Patrick McKenzie

And so in some fashion, we should be urgently concerned with what decayed institutionally in the interim.

I think one of the things that health departments specifically faced is that if you had just given them these kind of vanilla vaccination campaign, maybe they would have done better than they actually did.

I'm not positive of that.

I do think there are actually, and here I have to stop for a disclaimer, I think that people in county health departments did real important work.

I think they probably did work that saved lives on the margin.

I do not think that the United States should be satisfied with our performance in 2020 and 2021.

We should be very dissatisfied and we should get better for the future.

And that requires like recognizing that we underperformed by a lot.

There was a political decision made that the successful administration of vaccination was not going to be measured solely by saving lives.

The prioritization schedule that came up, which was Byzantine and complicated and routinely befuddled professional software engineers and health administrators, and which I could not diagram out on a whiteboard, even if you paid me a million dollars to get it right on the first time.

was downstream of the United States as political preferences.

And so schedule 1A versus 1B versus 1C was like in the first five seconds of the discussion dictated by medical necessity.

But immediately after that was about rewarding plums to politically favored groups.

And so one of the complexities of this is that the pharmacies and healthcare departments are not set up to discriminate along the axes of whether one is politically powerful or not, because that is not a thing that they have to do in most vaccination campaigns and not a thing that they have to do on like

the typical Tuesday of providing medical services.

We asked them to do this like radically new thing, which is in part responsible for the failures that we had.

If we had a much simpler tiering system, for example, we would have had more than 25% of the shots successfully being delivered in the state of California in January of 2021.

Oh goodness.

So this was different in different places and confusingly different places in the United States use the same names for these tiers for different people.

But in the state of California,