them, have been running their own clinic and have opened it to the local non-tribal population, but they were the ones who turned away that thousand. They can do the organizational stuff just fine, as can others, but supplies are the real problem. (There's a county clinic running even now. A friend of ours, a local veterinarian - the other kind of vet, is working there giving injections.)
We are hoping improved supplies make vaccination easier, but mRNA vaccines like the Pfizer and Moderna ones are a totally new technology. Stuff like the protein for encapsulating the RNA and convincing cells to absorb it and use it for making antibody targets were usually ordered by the milligram, but now the demand is for kilograms. I'm rather amazed that we are doing as well as we are. God bless the bioreactor engineers and may no one cheap out on UV lamps fo the emergency/overflow vents. The money that was spent responding to MERS and SARS and seemed to have been wasted when public health measures brought the diseases under control turns out to have been well spent.
Biden is doing what he can. As he himself noted, his original proposal for vaccination was jeered at for being to ambitious. Now it is being jeered at for being insufficient. Maybe with nation-wide coordination, the good guys can get on the case and deal with COVID-19 as it should have been dealt with.
My mother-in-law in England is in a rehabilitation place after surgery. She “got the jab” a few days ago with no effort on her part. I’m sure I’ve said this before on one of your pieces, but she also was born with a disability and has *never seen a medical bill.* The NHS is underfunded and has a lot of flaws but I’d take it and the higher taxes any day. Meanwhile, my parents (divorced) are navigating different systems with different requirements in two different Montana counties while I hear of friends who got it a bit earlier because someone had leftover doses from the 1a batch 🤦🏻♀️
Loved this analysis, so sharp as always! But I really liked the redpilling piece. I don’t know that it said anything new but it said it well (except that, as you probably remember, in the Matrix Reaves’s character didn’t get the name Neo after taking the red pill; it had been his hacker pseudonym). I’ve talked with a teen boy or two who don’t identify as liberal but scoff at the 8/4chan boards, so I wonder where that’s all going.