Patrick McKenzie: belief

Transcript context

…There's so much that's great here. We figured out that we couldn't delegate to big tech or any of the competent actors. The native infrastructure that we had — that was specifically earmarked for dealing with public health emergencies — was extremely incompetent to the extent that Discord servers vastly outperformed them. Suppose that public health is not uniquely incompetent among the different functions that the government is supposed to perform. Those functions also don't get tested until the actual emergency is upon hand. Say the president hears this and is concerned that the people running responses to nuclear bombs or earthquakes aren't up to snuff. Is there some stress test that you could perform on these institutions in order to learn whether they're competent or not, before the thing actually happens? Look at the experience of the last hundred years, or back to the flu pandemic in 1918. A vastly less wealthy and less technologically sophisticated nation — with many fewer people involved in the actual fixing of this problem — competently executed on nationwide vaccine campaigns and other various measures. We should be urgently concerned with what has decayed institutionally since then. If you had just given health departments this kind of vanilla vaccination campaign, maybe they would have done better than they actually did. I'm not positive about that. Here I have to stop for a disclaimer. I think people in county health departments did real important work. They probably did work that saved lives on the margin. I do not think 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. That requires 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 we came up with was byzantine and complicated. It routinely befuddled professional software engineers and health administrators. I could not diagram it out on a whiteboard even if you paid me a million dollars to get it right the first time. That was all downstream of the United States' political preferences. Schedule 1A versus 1B versus 1C was in the first five seconds of the discussion dictated by medical necessity. Immediately after that it became about rewarding plums to politically favored groups. 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. That is not a thing that they have to do in most vaccination campaigns. That’s not a thing that they have to do on like the typical Tuesday of providing medical services. We asked them to do this radically new thing, which is in part responsible for the failures that we had. If we had had a much simpler tiering system, we would have had more than 25% of the shots successfully being delivered in the state of California in January of 2021. For people who are not aware, what was the political tiering system that you're referring to?…

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