The US screwed up its vaccine roll out in part because it was too choosy about who should get shots first

  • The US has one of the lowest COVID-19 vaccinations per capita rates in the world. Israel has the best.
  • Israel chose to prioritize its elderly. The US, by contrast, rolled out its doses using a complicated priority tier system based, in part, on people's employment.
  • In order to fix the US's vaccination campaign, the priority tier system needs to go, some experts say.
  • States also need more federal aid during the roll out process.
  • Visit Business Insider's homepage for more stories.

Officials are scrambling to speed-up COVID-19 vaccinations across the US, but a complicated set of guidelines regarding who should get priority have stymied states' efforts to maximize the number of shots in arms.

Indeed, the US's roll out efficacy is so poor that it's roughly 12% that of Israel's, which is one track to become the world's first nation to immunize its population against the coronavirus. 

As of January 15, Israel has administered 24 doses per 100 people, the highest per-capita rate for any country by a large margin, according to Bloomberg. By comparison, the US has administered 3.6 doses per 100 people. 

The US's snail pace can be explained by states' lack of federal guidance and aid — Operation Warp Speed delivered vaccines in record time, but ultimately left it to individual states to figure out how to distribute their vaccine allotments. 

Experts like Dr. Peter Hotez, a molecular virologist from Baylor College of Medicine in Texas, also argue that the complicated CDC guidelines of which Americans should have priority access, and when, have scuttled the US's vaccination efforts.

"A massive vaccination campaign won't work with our current fussy and intricate criteria for who gets a shot and when," Hotez wrote in a piece for The Washington Post Monday.  

The story out of Israel may prove Hotez's point.

Israel chose to forgo priority tiers, and focused instead on vaccinating its older residents first — in the month since its roll out started, nearly 25% of Israel's 9 million-person population has received a dose. 

Why Israel's vaccine roll out outpaced the US's

Israel expects to administer COVID-19 vaccines to all of its citizens aged 16 and up by the end of March. For now, the country has limited vaccinations to people 60 years of age and older, as well as healthcare workers and people at high risk of severe illness. A person's employment status does not factor into their eligibility.

The US, by contrast, spent the month following the first vaccine approval partitioning its shot by priority groups based on where people work: healthcare workers and long-term nursing home residents and staff were to be first, followed by frontline essential workers and people over age 75. Americans aged 65 and older, and those with high-risk health conditions that exacerbated their risk of severe COVID-19, would come last before the vaccine floodgates opened to the general public.

While the CDC guidelines stipulated states could vaccinate multiple priority groups at the same time, the initial roll out was hampered by priority group members who did not want a vaccine, doses that went to waste because hospitals couldn't find eligible arms to put them in, and Americans badgering healthcare providers and pharmacies with regards to their eligibility and whether they could show up at the nearest clinic and get lucky. 

"There is no obvious path for vaccinating tens of thousands of people while ensuring that the first ones in line qualify by essential occupation or underlying health condition," Hotez wrote, adding, "confirming such criteria is complicated at best, and it's probably not even feasible to try under conditions of duress."

Israel's resounding vaccination success may be due to the sheer simplicity of their priority system, San Francisco blogger Elad Gil wrote: "Having age-based tiers makes it easy to know who should show up and who is eligible, and removes a big burden on enforcement."

That said, Israel's mass vaccination has also been aided by the country's small population and compact geographic footprint. Prime Minister Benjamin Netanyahu reached early deals with vaccine manufacturers BioNTech, AstraZeneca, and Pfizer, and didn't shy from paying top-dollar for more supply.

Experts have also pointed to Israel's centralized, government-sponsored public healthcare system as an asset in its efficient vaccination campaign.

Ronit Calderon-Margalit, a public health physician from Hadassah-Hebrew University, told CNBC that every citizen has a unique healthcare ID, so it's "easy to summon them, follow them" and make a centralized list of who has been vaccinated, and when.

States are struggling to vaccinate their citizens without federal help 

Moncef Slaoui, chief advisor of Operation Warp Speed, predicted last month that 50 million Americans would be vaccinated by the end of January. With just 16 days left until that deadline, only 11.9 million doses have been administered and just 30 million doses have been distributed, according to the CDC.

In order to accelerate the rollout, Health and Human Services (HHS) Secretary Alex Azar took a page out of Israel's book.

He said Tuesday that states should expand the pool of people who have priority access. That pool should now include Americans between the ages of 16 and 64 who have certain underlying health issues that increase the risk of developing severe COVID-19, he said.

But expanding that priority pool does little to address a critical, underlying problem of the US's vaccination campaign: a paucity of federal guidance (both now and ahead of the roll out) has put the onus of scheduling appointments, identifying and setting up vaccination sites, and vetting eligible residents to individual states. 

The issue boils down to attitudes among White House and HHS staff, Ashish Jha, Dean of the Brown University School of Public Health, told Insider. "They believe deeply that it's not the role of the federal government to help states in a health crisis, that it's the job of states to figure this all out on their own," he said.

The result has been that it's been easier for some Americans to get vaccinated — depending on where they live, and what priority scheme their state officials have elected to pursue — and created 50 disparate timelines of when eligible people can expect their shot.

According to Premier Inc., the US's leading healthcare performance improvement company, a decentralized roll out has resulted in widespread confusion, with providers unsure of which state or federal agency is making decisions or where to turn to solve problems. (Biden's new vaccine plan looks to address issues like this.)

And centralization, according to Boaz Lev, a member of Israel's Ministry of Health, was key to Israel's success, not priority tiers. 

"Create a good flow of vaccines, a good flow of people … with a good administrative background so that you can register them and they know when to come for their next jab. So there's a variety of things involving planning ahead basically, and having it rolled out so it flows." he told CNBC Wednesday. 

The validity of Boaz's comments are borne out in the data regarding which US states are winning the vaccination race.

States that opened up vaccinations to older residents sooner than the rest of the US, like Florida and Texas, are not the leaders in vaccinating their residents.

West Virginia and the Dakotas, by contrast, top the country in vaccinations per capita, a feat they achieved by planning strong partnerships with local healthcare systems and pharmacies to facilitate dose distribution ahead of the roll-out.

Andy Dunn, Aria Bendix, and Hilary Brueck contributed reporting to this story. 

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