The United States has, so far, earned a solid D+ on the vaccine effort. The high mark is not an F because people are actually being vaccinated. There are a multitude of factors that are making this already incredibly complex situation unnecessarily convoluted. From my research, which has been motivated by my company’s development of a digital tool that prioritizes and schedules vaccinations in multiple states, it has become apparent that the states and local governments are very much to blame – not just the federal government.

Among other failures, the federal government has had issues getting vaccines shipped to the right places and failed to, at the risk of the Right crying over Big Government, make a standardized, nation-wide vaccination plan.

The CDC could have given exact direction for how the vaccine was to be allocated and kept the process consistent across the country. Instead, each state has created their own vaccine priority groups. And, shockingly, some counties and even cities have their own priority groups.

On top of the fact that there are over 50 different vaccine distribution plans in this country, many of them are incredibly complex. Within phase 1 of Washington state’s plan, for instance, there are two tiers and within the second tier there are an additional four tiers. Then, within those tiers there are multiple factors to consider for order of priority – age, number of comorbidities, types of comorbidities, and industry. It is a 10-page document to explain who should be vaccinated in phase 1. It’s a logistical nightmare to do outreach to these different patient populations and in the correct order for scheduling, let alone explain this criteria to any human being without their eyes going crossed.

These vaccination priority groups have gotten so bad that there is uproar over people getting vaccinated out of their priority group. I agree that cutting in line is bad and that we should all wait our turns. But the problem is not with those individuals, it is with the system that has been set up to confuse everyone and have the vaccinators struggling to understand and follow it.

In Georgia, a medical center lost its vaccination privileges because it vaccinated teachers out of turn. Now this facility is no longer able to offer vaccines to its patients. The punishment being doled out by the department of health is not on the clinic, but on all of its patients that were relying on that clinic for a vaccine. The department of health is making it harder to end the pandemic by shutting down a perfectly good vaccination center.

I understand what state health departments are trying to do – get the people who need it most vaccinated first. And that is a noble goal, but the over-complexity has made the implementation of the actual vaccination process a nightmare.

The argument against simply vaccinating as many people as possible is, of course, that certain people are at much higher risk. I’m not arguing against giving preference to the higher risk individuals – I want my grandmother and parents vaccinated before college kids and 20-somethings. But it must be pointed out that any vaccine that goes into an arm is a good thing. That 20 year old who goes to college or parties and then goes home to see mom and dad is, once vaccinated, no longer a threat to their family – or to yours.

So yes, we must give priority to the highest risk individuals in this vaccine campaign, but not at the expense of over-complicating the vaccine rollout and potentially delaying vaccinations across the country. We must find the middle ground of vaccinating as many as possible with preference for the higher risk. Instead, we have a system that has everyone – patients, providers, and health systems – confused and wasting time trying to understand the priority groups for their locality.

There is hope that President Biden’s plan for improving the vaccine rollout will get closer to the middle ground and shorten the timeline for reaching herd immunity. His focus on the pandemic and delivering funding, reimbursement, and broadened access is promising. Hopefully, his plans for federally funded vaccination centers and a push to get vaccines into urgent cares, doctor’s offices, community health centers, and pharmacies will be the push that’s needed. And hopefully, this will be enough to drown out the confusing and conflicting prioritization plans that each state has put together and are slowing down the vaccine campaign.

Chris Moag is a physician assistant.

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