Where America’s vaccine triumph fell short

It's not surprising that pharmacies are turning out to be fantastic at distributing Covid-19 vaccines. As Alex Tabarrok and I pointed out in February, they are literally everywhere — 86% of the US population lives within 5 miles of one. And they have significant experience in large-scale vaccine delivery, giving out 40-50 million flu vaccines annually. 

But the success of pharmacies raises an important question about another part of the effort: the federally-run mass vaccination sites. 1 Managed by FEMA, staffed by the National Guard and flush with federal funds, they are underperforming the Biden administration's expectations, according to Politico.

There's a broader lesson here about how the government can combine its strengths with those of the private sector to deliver for its citizens during crises and beyond.

When it comes to committing enormous amounts of capital to provide public goods — like developing vaccines as quickly as possible — the US government is hard to match. That's what it did with Operation Warp Speed, putting over $10 billion into vaccine development and production, and securing manufacturing and pricing commitments that ensured Americans would benefit from any of the vaccine bets that paid off.

The government can also use its authority to get firms working towards a shared goal. In the past few months, the Biden administration has helped coordinate supply chains for vaccines and the manufacturing of personal protective equipment. It also brokered a vaccine production collaboration between competing pharmaceutical manufacturers Merck & Co., Inc. and Johnson & Johnson. (There remains more work to do in this area. As my collaborators and I have argued, existing capacity for both producing vaccine ingredients and manufacturing the vaccines themselves is far below the optimal level.)

The federal government is also well-positioned to set standards for ensuring orderly, transparent and equitable access to public resources — such as figuring out how to stage the vaccine rollout across different groups.

Unfortunately, however, the prior administration mostly left that task to states, leading to inconsistent — and sometimes heavily politicized — vaccine allocation processes. National-level guidance on priority groups, coupled with provider subsidies to ensure equitable access, should have been clear from the outset.

America's Covid-19 response has also suffered from a lack of centralized standards for the vaccination process itself. The government could have provided technology recommendations for appointment registration and eligibility verification, or developed a platform that distribution partners could plug into. Instead, we've ended up with a patchwork of appointment mechanisms — many of them quite difficult to navigate. 2 It's so complicated and chaotic that talented individuals have stepped in to help.

Meanwhile, as the vaccine mega-site experiment shows, the government can struggle to build distribution infrastructure from scratch, at least when compared to existing players in the market. Pharmacies and other medical offices already had the facilities, the staff and the trust and awareness of consumers. But doses that could have been allocated more efficiently through pharmacies and other local institutions were tied up in the mega-sites instead.

This disorganized approach to public-private partnership isn't limited to pharmacies and vaccines. Covid-19 testing and tracking has suffered from similar inability to leverage existing infrastructure and coordinate guidelines and standards.

Beyond established players like pharmaceutical firms (in the context of Warp Speed) and pharmacies (in the context of vaccine delivery), the government should be looking for ways to work with upstarts. A growing number of marketplace platforms are building supplier networks nationwide. DoorDash, for example, just started offering Covid-19 tests on-demand. Amazon, meanwhile, is experimenting with a large-scale telehealth initiative.

The government could support these efforts — and might even imagine building upon them for other forms of public service delivery in the future. With a flexible enough regulatory framework, delivery services could one day help manage and distribute food aid. Telehealth providers could dramatically expand public health care access.

There's a lot of opportunity here, but only if the government learns to lean on existing service providers to the greatest extent possible. As the nation gets close to turning the corner on vaccine delivery, it shouldn't forget how it got there.

1. These are distinct from the state-run mass vaccination sites, although some of those have had uneven performance as well.

2. Of course, there's a benefit to experimenting with different scheduling and registration technologies, but at present there's no way to integrate and scale the ones that work best.

Scott Duke Kominers is the MBA Class of 1960 Associate Professor of Business Administration at Harvard Business School, and a faculty affiliate of the Harvard Department of Economics. Previously, he was a junior fellow at the Harvard Society of Fellows and the inaugural research scholar at the Becker Friedman Institute for Research in Economics at the University of Chicago.

Disclaimer: This article first appeared on bloomberg.com, and is published by special syndication arrangement.