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This is how America gets its vaccines

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This is how America gets its vaccines


Biden’s newly released pandemic strategy is organized around a central goal: to oversee administration of 100 million vaccines in 100 days. To do it, he’ll have to fix the mess.

Some critics have called his plan too ambitious; others have said it’s not ambitious enough. It’s guaranteed to be an uphill battle. But before we get to the solutions, we need to understand how the system operates at the moment—and which aspects of it should be ditched, replaced, or retained.

From manufacturer to patient

At the federal level, two core systems sit between the vaccine factories and the clinics that will administer the shots: Tiberius, the Department of Health and Human Services’ vaccine allocation planning system, and VTrckS, the Centers for Disease Control and Prevention’s vaccine ordering portal. 

Tiberius takes data from dozens of mismatched sources and turns it into usable information to help state and federal agencies plan distribution. VTrckS is where states actually order and distribute shots.

The two are eons apart technologically. Whereas Palantir built Tiberius last summer using the latest available technology, VTrckS is a legacy system that has passed through multiple vendors over its 10-year existence. The two are largely tied together by people downloading files from one and uploading them to the other.

Dozens of other private, local, state, and federal systems are involved in allocating, distributing, tracking, and administering vaccines. Here’s a step-by-step explanation of the process.

Step one: Manufacturers produce the vaccine

HHS receives regular production updates from Pfizer and Moderna. The manufacturers communicate estimated volumes in advance to help HHS plan before confirming real production numbers, which are piped into Tiberius.

Both vaccines are made of messenger RNA, a biotechnology that’s never been produced at scale before, and they need to be kept extremely cold until just before they go into a needle: Moderna’s must be kept at -25 to 15 °C, while Pfizer’s requires even lower temperatures of -80 to -60 °C. In the fall, it became clear that manufacturers had overestimated how quickly they could distribute doses, according to Deacon Maddox, Operation Warp Speed’s chief of plans, operations, and analytics and a former MIT fellow.

“Manufacturing, especially of a nascent biological product, is very difficult to predict,” he says. “You can try, and of course everybody wants to you try, because everybody wants to know exactly how much they’re going to get. But it’s impossible.”

PFIZER

This led to some of the first stumbles in the rollout. While training the states on how to use Tiberius, Operation Warp Speed entered those inflated estimates into a “sandbox” version of the software so states could model different distribution strategies for planning purposes. When those numbers didn’t pan out in reality, there was confusion and anger.

“At the end of December, people were saying, ‘We were told we were going to get this and they cut it back.’ That was all because we put notional numbers into the exercise side, and folks assumed that was what they were going to get,” says Maddox. “Allocation numbers are highly charged. People get very emotional.”

Step two: The federal government sets vaccine allocations

Every week, HHS officials look at production estimates and inventory numbers and decide on the “big number”—how many doses of each vaccine will go out to states and territories in total. Lately, they’ve been sticking to roughly 4.3 million per week, which they’ve found “allows us to get through lows in manufacturing, and save through highs,” Maddox says.

That number goes into Tiberius, which divvies up vaccines on the basis of Census data. Both HHS and media reports have sometimes described this step as using an algorithm in Tiberius. This should not be confused with any kind of machine learning. It’s just simple math based on the allocation policy, Maddox says.

Thus far, the policy has been to distribute vaccines according to each jurisdiction’s adult (18+) population. Maddox says the logic in Tiberius could easily be updated should Biden decide to do it on another basis, such as elderly (65+) population.

Once Operation Warp Speed analysts confirm the official allocation numbers, Tiberius pushes the figures to jurisdictions within their version of the software. An HHS employee then downloads the same numbers in a file and sends them to the CDC, where a technician manually uploads it to set order limits in VTrckS. (You can think of VTrckS as something like an online store: when health departments go to order vaccines, they can only add so many to their cart.)

Even that hasn’t been an exact science. Shortly before the inauguration, in a phone call with Connecticut governor Ned Lamont, outgoing HHS secretary Alex Azar promised to send the state 50,000 extra doses as a reward for administering vaccines efficiently. The doses arrived the next week.

The deal was representative of “the rather loose nature of the vaccine distribution process from the federal level,” Lamont’s press secretary, Max Reiss, told us in an email. 

Step three: States and territories distribute the vaccine locally

State and territory officials learn how many vaccines they’ve been allotted through their own version of Tiberius, where they can model different distribution strategies.

Tiberius lets officials put data overlays on a map of their jurisdiction to help them plan, including Census data on where elderly people and health-care workers are clustered; the CDC’s so-called social vulnerability index of different zip codes, which estimates disaster preparedness on the basis of factors like poverty and transportation access; and data on hospitalizations and other case metrics from Palantir’s covid surveillance system, HHS Protect. They can also enter and view their own data to see where vaccination clinics and ultra-cold freezers are located, how many doses different sites have requested, and where vaccines have already gone.

Once states decide how many doses of each vaccine they want to send to each site, they download a file with addresses and dose numbers. They upload it into VTrckS, which transmits it to the CDC, which sends it to manufacturers.

A Pfizer shipment

PFIZER

Last week, Palantir rolled out a new “marketplace exchange” feature, effectively giving states the option to barter vaccines. Since the feds divvy up both Moderna and Pfizer vaccines without regard to how many ultra-cold freezers states have, rural states may need to trade their Pfizer allotment for another state’s Moderna shots, Maddox says.

When thinking about the utility of the system, it’s worth noting that many health departments have a shallow bench of tech-savvy employees who can easily navigate data-heavy systems.

“It’s a rare person who knows technology and the health side,” says Craig Newman, who researches health system interoperability at the Altarum Institute. “Now you throw in large-scale epidemiology…it’s really hard to see the entire thing from A to Z.”

Step four: Manufacturers ship the vaccines

Somehow, shipping millions of vaccines to 64 different jurisdictions at -70 °C is the easy part.

The CDC sends states’ orders to Pfizer and to Moderna’s distribution partner McKesson. Pfizer ships orders directly to sites by FedEx and UPS; Moderna’s vaccines go first to McKesson hubs, which then hand them off to FedEx and UPS for shipping.

Tracking information is sent to Tiberius for every shipment so HHS can keep tabs on how deliveries are going.

Step five: Local pharmacies and clinics administer the vaccine

At this point, things really start to break down. 

With little federal guidance or money, jurisdictions are struggling with even the most basic requirements of mass immunization, including scheduling and keeping track of who’s been vaccinated.

Getting people into the clinic may intuitively seem easy, but it’s been a nightmare almost everywhere. Many hospital-based clinics are using their own systems; county and state clinics are using any number of public and private options, including Salesforce and Eventbrite. Online systems have become a huge stumbling block, especially for elderly people. Whenever jurisdictions set up hot lines for the technologically unsavvy, their call centers are immediately overwhelmed. 

Even within states, different vaccination sites are all piecing together their own hodgepodge solutions. To record who’s getting vaccines, many states have retrofitted existing systems for tracking children’s immunizations. Agencies managing those systems were already stretched thin trying to piece together messy data sources.

FedEx and UPS trucks depart from Pfizer.

PFIZER

It may not even be clear who’s in charge of allocating doses. Maddox described incidents when state officials contacted HHS to say their caps were too low in VTrckS, only to realize that someone else within their office had transferred doses to a federal program that distributes vaccines to long-term care homes, without telling other decision makers.

“Operation Warp Speed was an incredible effort to bring the vaccine to market quickly,” and get it to all 50 states, says Hana Schank, the director of strategy for public interest technology at the think tank New America. “All of that was done beautifully.” But, she says, the program paid little attention to how the vaccines would actually get to people.

Many doctors, frustrated by the rollout, agree with that sentiment. 

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Reopening US schools is complicated.

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Reopening US schools is complicated.


Across the country, schools are wrestling with the difficult choice of whether to reopen, and how to do it with reduced risk. In Kalamazoo, Michigan—not far from one the main sites where Pfizer is frantically manufacturing vaccines—they plan to stay virtual through the end of the school year. In Iowa, a state without a mask mandate, kids can now go back to in-person learning full time. Meanwhile, in a school district in San Mateo County, California, that borders Silicon Valley, there’s no clear decision—and low-income and affluent parents are clashing over what to do

It’s been a difficult journey. Since March 2020, when most schools closed, districts have been asked to adjust over and over—to new science about how the virus behaves, new policy recommendations, and the different needs of families, kids, teachers, and staff. 

Now, as President Biden forges ahead with his promise to reopen most schools within his first 100 days, the debates sound as complicated as ever—and offer a glimpse into many of the difficulties of reopening society at large. 

The limits of “guidance”

Schools across the country have looked to the Centers for Disease Control and Prevention for guidance on how to operate in the pandemic. In its latest recommendations, the CDC says a lot of the things we’ve heard all year: that everyone in a school building should wear masks, stay at least six feet apart, and wash their hands frequently. But schools have found that even when guidelines seem relatively straightforward on paper, they are often much harder—or downright impossible—to put into practice. 

“There’s a difference between public health mitigation policies when we think them through and when we write them down, and then when we try to implement them,” says Theresa Chapple, an epidemiologist in Washington, DC. “We see that there are barriers at play.”

Chapple points to a recent study by the CDC that looked at elementary schools in Georgia. After just 24 days of in-person learning, the researchers found nine clusters of covid-19 cases that could be linked back to the school. In all, about 45 students and teachers tested positive. How did that happen? Classroom layouts and class sizes meant physical distancing wasn’t possible, so students were less than three feet apart, separated only by plastic dividers. And though students and teachers mostly wore masks, students had to eat lunch in their classrooms. 

Researchers also note that teachers and students may have infected each other “during small group instruction sessions in which educators worked in close proximity to students.”

Following the CDC’s best practices might be inherently difficult, but it’s also complicated by the fact that they are just guidelines: states and other jurisdictions make the rules, and those often conflict with what the CDC says to do. Since February 15, Iowa schools have been required to offer fully in-person learning options that some school officials say make distancing impossible. Because the state no longer has a mask mandate, students aren’t required to wear masks in school.

Jurisdictions following all these different policies have one thing in common: although case totals have dipped since their peak in January, the vast majority of the US still has substantial or high community spread. A big takeaway from the CDC’s latest guidance is that high community transmission is linked to increased risk in schools. 

“If we are opening schools,” Chapple says, “we are saying that there’s an acceptable amount of spread that we will take in order for children to be educated.”

Meeting different needs

Some schools are trying alternative tactics that they hope will reduce the risks associated with in-person learning. 

In Sharon, a Massachusetts town just south of Boston where about 60% of public school students are still learning remotely, pods of students and staff are called down to a central location in their school building twice a week for voluntary covid-19 testing. One by one, children as young as five turn up, sanitize their hands, lower their mask, swab their own nostrils, and place their swab in a single test tube designated for their whole cohort. To make room for everyone, sometimes even the principal’s office becomes a testing site: one person in, one person out. The tubes are then sent to a lab for something called “pooled testing.”

After just 24 days of in-person learning, the researchers found nine clusters of covid-19 cases that could be linked back to the school. 

Pooled testing allows a small group of samples to be tested for covid all at once. In Sharon, each tube holds anywhere from 5 to 25 samples. If the test for that small group comes back negative, the whole group is cleared. If it’s positive, each group member is tested until the positive individual is found. Meg Dussault, the district’s acting superintendent, says each pool test costs the school between $5 and $50, and over a third of Sharon Public Schools students and staff participate. 

“I’ve seen the benefits of this,” she says “And I believe it’s essential.”

Because schools are funded unequally and largely through taxes, access to resources is a common theme in discussions of school reopening. The state paid for Sharon’s pilot period, but not every district or school has the money or staffing to mount large-scale programs—and Dussault says the district will need to foot the bill for any testing once this program ends in April. It will also need to keep relying on the goodwill of the parent volunteers who wrangle students and swabs for testing each week. 

In the seven weeks since pooled testing began, Dussault says, only one batch has come back positive. It’s given her peace of mind.

And even with mitigation measures in place, there are stark demographic differences in opinion on reopening. A recent Pew study found that Black, Asian, and Hispanic adults are more likely to support holding off until teachers have access to vaccines. Those groups are also more likely than white adults to say that the risk of covid-19 transmission “should be given a lot of consideration” when weighing reopening.

Chapple worries that these parents’ concerns will be overlooked, or that funds for remote learning will dwindle because some districts decide to move to in-person learning.

She says: “School districts need to keep in mind that if they’re reopening but a small percentage of their minority students are coming back, what does that look like in terms of equity?” 

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SpaceX has successfully landed Starship after flight for the first time

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SpaceX has successfully landed Starship after flight for the first time


On March 3, SpaceX’s Starship pulled off a successful high-altitude flight—its third in a row. Unlike in the first two missions, the spacecraft stuck the landing. Then, as in the last two, the spacecraft blew up.

What happened: At around 5:14 p.m. US Central Time, the 10th Starship prototype (SN10) was launched from SpaceX’s test facility in Boca Chica, Texas, flying about 10 kilometers into the air before falling back down and descending safely to Earth. 

About 10 minutes later, the spacecraft blew up, from what appears to have been a methane leak. Still, the actual objectives of the mission were met.

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Rocket Lab could be SpaceX’s biggest rival

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Rocket Lab could be SpaceX’s biggest rival


In the private space industry, it can seem that there’s SpaceX and then there’s everyone else. Only Blue Origin, backed by its own billionaire founder in the person of Jeff Bezos, seems able to command the same degree of attention. And Blue Origin hasn’t even gone beyond suborbital space yet. 

Rocket Lab might soon have something to say about that duopoly. The company, founded in New Zealand and headquartered in Long Beach, California, is second only to SpaceX when it comes to launch frequency—the two are ostensibly the only American companies that regularly go to orbit. Its small flagship Electron rocket has flown 18 times in just under four years and delivered almost 100 satellites into space, with only two failed launches. 

On March 1, the company made its ambitions even clearer when it unveiled plans for a new rocket called Neutron. At 40 meters tall and able to carry 20 times the weight that Electron can, Neutron is being touted by Rocket Lab as its entry into markets for large satellite and mega-constellation launches, as well as future robotics missions to the moon and Mars. Even more tantalizing, Rocket Lab says Neutron will be designed for human spaceflight as well. The company calls it a “direct alternative” to the SpaceX Falcon 9 rocket

“Rocket Lab is one of the success stories among the small launch companies,” says Roger Handberg, a space policy expert at the University of Central Florida. “They are edging into the territory of the larger, more established launch companies now—especially SpaceX.”

That ambition was helped by another bit of news announced on March 1: Rocket Lab’s merger with Vector Acquisition Corporation. Joining forces with a special-purpose acquisition company, a type of company that ostensibly enables another business to go public without an IPO, will allow Rocket Lab to benefit from a massive influx of money that gives it a new valuation of $4.1 billion. Much of that money is going toward development and testing of Neutron, which the company wants to start flying in 2024.

It’s a bit of an about-face for Rocket Lab. CEO Peter Beck had previously been lukewarm about the idea of building a larger rocket that could launch bigger payloads and potentially offer launches for multiple customers at once. 

But the satellite market has embraced ride-share missions into orbit, especially given the rise of satellite mega-constellations, which will probably make up most satellites launched into orbit over the next decade. Neutron is capable of taking 8,000 kilograms to low Earth orbit, which means it could deliver potentially dozens of payloads to orbit at once. As a lighthearted mea culpa, the introductory video for Neutron showed Beck eating his own hat. 

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