The dismay ofthe deployment of the US vaccine against SARS-CoV-2and the distribution is likely to result in tens or even hundreds of thousands of unnecessary deaths. The vaccines are very effective, but millions of doses remain in hospital coolers across the country. How is it possible? Why don’t they put needles in their arms literally the minute the vaccine coolers get off the trucks?
The answer goes back to Ronald Reagan: it is distrust of big government.
The United States has long enjoyed a healthy dose of skepticism about government solutions. Yet we owe our existence as a nation to great government. Prior to the formation of the Continental Army and the decision of the founding states to allow the newly created federal government to raise funds for this army, the first colonial soldiers were destitute, starving and ill-equipped. Loans from other foreign governments and federal bonds – other manifestations of the big government – have also helped. We did not defeat Adolf Hitler hoping that each state could provide enough troops and that their radio systems would communicate with each other. And we did not fund World War II by asking every state to participate. Instead, the federal government issued national war bonds. Wars have traditionally been big government work, and rightly so.
National emergencies that require top-down decisions on key issues have almost always gone better when the big government stepped in to take the lead. This extends to the field of public health. The victory over smallpox was the product of the big government, with a centralized plan to eradicate this scourge. We have not progressed towards clean water and clean air without the intervention of the big government. The acid rain crisis was resolved by market forces, but these forces were harnessed by the big government and the Environmental Protection Agency through the organization and enforcement of emissions markets. and sanctions. State-by-state laws on the pollutants responsible for acid rain would not have worked as well, especially since the causes of the acid rain were power plants in the Midwest while the victims were mainly the states on the East Coast.
Ronald Reagan said, “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.’ This quote has since animated much of conservative thought. The idea that great government is invariably intrusive, incompetent, and unnecessary has become a key principle almost all Conservative lawmakers had to recite and be faithful to.
Reagan was the product of his time and place. It was reacting to a Soviet threat and the manifest failure of centralized economic planning that ultimately destroyed the Eastern Bloc. Reagan also exploited a long-held American border philosophy that people can and almost always should do it on their own without government interference. Yet Reagan himself pushed for and oversaw a large military expansion, a clear manifestation of great government. In fact, the big government was fine if it fit the political mold of military needs.
This old fashioned way of thinking is now hurting our nation when it is needed most. The federal government has waited this week to provide even basic advice to states on how to distribute vaccines, and even now, many questions remain unanswered. States, in turn, provided only light advice to hospitals. Hospitals froze, like deer in headlights, and implemented questionable policies.
The basic guidelines of the federal government have been that the first people to receive vaccines should be frontline workers and residents of nursing homes. Even within these guidelines, there is a lot of room for interpretation. Are grocery store workers on the front lines? Are the hospital’s administrative staff front-line workers? Should nursing home residents who have had COVID-19 in the past and have recovered, be given the vaccine? If some frontline workers in the hospital refuse the vaccine, how long should their doses be kept in case they change their mind?
This debacle calls for advice and simplicity. Immunize all health workers first. Those who refuse the vaccine now may receive it in the future, but for now their dose will be immediately released to others. Vaccinate everyone over 65. Vaccinate all frontline workers and make sure first responders, transit workers, and supermarket workers are included in the definition. Ask for proof of employment, but don’t be precious about it. The perfect is the enemy of the good, and “good enough” is much better than letting the vaccines go bad, as it is now.
The emptiness of top leadership means we all suffer – and some of us die. In this time of national crisis, the five scariest words are “Find it for yourself”. We learn this Hobbesian truth firsthand, and it literally kills us.
Vivek Wadhwa and Alex Salkever are co-authors of From incremental to exponential: how large companies can see the future and rethink innovation, a new book on how businesses can thrive in this era of rapid change.
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