Last week marked one year since COVID-19 was confirmed in the United States. The US’s death toll now stands at more than 400,000 lives. President Biden said at a White House press conference on January 21st that the Trump administration’s distribution of COVID-19 vaccines has been a “dismal failure.” The new President set a goal to vaccinate 100 million Americans by the end of April. Based on the current vaccine logistics, this is a very doable. In fact, the goal should be far higher.
During the Trump administration, every state and hospital were forced to fight against each other in a bidding war for scarce supplies like personal protective equipment. Later, the government did begin to allocate vaccines to the states when they became available. The allocation to states was based on population, not need or risk.
Last April I interviewed Professor Keskinocak – a professor at Georgia Tech and Director of the Center for Health and Humanitarian Systems. She pointed to the importance of resource allocation and prioritization in all disasters, but particularly in a global pandemic. There needs to be a “system wide response” that coordinates these decisions across the nation.” This perspective, which is very much a supply chain perspective, would allocate the vaccines to where the need is the highest. For example, states whose emergency rooms are overwhelmed would be prioritized.
President Biden is planning to use a centralized approach to vaccine distribution. He plans to use a Cold War-era law – the Defense Production Act – to boost the Covid-19 vaccination effort. Experts believe this isn’t likely to expand production significantly in the near term, but it could jump-start vaccinations by increasing other supplies such as syringes. The Defense Production Act allows the federal government to produce more equipment and materials used to make shots. He also will use the act to boost supplies such as “low dead space” syringes, which can be used to squeeze more doses out of vaccine vials.
But the vast variations in local scheduling and distribution that we have seen across the US highlights the need for centralized planning that goes beyond producing more vaccine related supplies. Logistics has been a critical constraint that needs to be addressed. When Biden laid out his five-part plan for how to speed up the vaccination campaign on January 15th, vaccine logistics was only partially addressed. The administration wants to have the Federal Emergency Management Agency set up more vaccination sites across the nation so that millions of people can be vaccinated in places like school gymnasiums, sports stadiums, and community centers. This will require Congress to pass a relief package that in total would costs hundreds of billions for the national vaccination program as well as other public health measures to fight the virus, such as testing and contact tracing; new jobs for public health workers; and expanded U.S. manufacturing for protective gear.
But the Philadelphia Inquirer argues we need to go further. “Vaccine administration, not supply, is the current bottleneck, and it is time for states to call in experts in logistics and to deploy the National Guard. Military engagement in global outbreak response is becoming more common in many countries. Doctors Without Borders even called for military medical teams during the 2014 escalation of the West Africa Ebola epidemic… we have experienced how their logistics expertise, technical support, and clear command structure can buttress an outbreak or disaster response.” It is abundantly clear that at the state level there is not enough logistics and project planning expertise.
A core concept of supply chain management is that holistic optimization trumps local optimization. Local optimization deals with optimizing a single function without considering its effect on other portions of the end-to-end supply chain. For example, say a manufacturing company decide to optimize factory throughput by having long production runs. If those long runs lead to the production of goods that are not needed and sit in the warehouse, the company’s overarching goals have not been met. Similarly, even if every state does its utmost to maximize the vaccine supply chains that exist in their state, the nationwide response will still be far from optimal.