When Covid-19 death rates, along with desperation and angst, were at their peak in January, Google announced it would offer up its own real estate as clinic locations to distribute vaccines. It was welcome news.
But the failure of Google’s plans shows just how difficult it is for corporate America to tackle a problem of this scale.
The early days of vaccine distribution were chaotic – the Trump administration had provided tens of billions of dollars to pharmaceutical companies to develop vaccines but almost nothing to state departments of health expected to distribute them. Corporate America was ready to help.
Donald Trump enlisted Target, Walgreens, Walmart and CVS to help with vaccine distribution. Facebook launched a Covid-19 tracker. Now, as the vaccine rollout picks up steam, more companies are coming forward. Amazon, arguably owner of the world’s most impressive distribution system, is offering to help out, while also hoping to expand into America’s lucrative health sector. Whether it can avoid the errors of its peers remains to be seen.
“To help with vaccination efforts, starting in the United States, we’ll make select Google facilities – such as buildings, parking lots and open spaces – available as needed,” said Google’s chief executive, Sundar Pichai, in a blogpost in January.
“We’ll start by partnering with health care provider One Medical and public health authorities to open sites in Los Angeles and the San Francisco Bay Area in California; Kirkland, Washington; and New York City, with plans to expand nationally.”
Less than two months later, that distribution plan looks kaput. Experts said One Medical’s stumble serves as an extreme example, but by no means the only one, of the uneven private sector response that has, at times, been as rocky as government distribution plans.
Now, One Medical is under congressional investigation after a whistleblower leaked internal communications to NPR alleging clinics allowed young, healthy and ineligible tech workers and executives to cut in line to get the vaccine, while healthcare workers were waitlisted.
One Medical received thousands of doses of scarce vaccines. Unfortunately, One Medical’s business model made it poorly suited to deliver vaccines to members of society hit hardest by Covid-19.
The public company’s $199-a-year membership model focuses on office workers in well-off neighborhoods, backed in part by Google’s venture capital arm. Google employees receive an annual membership free as a job perk.
Google did not respond to questions from the Guardian about whether it plans to continue its vaccine distribution efforts, but a spokesperson for One Medical said the company did “not anticipate partnering with Google on vaccine sites at this time”.
The company also said it had “tightened” its “vaccine eligibility confirmation processes” and was cooperating with the House subcommittee. “We share Congress’s goal of ending this pandemic through a fair and equitable national vaccine rollout,” a One Medical spokesperson told the Guardian.
Joe Biden’s $1.9tn Covid-19 stimulus bill holds the promise of boosting the public health infrastructure needed to distribute vaccines, though this funding too may find its way to the private sector.
But researchers such as Dr David Himmelstein, a professor at the School of Urban Public Health at Hunter College in New York City, said there was a fundamental issue with expecting the private sector to be better at distribution than the government.
“When the government said, ‘Oh, we need to expand the infrastructure,’ they have turned to private firms,” said Himmelstein. In effect, the government depended on “the same kind of arrangements that have deprived people of color and poor people of care for the last 20 years, 40 years”.
What has developed in the wake of this reliance on the private sector, Himmelstein and others argue, is a paradox: care is often delivered in inverse relation to need. This, they said, is a phenomenon mirrored in the vaccine rollout, and which could have far-reaching consequences for the project to reach US herd immunity.
In the context of vaccines, equity represents not only the ideal of a just society, but also the ability to protect people who are ineligible to take the vaccine. Most researchers believe the US will need to reach the vast majority of adults to protect people ineligible for the vaccine, such as most teenagers, children and the immune-compromised.
“Pretty much across the board the distribution has been grossly unequal,” said Sam Scarpino, a researcher studying infectious disease dynamics at Northeastern University. “One of the big concerns is that the result will be pockets of communities that are well protected, and pockets that are vulnerable.”
While the federal government has purchased all Covid-19 vaccines, advised on their distribution and provided them to states, it is ultimately up to states to decide how to get shots into arms. In many cases, that has meant relying on the same institutions which have proved poorly suited to reaching neighborhoods and people in need.
Scarpino said gross inequality could result in a new pandemic problem – areas of localized Covid-19 spread which are poorly tracked by fragmented health systems and overwhelmed public health authorities. In all likelihood, unvaccinated individuals will share the same social networks in areas where proportionally fewer people will have received a vaccine because time, technology or transportation made it difficult to obtain one.
“It’s also incredibly concerning that the patchiness seems to correspond inversely with places that have been hit hardest with Covid, especially as it pertains to the race and ethnicity of people receiving the vaccine,” said Scarpino.
In many cases, equity has been sacrificed on the altar of speed, as many states have turned to established private infrastructure. Florida chose Publix as a major distributor of vaccines, even as grocery stores are known to be absent in low-income and minority communities.
In Boston, the city located its first large vaccination site at Gillette Stadium, a place best reached by car, according to Atyia Martin, chief executive of the Boston-based diversity and inclusion firm All Aces.
“The rollout was just anticipated to be unjust,” said Martin, who previously directed the office of public health preparedness in Boston. She is advocating for greater access to vaccines in Boston’s traditionally underserved neighborhoods. “If we keep using the same approaches to how we put policy and initiatives together, then we’re inevitably going to keep producing the same outcomes.”
For Martin, there are examples of successful partnership. The Black Boston Covid-19 Coalition helped register 800 people in a historically black neighborhood for vaccines in the last weekend in February by going door-to-door and storefront-to-storefront.
“We gave out hot soup to folks, gave out masks, food, all types of resources to support folks as they transition back to their life. We had Lyft codes to give to folks to get home if they needed it,” said Martin. “Really, it was an example of what partnership can look like.”
Poor transportation has long been an impediment to reaching healthcare, especially in underserved urban and rural communities. Uber and Lyft have tried to help, promising free rides to vaccination centers. But here too experts see difficulties.
“If you don’t have internet access or a smartphone to get you access to the ride-sharing app, or check the websites for a vaccine appointment, it will definitely pose a challenge,” said Kelsey Jones, a principal at the healthcare consulting firm Avalere Health.
Walgreens, CVS and Walmart pharmacies have also served as important distributors of vaccines. However, they have all also said they hoped to develop new business off the back of their involvement, even as they charge patients’ insurance for the logistical cost of delivering the vaccines.
“Every one of these customers is coming through our digital front end, so we have their email, we have their text message, and we have the ability to communicate with them regularly,” CVS’s chief operating officer, Jonathan Roberts, told the Wall Street Journal.
Daniel Dawes, director of the Satcher Health Leadership Institute at Morehouse School of Medicine, warned it was an “all-hands-on-deck” moment. The private and public sectors “need to work hand-in-hand in unraveling these political determinants of health”.
The reality that the private sector has failed to serve many of the same communities left out for decades is part of the “disquieting and harsh truth that health inequities have rarely been addressed unless their reduction or elimination served other purposes”, he said.
