Last week, Gov. Andrew Cuomo conceded that his plan to vaccinate New Yorkers was failing. Of course, the proud, imperial governor would never say so directly – but his announcement that people over the age of 75 could now sign up for the coronavirus vaccines was evidence that pressure had been sufficiently applied for him to change course.
Until then, Cuomo had been making the kinds of mistakes that belied his media reputation as an adept steward of state bureaucracy. Doses of the vaccine had been sitting in freezers for weeks, with some tossed out altogether, due to overly restrictive rules about who was eligible to be vaccinated and harsh punishments for any medical provider that vaccinated an ineligible person.
It is good the state has widened the groups of people eligible for vaccines and planned to open more mass vaccination sites, but New York must go further. With a new, more contagious strain of COVID-19 on the loose, time to ward off further death is running out. The priority groups have to be expanded quickly and signing up for an appointment – in a perfect world, appointments wouldn’t be necessary – must be made more simple. As of now, anyone accessing New York City’s website must answer a lengthy and confusing questionnaire, a challenge for anyone who is not computer-literate or doesn’t have access to reliable technology.
Cuomo is not alone among governors in rolling out coronavirus vaccines far too slowly. In fact, New York’s performance is sadly typical. But New York had developed a confusing and overly stringent matrix for who could receive a shot and when. Not only were vaccines restricted to health care workers and nursing home residents, the state instructed healthcare centers to vaccinate their employees in a specific order according to risk and taking into account job description, the environment the employee worked in and how old they are, among other factors.
Part of the problem lay in how Cuomo bypassed local health departments, which had developed vaccination plans and were ready to distribute doses at schools, churches, firehouses, and other public gathering places.
Many of the vaccines were restricted to hospitals. While it was understandable that Cuomo wanted to give vaccines to healthcare workers and nursing home residents, it made little sense to be so punitive and parsimonious with shots when the pandemic was still raging.
Healthcare providers that vaccinate people should not be threatened with million dollar fines for not exactly following complex rules that are sometimes hard to apply in time and resource-constrained and constantly changing circumstances.
First, Cuomo should revoke the threat of fines. In a pandemic, there is no such thing as “vaccine fraud.” If a person is given a vaccine – no matter how old or young or the job they work – one small step is taken toward ending the pandemic. Medical professionals should not be terrified of giving out doses. New York should never be in a position of letting doses expire in freezers. Shot needs to be entering arms at all times of the day and night.
At a minimum, the priority age must be lowered to everyone 65 and older. The science of coronavirus is abundantly clear: the older you are, the more likely you are to die from infection. There is no good reason to hold back shots from the elderly. New York can follow the lead of Israel, which has less than half of New York’s population, and launch a mass vaccination program for senior citizens. (Israel, in a horrifying human rights violation, has exempted Palestinians in the West Bank and Gaza Strip from their vaccination push, but it is making swift progress on vaccinating Israelis, including Palestinian Israelis.) If New York has vaccinated most of its senior citizens within the next two months, the threat of coronavirus will have been reduced dramatically.
After seniors, the rest of the population can come. There are various ways to allocate the rest of the shots. First, New York can keep expanding large testing sites and operate as many as possible 24 hours a day, seven days a week. A time should come when anyone can wander off the street to a site and get a vaccine. To convince younger people worried about the side effects of shots, New York should embark on an aggressive television, radio, and digital marketing campaign to show them the vaccine is safe. Currently, far too many eligible workers – as much as 30% – are choosing not to get vaccinated, and there isn’t a significant effort to educate the public to combat misinformation.
If supply remains limited for the remaining New Yorkers under 65, the state can turn to a lottery system to determine who gets the shots first. Lotteries are not ideal, but they beat all other alternatives. The state cannot keep inventing complex criteria that slow down the vaccination process. Many New Yorkers can argue, plausibly, they face larger threats – either due to the job they work, the health conditions they have, or the color of their skin. But parsing who is most eligible in some complex matrix is clearly delaying the deployment of the vaccines and thus prolonging the pandemic. Moreover, the more complicated the criteria are, the easier they are for rich or well-connected people to game the system.
The temptation for government will be to complicate this process and invent further tiers of priority. If we had more time, that would be acceptable. But New York should learn to treat vaccines like Congress regarded emergency stimulus checks. Every American under a certain threshold got free money, no questions asked, and the program was largely popular and successful. The typical bureaucracy that accompanies safety net programs – the daunting paperwork, the crashing websites, the denials on frustrating technicalities – was cast aside. people got their money quickly. That stands in contrast to the disaster of trying to sign up for unemployment last spring, when some New Yorkers went months without receiving benefits.
Now, we need shots in arms. The fight to end the pandemic is simple and straightforward and must be kept that way. Vaccinate the elderly, and then do everyone else as much as possible until the supply needs to be replenished. End the fines. Empower hospitals, clinics, and local governments to dole out vaccines as quickly as they like. If New York does all of this, Cuomo can begin to become the national leader he imagines himself to be.
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