The Unique Trouble of Vaccinating America

By Casey Kermes

Covid-19 has been an economic and healthcare wrecking ball throughout the world. Especially worrying is the lack of a competent response from many western nations, with the US nearing the top of the list. Where some countries may not have had the technical expertise or vast resources to properly respond, the United States of America responded to the crisis by acting fragmented. Uniquely challenging to the US response is the historical debate about individual states rights versus federal rights, dating back to the founding of the country.  

After the revolutionary war, as the Founding Fathers were drafting the Constitution, there was reticence to create anything similar to the top-down centralized government of the UK. The initial drafting of the Articles of Confederation gave so much power to individual states that the government almost failed to take hold in 1776. In 1778 the founders reconvened to create the rules for Federalism, which is the basis for the current separation of states’ rights and nationalized powers.  

Federalism has succeeded at keeping individual states from returning to printing their own money or changing their borders. However, the debate only begins from there. Under the “supremacy clause”  the federal government is able to set national priorities and intervene when it benefits the national interest. Throughout the history of the US this has been the basis for debates over civil rights, gun rights, voting rights, and healthcare access. Today this same system that was devised before the light bulb still controls the federal government’s ability to tackle 21st century problems that affect the whole nation. 

There is a special irony to the US response to Covid-19. When the US decides to wage war on foreign soil they are quick to draft a federal military. At the beginning of the pandemic Former President Trump declared himself a “wartime president” amid signs he was going to apply the full scale of the federal government to protect the American people. Yet, in hindsight it has become clear the federal government shirked all responsibility, allowing an uncoordinated state by state response. Were this an enemy on foreign shores the full might of the US would be deployed, however as this fight is at home we have split our collective power 50 ways producing a result that is less than the sum of its individual parts.  

As the US now tries to change its strategy towards tackling the Covid-19 pandemic, this is the backdrop for the challenges now faced. This unique history has also led to no unified healthcare systems, a lack of adequate funding, and the lack of a centralized database for planning and coordination. 

With individual states being left to create their own vaccination plans, supply chains, and guidelines for who can get their arm pricked, there have unsurprisingly been many hiccups. As President Joe Biden has found out since taking office, there are roughly 20 million doses of vaccine that are lost in the supply chain. As the federal government bought vaccine’s from suppliers, passing them off to states to inoculate their population, around 20 million doses have been lost in this handoff. With no federal tracking program from the beginning it is unclear what stage in the supply chain these vaccines are stuck in, other than they are not being used to quickly protect the population.  

As states were locked out of any stimulus money that was passed by the federal government in the summer of 2020, many states do not have the funds required to properly staff and manage their vaccine supply chains. With fewer trained staff at the ready, an already overstretched American healthcare system is showing its vulnerability. Creating a common database of all vaccine doses across the nation would seem to many as the best option from the beginning. However, because of the historical debates over who is in charge of solving domestic issues, each state has been left to sort their own morass without a compass or guiding light.  

In a 2018 study on healthcare access, the US ranked last in health outcomes among a group of 11 wealthy OECD nations.. Even in non-pandemic times the US healthcare system has the highest rate of preventable deaths, highest suicide rate, and lowest overall life expentancy, all while spending considerably more on healthcare than any other wealthy nation. Turning an already struggling system around during the most challenging period in a generation is an extremely difficult task.  

Whereas some countries, such as the UK, have a centralized healthcare system which every citizen has access to, each US state has its own rules for health insurance plans, many different providers of healthcare, and no centralized health database in any state, let alone on a national level. Even trying to find the citizens that need to be vaccinated can be difficult if they are not technologically savvy. Had the federal government given states funding to create badly needed patient databases, form large vaccination clinics, and coordinate staffing levels there would at least be a competent state by state response.  

However, there is hope finally. With new leadership in Washington, Joe Biden’s administration has proposed giving states $350 million for Covid-19 responses. There is now a team in place tasked with finding those 20 million vaccines, creating a national database, and tracking all current and future doses from the point of purchase, all the way through till the shot is in a human-being’s arm. Combined these two efforts will, hopefully, get America back on track to suppressing a pandemic that has rattled the globe for the better part of 15 months.  The US has always been, and always will be, a grande experiment. The eyes of the world are watching as a large, diverse, and powerful nation tries to wrest itself from the grips of an internal battle created by themselves. Former President Ronald Reagan instilled in a message long ago which has persisted to this day: “The nine most terrifying words in the English language are ‘I’m from the government, and I’m here to help.” However, in times of crisis we need the United States of America to tackle big problems. Never would the Pennsylvania armed forces be sent to fight terrorism abroad. Rather it is with the full unification of the United States of America that big problems can be solved and the nation can go back to fighting over which states a person is able to smoke weed in.

The views expressed in this article are the author’s own and may not reflect the opinions of The St Andrews Economist

Photo by CDC on Unsplash

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