While it is wildly unfair to characterize CDC’s preparedness/support with this one document, by itself, it suggests they started looking at mortality and morbidity data based on the data they had mid-summer, and came up with an obvious answer for how to prioritize the sequencing (but not how to implement it!?) ...six. Months. Later.
Unless there were other studies developing specific implementation approaches simultaneously (distribution, logistics, comms, governance, etc.) no wonder implementation has been a cluster-frenzy in many places. (“Look we got vaccines, I know, let’s give them to our rich work-at-home executives and big donors!”)
What just about everyone keeps forgetting is that vaccine administration, once it is delivered to states, is 100% on the states to coordinate.
This has been a HUGE @#$% show in some states.
I'll give a personal example:
My wife and I both fall under Tier 1A/B for vaccine administration in CA state. She's a vet, actively doing house calls (relatively high risk). I'm a retired physician, but do some locum tenens work occasionally, so I'm considered a "reserve" to be called up if needed. Most physicians are getting vaccinated at their place of work, but because we are both independent contractors, we do not qualify for that, so both of us this week went to get our first vaccine dose at the SD Health Department. I was THIRD in line when they opened up, there were maybe 10 people behind me. Things were supposed to start at 9:30 (that's a really late time to start something like this), but no one actually got setup and started talking to the healthcare workers in line until 10:00. I pre-filled out the paperwork in advance online, but that didn't matter as they made me fill out everything again, on paper, by hand (clipboard). They asked the same set of questions 3 times, by 3 different people, in addition to having me write answers to them out. After 2 hours, I finally got my shot.
My wife was even less lucky, as she worked late the night before so she went later in the day. She was FIRST in line when she got there, but because she was "on the wait list" had to wait till the very end of the day till after everyone that had an appointment had a chance to be vaccinated. In 4 hours, she watched 8 people TOTAL go through the doors and come out to get vaccinated. After the appointments were up, she was 2nd in line on the wait list, and it still took over an hour for her to get her shot.
I have done some vaccine clinics, and usually we process a thousand or more per day, per site, when we do them. What I saw was an unacceptable pace for vaccination. And this is the HEALTH DEPARTMENT, an entity that routinely administers vaccinations and should have this running like a well-oiled machine, since vaccine was first delivered in SD county almost a month ago.
By contrast, my father is 77 and in good health. He lives in a state on the opposite side of the country. They have vaccinated 100% of their healthcare force over the past month, and are now moving on to seniors and those with chronic medical conditions. The pace of vaccine administration has been substantially higher.
The difference is how states are implementing their vaccine administration. YES, the vaccine could be delivered faster to states, but some states have not planned their vaccine administration out at all and are still sitting on a substantial number of doses.
IMO, the National Guard should be administering vaccine. They are setup and trained for "humanitarian relief" and could accelerate deployment of the vaccine. The one downside to this is that the National Guard is controlled 100% by states and called up by state governors, not the federal government. So we will be at the will of individual governors to actually implement a plan like this.