I get asked reasonably frequently about international comparisons in the vaccination rollout.

With proviso that I'm much more informed about US and Japan than any other healthcare system and my only expertise is from working on this during the pandemic:
People know that the U.S. "does healthcare a bit differently" but almost everyone underestimates the degree to which this is true. In particular it leads to *massive* structural differences with regards to the distribution and physical location of where and when care provided.
The choice in the U.S. to allocate a very large percentage of all doses to the Federal Retail Pharmacy Program is a choice that I would predict less than 20% of nations will make. This is, again, heavily coupled with the structural setup of how healthcare is accessed in the U.S.
Decisions about who physically injects shots are ultimately political ones and have almost nothing to do with the medical or pharmaceutical needs of the vaccines. Narrative that vaccines presented unique logistical challenges never encountered before was wrong then, wrong now.
The U.S. is a federal system of government and Americans overestimate the degree to which other nations structure their governments in a similar fashion. Non-Americans far underestimate number of people in the U.S. who can tell the President "No, absolutely not" on this issue.
The U.S.'s polity is heavily divided including with stark divisions between peers at non-federal levels regarding the vaccine, and in some cases those peers are not allowed to collaborate without substantial unanimity or a directive from higher in stack. This not true everywhere.
The U.S. is relatively rich, even compared to nations who the average American considers "I mean we're *basically* peers with them, right?", and an option it has available to it which relatively few nations do is to hit any problem with an orbital bombardment of sheer wealth.
The U.S. is far, far, far more reliant on the private sector and non-profit sector for what some nations consider core government functions, which fact both complicates decisionmaking / unanimity of control and which gives it a reserve army that deploys during times of crisis.
There are stark differences between nations in routine uptake of vaccinations, including among vulnerable populations, and the choice to treat the covid vaccines as "Much closer to a flu shot than you'd expect" is downstream of this user behavior and the infra that supports this.
For example, in the U.S., which struggles with a noted anti-vax disinformation campaign pervasively through digital channels, only ~35% of seniors get vaccinated annually against the flu. In Germany, with socialized medicine, 70% do.

Oops, those numbers are actually reversed.

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More from @patio11

27 Apr
"The name of our register agent's LLC is causing many questions already answered by the name of our registered agent's LLC."
Seriously though from a marketing perspective I sort of like it.

Registered agents are a commodity; the service is (literally, in the literal sense of literally) being alive in a consistent location daily to perform a largely outmoded function the government mandates.
You'd expect there to be as much marketing differentiation for registered agents as you'd expect for soap, because the job to be done for soap has been a solved problem for hundreds of years, high margins, and a stupidly high LTV.
Read 6 tweets
24 Apr
A useful rule of thumb for the vaccine is 10,000 dose-days : 1 life saved.

So if you hypothetically had a million doses of a vaccine sitting in the freezer, and you decided to keep them there for a week rather than injecting them, that's something like 700 lives.
This is sensitive to, among other things, the progress of the vaccination campaign (dose-days save exponentially more lives early when they're being administered to seniors than when they're being administered to the general population), presumed infection rates, etc.
But some calculation like this is very useful to remind us that there is a cost to waiting, and the cost for waiting on this particular topic, at this particular moment, is so wildly disproportionate to the costs to waiting we typically endure as to stagger our imagination.
Read 4 tweets
24 Apr
It is Day 100 of VaccinateCA, and now Day 1 of the Vaccinate The States. We’re a non-profit collecting and publishing the best public data set of coronavirus vaccine availability across the U.S.

We work with the federal government, some state and local governments, and partners in the community to collect, verify, and distribute information about where to get the covid-19 vaccine. We back official efforts & some of the largest publishers in the world, e.g. Google Maps.
We will increasingly act as a data broker between other community efforts, the government and provider vaccine data systems, and publishers. We are uniquely resourced and experienced in the ecosystem to verify ground truth.
Read 5 tweets
22 Apr
Day 98 at VaccinateCA. By what I swear is coincidence, I think we'll have something fun to show off on Day 100.
And since I don't want to be a total tease, we took the embeddable map now backing e.g. Alameda County's health department and localized it into all eight languages we support.
Instructions for how to use that embed are here: blog.vaccinateca.com/put-vaccine-lo…

We welcome government health officials, politicians, community organizations, and other to use it to help accelerate the vaccination campaign in your community.
Read 4 tweets
20 Apr
Ballpark math here:

The first day of US's manufacturing capacity being redirected to vaccinate a new county ex-US will save +/- 1,000X more lives than the last day of the US's manufacturing capacity being reserved for the US.
I think the ethics of the situation are reasonably complex, but the useful takeaway from this should be "If you are waiting to get the vaccine because you perceive low personal risk, please get it *as soon as possible* to free up the spot for someone with much worse risk."
(We've had a great, great deal of suffering this year because people had a model which suggested "If I don't take this shot, someone else will get it" where that decision lead to others being delayed, for example during the initial phase of vaccinating healthcare workers.)
Read 4 tweets
20 Apr
A lot of our innovations for VaccinateCA are *extremely* low tech. One that surprises folks: “web bankers.”

There are thousands of places vaccine information can be, including county FaceBook pages, the personal Twitter feeds of elected officials, in mind of pharmacists, etc.
We use a material amount of scraping, but we’re rate limited on how many scrapers we can write, and a county dropping a PNG of their PSF announcing a clinic to their Facebook page is not easily scrapeable.

Enter the web bankers, called that to distinguish from our phone bankers.
When we identify a page/FB page/Twitter/etc which is likely to have interesting updates on it in future, we put an automated watcher on it. When it changes, that goes into a queue for the web bankers.

They go read it, manually compare against what it had last time, and type up.
Read 5 tweets

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