The Vaccine Rollout Could Prompt Real Reform to the US Health System

When I received the COVID vaccine on Dec 24, it was the end of a tense, frustrating two-week period.

Thousands of healthcare workers like me — doctors, nurses, physician assistants and more — at the Mass General Brigham health system were eager to get vaccinated, and antsy about whether we’d get the shot as soon as it was available.

The rollout at Mass General Brigham had problems from the beginning. There was a delayed start in announcing the process for scheduling vaccine appointments. Then came confusion about who was prioritized for the vaccine. Technological flaws caused the scheduling system to crash multiple times. One night, we experienced a tense free-for-all where thousands of staff raced each other to see who could click through a complicated online scheduling site to grab one of the coveted vaccine slots before they were all taken.

I was lucky, and thankful, to get my first dose of vaccine on Christmas Eve. Many of my colleagues, people who have also treated their share of COVID patients this year, had to wait longer.

This tale, for the time being, has a happy ending. All of the top-priority staff in our health system—those who care for known COVID patients—have had the opportunity to receive the first of two doses of the vaccine. But the sluggish and confusing vaccine rollout at Mass General Brigham isn’t unusual. We saw other hospitals around the country struggle with running an efficient and fair vaccination program (Stanford’s debacle is a more extreme example).

As we look beyond the current rollout to healthcare workers and nursing home residents to much larger swaths of the population, such as essential workers and the elderly, I worry my experience is a microcosm for what is to come.

The consequence on that larger scale is not just confusion and frustration. People could be waiting for months longer than necessary to receive their vaccine. When thousands of people are dying every day from COVID, delays in the vaccine campaign come with an enormous toll of suffering and death.

The COVID vaccination campaign, the largest ever attempted, is off to an alarmingly slow start across the country. As of Tuesday, the CDC said that over 17 million doses of the vaccine had been distributed but only 4.8 million doses had actually been administered. These doses are primarily being used for hospitals and clinics to vaccinate their own staff.

When the rollout shifts gears and larger groups of people become eligible, the complexity of administering the vaccine will only increase. It will be more difficult to allocate the right number of doses to specific sites. It will also be more tricky to determine patient eligibility, schedule patients, and make sure everyone is getting their second dose of vaccine on time.

The Unites States is likely to struggle with the vaccination logistics more than other developed countries. First, there has been minimal coordination at the federal level, aside from determining how many doses each state would receive and the CDC making high-level vaccine prioritization recommendations. Instead of taking responsibility for overseeing the rollout, the federal government has passed that task to the 50 state departments of health. These are chronically underfunded institutions that need far more resources to effectively carry out such an important responsibility.

Most problematic for the vaccine rollout is the decentralized manner in which care is provided to patients in this country. Patients in the US receive care through an archipelago of hospitals and clinics that compete with one another instead of collaborating. While most countries in the world have healthcare funded and administered by the government, the US has long favored a decentralized, privately-run model.

The US approach to healthcare can work wonderfully for individual patients in need of acute care. If I needed a heart transplant, knee replacement, or intensive care for a COVID infection, and I had access to good insurance, there is no place on Earth I’d rather be than the US. But when it comes to primary, preventive, and population healthcare, America’s approach does not deliver good results.

The failure of the US healthcare system for primary, preventive, and population healthcare is not news. Although the US spends far more on healthcare as a share of our GDP than any other country, we have one of the lowest life expectancies of any of the 36 countries in the OECD. According to the Commonwealth Fund, compared to 10 peer countries, the US had the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.

These failures disproportionately affect the poor and vulnerable members of our society who cannot afford health insurance and struggle to navigate the enormously complex maze of entities that administers and pays for care in this country.

What’s new is that, suddenly, a population health measure has captured the entire nation’s attention. As thousands of people die each day, lack of coordination will lead to chaotic and slow vaccination efforts. Delays of weeks or months could end up costing tens of thousands lives in a pandemic that is killing more than 2,000 people every day.

It is no coincidence that Israel and the UK are two of the countries furthest ahead in the race to vaccinate. In Israel, healthcare is universal and every citizen must join one of four integrated healthcare organizations. In the UK, healthcare is even more consolidated through the National Health Service, which guarantees care to every UK citizen through a single public entity.

Similarly, I anticipate that integrated care organizations like Kaiser Permanente and Geisinger Health, because they handle both paying for and providing care at a very large scale, will be more successful than most clinics and hospitals in the US at vaccinating their patients.

Could the emerging crisis of the delayed vaccination rollout in the US be the catalyst to prompt real reform in our health system? Dysfunction in Washington may make any major legislative effort appear improbable. But we have already demonstrated the ability to achieve highly improbable goals during this pandemic. Creating and developing vaccines with 95 percent efficacy against a novel infectious disease, in less than 12 months, is nothing short of breathtaking. This country’s scientific and biopharma sectors (with the help of German collaborators at BioNTech) have delivered the two most effective COVID vaccines so far. There could be more to come, thanks to our scientific and industrial efforts.

We discovered and developed the vaccines that have the power to end this plague. Now, we are faced with an equally difficult task. Will we be able to efficiently deliver the vaccine to protect people from infection?

Our health system, as currently configured, is not able to execute well on this crucial job.

We can use this moment as an opportunity to catalyze reforms that will deliver the vaccine more quickly by fostering integrated care models and ensuring universal coverage through a public insurance option—reforms that will leave us with a health system that provides better, more equitable health outcomes for all Americans during this pandemic and beyond.