American's aren't getting vaccinated fast enough to outpace covid-19, and part of the reason is the inefficient, sometimes broken technology involved. We’re the team at MIT Technology Review who has been looking into the complicated data systems and processes behind America's vaccine rollout, trying to understand why they aren't up to their task in many ways. We've learned a lot about how it works (and doesn’t) in the US, and we've spoken to experts about what needs to change. There are a lot of pieces to this puzzle, and so we've written about them over several stories:

1 - We did a deeply researched overview of how America gets its vaccines. (it's a giant maze, pretty much)

2 - We investigated the $44 million vaccine data system that isn't being used much and has, in the words of one expert, "become a cuss word."

3 - So what are Americans doing instead to get signed up for their shots? Some are crowdsourcing ideas and tactics with their neighbors and even strangers.

4 - We also looked at one faulty system used by Stanford to say who'd be eligible for vaccination at its medical facility.

Some ideas for things to ask us about:

  • How vaccines get from point A to point B
  • Why it's been so hard for you to sign up
  • Where public health data needs to be improved
  • How you might eventually prove you've been vaccinated
  • How decisions are made about the vaccine rollout process

(We're less likely to be able to speak about the science of the vaccines themselves, or where you or your family should personally go to get a vaccine.)

We’re Cat Ferguson, Karen Hao, Lindsay Muscato, Bobbie Johnson, Tanya Basu, and Eileen Guo.

Want more news like this? Sign up for our coronavirus newsletter here:


Ask us anything!

Comments: 298 • Responses: 47  • Date: 

PackNit169 karma

So, I'm a mid-30s guy who is blessed enough to be working from my home office. My wife is a teacher who has received the first vaccine dose (second coming up in another week).

Should I be sitting on my hands waiting for my group to be called in my state (I'm in the everybody else/last group) - OR should I be calling up pharmacies around to see if they've had cancellations so I could get that instead of it potentially going to waste? EDIT:Just realized I spelled dose does. Corrected. What a fool I am.

techreview130 karma

Hi! This is a good question, and I don't think there's a perfect answer. We've certainly heard reports that pharmacies are overwhelmed with calls, and overall any phone-based vaccine sign-up system will be already be over-stressed, because elderly people may be trying to call instead of use the clunky websites we've written about. But if you happen to be _offered_ a dose outside of your phase, there may be more to think about. We just published an essay by Wudan Yan about her experience of getting a vaccine outside of her phase. It talks about some of the mental gymnastics she had to go through, and points to some broader ways to think through this.

I also appreciated this overview from an ethics perspective:

-- Lindsay

okletssee41 karma

I'm curious how the second dose will be handled in this kind of scenario. Are you expecting to get it "on time"?

techreview29 karma

There’s not really a generalizable answer to this — it’s going to depend on how the jurisdictions/vaccination sites are handling scheduling and follow-up.


mmm_toasty151 karma

Thanks for doing this AMA! I've got a couple of questions for you.

First, what are the most frustrating bottlenecks or technological/logistical barriers that you've identified in rolling out the vaccine more efficiently across the country?

Second, of all of the barriers you've identified, do you think any are simple to resolve?

techreview254 karma

Oh god, the most frustrating part is the whole thing. It's not exactly high-tech, but the lack of good public communication makes me the most frustrated. Since it's really hard to figure out what the hell is going on, people have to do a bunch of Google searches to find a reliable answer -- that's expecting an unacceptably high level of computer literacy, especially since we're trying to vaccinate a bunch of elderly people.

As for solutions, more health departments need to meet people where they live, by reaching out to places like church and senior centers and setting up mobile clinics (which will obviously become easier as vaccine supplies increase). We need to fund public health departments and hire people to do the work -- more hands on deck will solve a lot of other problems, too.


Hillytoo29 karma

Thank you for doing this work! I am really happy to see someone is looking at this in research. One thing you said is "meet people where they live". I have been thinking about this as well but I had no training in logistics at all. Right now people are going to the vaccine. Would it be more efficient to take the vaccine to them? Aside from the front line workers ( I know this is a value laden statement) who should be first and have earned that priority, and the people in the care homes, I have to wonder if the assumptions underlying the rollout are right. So if you lay aside the age related rollout and went ahead geographically, getting everyone in a prescribed area then pushing forward county by county, would that help? I say this because all those deployments for each age group have to be re-mobilized each time another age group comes up. Also, is there anything to learn from the rollout of the polio or small pox eradication efforts in the past? Thank you.

techreview56 karma

I think focusing on older people is definitely the move here. Of people who have died from covid, 80% were over 65, and 60% were over 75. According to CDC data, around 5,500 people who have died were under 40.

I don't want to minimize the suffering of younger people and their families, but from a public health standpoint, there's a clear reason to prioritize elderly people.

I'll have to think more about smallpox and polio! I'm sure we have plenty to learn. But mass vaccination has never been a quick process -- it took 18 years of concerted effort to eradicate smallpox worldwide, and 26 years to eradicate polio in the U.S.


THECapedCaper8 karma

Will staffing be considered such a bottleneck, once supply is picking up, that it may be time to consider training certain healthcare workers or students on how to administer the vaccines? We already allow nurses, doctors, and pharmacists to do them, but what about healthcare workers lower on the totem pole such as pharmacy technicians, dieticians, medical assistants, nursing students? Provided they are under the supervision of a doctor or nurse, of course!

techreview11 karma

This is already happening! It's state-by-state, but the Association of Immunization Managers recommended making it easier to give shots back in December.


glahtiguy68 karma

Denver CO here. My wife went in last night for her first shot. She almost got rejected.

For background: My wife is a veterinarian. A couple weeks back they announced they were allowing vets to administer the vaccine. They didn't, however, open up vaccines to the DVMs. The CVMA basically came out with "da fuq? We are not endorsing any of our docs to do this until they can be protected, as you are basically turning them into frontline workers even more than they already are..."

They corrected that and moved vets up to group 1c or whatever they are on right now. Last week on Thursday one of her coworkers, an ER specialist, got rejected at the vaccine site. Even though she had her proof of permission and unique ID code, they refused to vaccinate her. They didn't believe she was eligible and she couldn't convince them they were wrong. So, she's back at work interfacing with clients bringing in animals through the emergency service, still unprotected. She's not happy.

My wife went in, and the same thing very nearly happened to her. They finally accepted her, after she had to give her unique ID code, her permission letter, and the communications coming from her management. They weren't happy, but stuck her. Huge load off my mind, because she is underlying health issue high risk on top of all her job interaction with clients. We've been terrified of her getting infected, as they've had several outbreaks in her hospital over the last 6 months.

Given how this has all been going, the failure to give vaccines to people cleared to administer them, and then denying some of the people trying to get them when they were made eligible has completely soured all the vets I know on helping out. They don't feel like it would be safe, given how piss poor the communication and coordination has been.

techreview51 karma

This sounds really, really frustrating, and it reminds me of things we've heard all over the country, although this specific issue (vets) isn't something that's been on my radar. It must have been incredibly defeating for someone to volunteer for such a brave task, and then realize that the underlying process was so broken. Part of the issue is that there are many interlinking data systems that aren't necessarily "speaking" to each other, because they were all created at different times for different purposes. Or, even if the tech was working, the person-to-person communication broke down. We'll need to look into this kind of issue more. Thank you for bringing this to our attention. - Lindsay

ozaveggie46 karma

It seems like there was some consensus that strict prioritization requirements was slowing down overall distribution of vaccines. This lead to a lot of simplifying in the last few weeks and "opening up" of eligible groups (my state when from 75+ to 65+ being eligible within a few weeks). Was there evidence that these prioritizations were actually a significant bottleneck or was the slow pace caused by other issues?

techreview19 karma

Hey! Thanks for this question. There are a lot of possible bottlenecks in these systems (from production to coordination to distribution to sign ups and on and on), and they could be different for every state, so it’s difficult to say there’s a consensus across the board.

I’ve wondered, like you, about how states determine when the next group should be called up for their vaccines. I’m not sure of the answer but perhaps this could be a future story for us to look into!

—Mia Sato, reporter

bdone201232 karma

I read the first couple articles you posted and one thing that annoyed me was how they keep giving these contracts to companies with a proven track record of incompetence. Are people trying to fix the requirements for getting these contracts and how likely does that seem? If not are there ways around it? For instance could deloitte sub contract out to an agency that was better suited to the projects? Yes it would waste whatever money doloitte pocketed but at least you'd have a better chance of getting something useful out of it.

I'm a developer although I don't work on health software but it seems like 100 million is way more than you'd need to build something like that. Yes it's been a rush job but people are insanely motivated. And big software projects tend to just get more and more complicated the more people you add. We've seen so many of these giant well funded projects fail in the public and private sectors. I think you'd have a much better chance by giving 25 million to 4 companies and then use the best completed one.

It's good to see that you guys are paying attention to all these technological problems so that we can fix the current vaccination problems. That's obviously more important right now than what I'm talking about. But if we don't look to the future and fix the underlying issues we could easily have the same thing happen again.

techreview27 karma

This is a great question, and I agree, a frustrating problem. While reporting on this, I attended an event where an expert addressed this question directly. My summary is as follows. It's a mix of overlapping issues: the government's inflexible processes (eg: when budgets are approved), which makes it difficult for them to think and plan ahead, and sometimes their lack of technical knowhow (eg: people who can evaluate tech vendors and understand what to look for).

The first of these problems is often less talked about. But many of the government procedures are set up in a way that makes it hard for governments to adapt on the fly to emerging problems like the pandemic. It's also hard for them to think long-term about what research they need to be conducting now so that they are set up to tackle something a few months later. This is why governments, in the urgency of a crisis, will just return to the exact vendors they've worked with. They haven't had the time to explore other options, and don't necessarily have the on-staff knowhow to do so anyway. Then once a vendor is locked in, due to budgetary reasons, they can't really get rid of them.


Condoggg29 karma

I'm young, in good health and already had covid with very minor symptoms (very mild fever for <48 hours, no lasting symptoms). I had my antibodies tested a few weeks ago and they are present. Should I even bother with the vaccine when it's available?

techreview52 karma

Hi! First, so glad to hear that you were able to get through covid with minor symptoms. The research on this question is very, very new, and we expect that we will learn more as things become more clear. The best answer I have is from a Q&A that we did with Dr. Rajeev Venkayya:

Dr. Venkayya's answer:

If you were exposed previously, it shouldn’t affect the potential of a vaccine to give you even better immunity than you received with a natural infection. The clinical trials that were done, most of them—that I’m aware of—did not exclude people that have previously had covid infections. And I don’t think we’d heard from anybody that we’re going to be withholding the vaccine from people that have previously had covid. There are a couple of reasons for that. One is that there’s a lot of variability in the antibody levels that we can measure after a person has had covid. And so you don’t know whether that level of antibodies, for that person, is going to be protective, unless you actually go in and measure that. And even then, we don’t yet have a clear-cut idea as to what level you need to have. And the second thing is that we know with other coronaviruses that you can have protection against reinfection for some period of time, but then that protection wears away or it goes down over time. And thirdly, we also know that in many instances, vaccines will provide more long-lasting protection than natural infection will.

Thank you!


itb20623 karma

What are 3 moves the federal government in coordination with states could make that massively improves the situation?

techreview51 karma

Great question. When we asked experts the same thing, they said the following:

  1. Communication! Sounds simple, but one of the hardest challenges that state's have dealt with so far is a lack of clarity from the federal government about when and how many vaccines will be available. This hinders their ability to plan.
  2. Different distribution strategy. Right now, the federal government splits up vaccines purely based on state population, without regard to which states have the capabilities to store which vaccines. But rural states, for example, may have a much harder time accepting Pfizer because it has to be stored in ultra cold storage, and this is not conducive to these states' highly distributed populations. So those states have been left to barter with others if they want more Moderna. This has led to a lot of confusion, complexity, and wastefulness because states can't accept all the vaccines that are available to them. If the federal government changed the way they allocate vaccines to account for these kinds of differences, it could really improve the whole operation.
  3. Tech support. A lot of states have neither the funding nor expertise to spin up their own appointment scheduling and tracking softwares. This is why so many states now have failing systems, or, like in the case of Florida, have resorted to publicly available options like Eventbrite. The biggest thing the federal government could do is put together a tech team to create these softwares and give it to states as an option if they need it. As Latanya Sweeney, a professor of government and technology at Harvard University, said, building the software wouldn't take too long if it's a properly resourced team. And software built now has the advantage of using the latest technology, plus using the latest UX design principles, which will make it much more familiar and easy for people to use.

You can read more about "where to go from here" in our article:


kasey195118 karma

My state is close to the bottom on distribution of the vaccine. Each county does its own thing. No one knows when vaccine signups via the web will be available. The counties post vague window openings like maybe Tuesday or Wednesday. There is no waiting lists. So elderly people like myself have to keep our phones, tablets and computers open to check every half hour. If you miss the opening time the slots are reserved in an hour or so. Please. This is shameful. No one in leadership on the state level wants to interfere with the counties. All counties use different software. No one talks to the other. The state health department site is useless. All it does is show the addresses of county health departments and lists grocery store pharmacies. You must visit each separately. My state? Georgia. It's run by back water GOP idiots.

It's bloody awful here.

techreview10 karma

Hi; I just wanted to chime in on this one and say that this issue is so vital, and we as journalists are very concerned about whether older people are able to properly access vaccine sign-up. Quick fixes are certainly few and far between. We _have_ seen a bright spot in that some people are banding together with neighbors and even strangers to help people find appointments. My colleague Tanya wrote about this here:

I did a quick search and can't vouch for this tool but there is a crowdsourced solution developing in Georgia. Obviously a more official solution would be a million times better. but I wanted to drop that there on the off-chance that it is useful.

- Lindsay

techreview14 karma

Hi everyone! We're the team at MIT Technology Review reporting for the Pandemic Technology Project. We're so excited to be hosting this AMA! Here are some conversation starters you could ask us about:

  • How vaccines get from point A to point B
  • Why it's been so hard for you to sign up
  • Where public health data needs to be improved
  • How you might eventually prove you've been vaccinated
  • How decisions are made about the vaccine rollout process

But feel free to ask us anything!

MalaiGhevar8 karma

As far as I understand, only the mRNA based vaccines from Pfizer and Moderna have been given approval for emergency usage in US. Is there any viral vector based vaccine available in US? If not, is the FDA going allow its usage in the near future?

techreview8 karma

The only two vaccines available right now in the US are the Moderna and Pfizer shots, both of which use mRNA. Any other vaccines will only be approved after FDA reviews clinical trial data for safety and efficacy.


blondiecommie7 karma

What is preventing America (and any other developped country for that matter) to take a "all hands on deck" approach and mobilize its resources to make, and distribute the vaccine to all citizens as quickly as possible?

The vaccination efforts seem so nonchalant, slow and overall mismatched to the urgency of the situation.

techreview13 karma

Hi! Gonna add a few more thoughts on your first point:

It may be helpful to look at countries that have distributed vaccines efficiently and quickly (relatively speaking, of course). You’ve maybe seen some headlines about Israel’s vaccination effort, and it’s true: They’ve gotten shots in many arms in just a few months.

I talked to Hadas Ziv, from Physicians for Human Rights-Israel, about what it’s like there. She told me Israel’s streamlined public healthcare system was key to the country’s speedy vaccine distribution. There are four HMOs (health maintenance organizations) in Israel, and if you want a vaccine, you just go to your provider site to find out if you’re eligible, make an appointment, and ultimately get a vaccine. This is obviously very different from the U.S.!

But even in Israel situation is complicated, especially around equity and trust. Specifically, Israel’s earlier decision to not vaccinate Palestinians was criticized by health and human rights organizations. And it was revealed in January that Israel struck a deal with Pfizer to exchange medical data for extra doses, which raises privacy questions. You can read more about the rollout in Israel here.

—Mia Sato, reporter

techreview7 karma

Thanks for your question. Part of the problem with America's vaccine rollout lies in politics. Distribution began under the Trump administration and is now continuing under the Biden administration. Besides the federal level issues of communication between the two administrations was the fact that states have been handling distribution differently. Some, like Florida, have used ticket sales platforms like Eventbrite to make appointments. Others have cobbled together regional websites and hotlines for local residents. In many cases, the systems aren't built for the crush of people seeking vaccinations and information, which has led to many citizen-level, crowdsourced sites popping up to fill in the gaps. In short, government responses seem haphazard because of the one-two punch of a lack of communication at the federal level and states unable to handle the need for information with existing communication networks. More here on how grassroots efforts are trying to help out: - Tanya

Goatzinger6 karma

Do you consider a hot dog a sandwich?

techreview2 karma

No, but I do think a pizza is a taco.


FillsYourNiche6 karma


techreview11 karma

Thank you for being here with us. Considering we now have several vaccines rolling out what are the ethical challenges/solutions to deciding who recieves which vaccine? Who is making these decisions?

Good questions!

So, the short answer is: the ethics guidelines focus on how to prioritize different populations for the vaccines, not between the ethics of administering different vaccines. This is partly because we didn't know how effective the Johnson and Johnson vaccine was until this week.

But regarding the ethics of overall vaccine distribution: in December, the CDC's Advisory Committee on Immunization Practices put out recommended guidelines for how to ethically roll out the vaccines to different populations. (I wrote about this with a colleague in a round-up of three different countries' approaches here.)

ACIP may provide guidance in the future on how to treat the different vaccines differently, but currently, from an ethical standpoint they're treated the same. A lot of bioethicists and public health experts are suggesting, however, that if you have the option of getting the Johnson and Johnson vaccine, you should do it. As Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, told CNN, “You want to stay out of the hospital, and stay out of the morgue.”

So back to your second question, on decision-making on who gets what vaccine: in the absence of more guidance, the decision may be more logistical than ethical -- and my my colleagues Cat and Karen have an excellent explainer about in the distribution technologies and infrastructure that actually send the vaccines from point A to point B.

-Eileen Guo

Trickypedia5 karma

Is there consistency across states as to whether or not people are first invited to come forward for the jab if they qualify? Or does a person have to apply for a vaccine first and then they’re assessed as to whether they’re eligible?

I suppose my question is whether there could be people who are considered most vulnerable to Covid but who don’t get vaccinated because they were expected to be pro-active and seek out the vaccine, versus local public health getting in touch with people to say ‘hey, you’re entitled to this vaccine and this is how you can get it etc ‘

techreview4 karma

Thanks for your question. Across the country, senior citizens (in most states, that's those over 75, though in some states that's those over 65, depending on demographics) are the first to qualify, along with nursing home workers and other essential workers. There isn't necessarily an application process, per se. All you theoretically have to do is show up at a location and, if you qualify based on age/category, you get the shot.

*However*, there's the huge caveat that these vaccines need to be kept super cold and can only be exposed for a brief period of time before they must be tossed, which has led to some places asking anyone to come and get the vaccine so it doesn't get wasted (see our recent piece by Wudan Yan here:

You make an excellent point in that some people have more information and access to where and how to get the vaccine compared to others, which is a huge division among elderly people. Some people have poor Wi-Fi. Some people don't speak English. Some people don't have computers. Some people don't have help. These people are the ones we're seeing falling through the cracks. Local groups are trying to help, whether it's by crowdsourced information ( or community groups making a phone call. But unfortunately, there's emerging data to suggest that some of the most vulnerable Americans are unable to get the vaccine — and that's a big problem.

- Tanya

klstopp5 karma

Why was I asked to provide insurance information when I got my vaccine?

nancylyn3 karma

I was told at my visit that they might be trying to recoup some of the administration the vaccine is paid for by the government but the nurses time isn’t (and the person checking you in etc....)

techreview2 karma

Yep, this. Under the CARES Act, public and private insurers are mostly supposed to cover the cost of actually giving the vaccine; if you don't have insurance, providers can submit for reimbursement from the 'Provider Relief Fund.'

That said...there are a lot of hurtles in the way, and some things are still getting up and running (i.e., states are still setting up systems so providers can bill Medicaid). Many hospital clinics have been running on volunteer labor and not asking for insurance, although that's probably changing as it becomes easier to actually get paid.

Like everything we're talking about, things are changing really fast, and look very different across jurisdictions and sites, depending on who's paying for/staffing/running the clinic.


techreview4 karma

Hi everyone! It's officially after hours for a lot of us, but our West Coast bureau may still answer some of your questions in the next few hours. Keep them coming! We're having a blast. We'll all be back tomorrow morning to answer more of your questions.

Kevinnight4 karma

A couple of questions.

  1. Who is buying the vaccines?
  2. How many doses dose the US have vs how many have been given?
  3. How effective would it be for the US govt to use the defense production act to speed up vaccine production.

I just saw a statistic that about 6% of the US has been vaccinated in 6 weeks. At this pace it would take about 2 years to vaccinate the whole country.

techreview13 karma

A couple of questions.

Who is buying the vaccines?How many doses dose the US have vs how many have been given?How effective would it be for the US govt to use the defense production act to speed up vaccine production.

I just saw a statistic that about 6% of the US has been vaccinated in 6 weeks. At this pace it would take about 2 years to vaccinate the whole country.

1) Vaccines are being purchased primarily at the country-level, with the international Covax alliance trying to help low-income countries that may not be able to purchase vaccines buy them as well. They're free for individuals in the U.S.

2) The U.S. has purchased 100 million doses of the Pfizer vaccine and 200 million doses of Moderna's vaccine. The U.S. has distributed nearly 50 million vaccines to the states. (The CDC has a handy tracker here:

3) This is a fair question, but I think there's a better one: will the DPA speed up vaccine distribution/administration? Because that's a major challenge right now: getting the vaccines out to the right locations, and getting them administered before they all expire. We're really struggling with that part right now even with the limited amounts of vaccine that we have. That's both because of website/system issues, but also because we're not really doing a great job of communicating and reaching out to communities that are most vulnerable and eligible for a shot.


Totesmcgotes7024 karma

I live in Nevada. We’re the second worst state to give vaccinations per 100 ppl. Why do you think that is? What makes us different than other states?

techreview9 karma

Hi! So, we have not specifically looked at Nevada, so I can't speak with total certainty about what's going on there. I did do a quick search for some relevant news (not to be like "let me google that for you" :)) and came up with something that does sound like what we've been hearing:

state leaders say publicly reported vaccine totals typically lag behind reported totals because of the logistical burden of entering each dose into a state vaccine tracking system.

and also this:

"Nevada simply does not have the dollars and monetary resources in order to set up plans like some of the other states do..." he said.

Two major things we've heard are that states were left to their own devices to create their rollout plans, and that states are using all kinds of systems because the one coming from the feds simply wasn't appropriate. My colleagues Karen and Cat wrote about these issues:
(, and then my colleague Tanya wrote about how people are getting around these clunky systems via crowdsourcing:

So, that's not a super specific answer, but we will keep looking at more states individually, and please keep us posted about your experiences trying to navigate this.

RDMvb63 karma

The (maybe not so) simply question is why is this even a complicated question that involves teams of MIT data scientists in the first place? If amazon can get any of thousands of widgets directly to my door step in less than two days, why is it so freaking complicated to give shots in the arm to nurses and old people without royally screwing something up? This just seems like it should be a no brainer process- overnight UPS ship those vaccines with freeze packs to the hospitals and pharmacies and the local people give out shots. Should not be so freaking complicated. Fill out an online form saying who got it and when. This is just another instance of the government getting involved and making everything worse for everyone.

techreview6 karma

Hi! So just to be clear on who's responding here, we are not MIT data scientists. We are a team of journalists at MIT Technology Review that have been reporting on exactly the question that I think you're really asking, which is, why is this complicated?

This story, This is How America Gets Its Vaccines, talks about the entire supply chain of the vaccine: how it goes from manufacturing, the government allocating the vaccine on the national and then state level, shipping the vaccines, and then finally, administering them. There are a lot of moving parts (pun...intended :D) and also challenges in basically every step along the way.

And as to how the government is getting involved and things worse for everyone...well, I don't think the evidence actually supports this.

If anything, most experts agree that if the federal government had taken a stronger lead in the beginning, rather than leaving it to states, that we'd be better off, which have had budget issues for years, and therefore much lower capacity.


Kresnic023 karma

How's Supply Chain handled for vaccines fabricated outside the US?, or more specifically, how are Europe Vaccine exportation Policies affecting the US?

techreview4 karma

How's Supply Chain handled for vaccines fabricated outside the US?, or more specifically, how are Europe Vaccine exportation Policies affecting the US?

Hey Kresnic02, thanks for the question! Each country orders its vaccines directly from the manufacturers, and a lot of countries (including the U.S.) made pre-orders, so it's not really a supply chain issue anymore.

That said, there are limited amounts that the companies can produce, and this did affect the U.S.'s ability to reserve vaccines. For example, the U.S. originally ordered 100 million doses of the Pfizer vaccine, and declined to make additional orders. By the time it reconsidered, the vaccines had already been accounted for by European and other countries.

I wrote about the different strategies that the U.S., UK, and China are taking here, if interested!


rollie823 karma

Thanks for the AMA! Really enjoyed reading your first linked article on the distribution system :)

My question: What went into the decision to handle distribution at the state level? Was this something the federal government just didn't want to deal with, did the states request this method, or was it believed that states were simply better equipped (i.e., understanding local policies, capabilities) to handle their own distribution?

techreview2 karma

Funnily enough, we're asking the same question! If you figure out the answer, please hit me up: cat.ferguson at technologyreview dot com

Onepopcornman3 karma


techreview4 karma

Thanks for your question. With the major caveat that I haven't been able to listen to this podcast episode yet, there's a consensus among public health officials that the outgoing Trump administration did not communicate with the incoming Biden administration regarding vaccine rollout and distribution. Much of that is muddied by transition politics, but there seems to be agreement that had the two administrations communicated more, there would be a smoother rollout and possibly more efficiency than what we are seeing now.

As my colleagues Karen and Cat reported in their piece here (, the Trump administration left vaccine rollout to state discretion, which is why you're seeing different states -- even different counties and cities -- handle the rollout differently. Add the infamously clumsy tech these governments are using and we're seeing how states are scrambling to catch up to demand for the vaccine. Some local groups are trying to fill in the gaps with crowdsourced information (, but that's a patchwork effort as well.

- Tanya

wonderboywilliams7 karma

Much of that is muddied by transition politics, but there seems to be agreement that had the two administrations communicated more, there would be a smoother rollout and possibly more efficiency than what we are seeing now.

You're attempting to be politically neutral with the way you phrased that, but it's not "both sides". The Biden administration wanted the communication, the Trump administration was not cooperating.

techreview5 karma

To be clear: “it’s muddied by transition politics” doesn’t mean “both sides are equally responsible” — just that it’s been harder to pin down precise answers because one side has walked off the stage and has made it a lot harder to understand what happened (or didn't happen.) —Bobbie

like_2_watch2 karma


techreview2 karma

Hi; we haven't looked closely at state-by-state delays, so I can't speak directly to MA (even though of course it'll be interesting to find out, since many of our folks are based there). We've been focused on the overall system. But we _do_ know that some states are doing better than others, and a few factors are unpacked nicely in this article (not by Tech Review)

Things include: simplified hospital systems, rolling out vaccines to independent pharmacies, rethinking what vaccination sites look like, and more.

As for line jumping, we just published an essay by someone who received a vaccine this way:

I realize I'm simply pointing you to more articles and not really answering your question about MA! But we'd like to focus more on individual states, as our reporting continues.

Thank you for asking!


Aandaas2 karma

I'm in New Hampshire and I've already received my first shot. I had very few problems with VAMS until today when they tried to load the system with special "2nd shot" priority shots. It has consistently found schedules and the recent update that I've seen with showing earliest available in the sign up window has been great. Do you think the VAMS issues have been state based or an inherent failing with the system as a whole?

techreview10 karma

People/institutions/states are running into lots of different issues with VAMS. I think most of them are driven by two big problems: 1) The system isn't flexible enough to meet the needs of different jurisdictions and vaccination sites, and 2) the UX doesn't meet the needs of the user base.

The people building this knew it would be used by an older crowd, but still made a product that works best on Chrome and doesn't work at all on Explorer. Plus, 37% of American adults, including 15% of seniors, only access the internet through mobile devices. We've all learned to tolerate janky government sites that suck on mobile, but this is life-or-death for literally millions of people. It's 2021 -- easy-to-navigate websites aren't some unsolved mystery.


chaosbutters2 karma

Has anyone tried vaccine trebuchets yet? We tell people there is free pizza or love music somewhere, then, we load up a trebuchet with weighted syringes of the vaccine and fire once enough people are there.

techreview5 karma

Personally, I think we should use t-shirt canons. Much friendlier.


Username_1232 karma

I just got my second dose and was curious as to why places don’t book the second appointment after getting the first one? When I went I was told an invitation email would be sent out. I got it Saturday (3 days before I was due). Other locations have different methods but it seems like they should just go automatically 3 weeks out and same time slot. Why is it such a pain to schedule?

techreview8 karma

Unfortunately, states have been riddled with bad scheduling software solutions. And the root of that largely comes down to two issues: First, building scheduling software for the pandemic is a pretty novel problem. We've never had to vaccinate so many people so quickly before, and with vaccines that require two doses. So there aren't any existing scheduling software solutions that are fill this niche. This means they need to be built from scratch quickly, which heavily relies on available funding and technical expertise. With the federal government's previous hands-off approach, state governments had to do this all themselves. But they are often underfunded and understaffed, and therefore neither have the money nor expertise to do so. As a result, we have ended up with a whole host of scheduling tools that have really terrible UX or just don't work.


ohhim2 karma

Right now, the two states that seem to be succeeding at getting the most people in their state vaccinated are Alaska and West Virginia, both of which present massive logistical challenges with large rural populations.

What is the secret to their success??

techreview4 karma

Hi! We haven't dug deeply into every state, but we're hoping to keep an eye on this in the future. Meantime, I think this article (not from us at Tech Review) has a good overview of what's going on. It mentions things like how the various layers of state admin are working together, and how having fewer hospital systems makes things easier than having many.

- Lindsay

eqleriq2 karma

So there will be an obvious issue of “proving you’ve been vaccinated” as being resisted as the “elites want to chip us.”

So even if it was attached to a fully opt-in system, wouldn’t laws have to allow for discrimination against those NOT showing proof of vaccination?

People bristle at the thought of it being mandatory, but it at least needs to be legal to disallow access / services otherwise what’s the purpose of being able to prove it?

It is literally opening up medical records to allow for disinclusion based on status. I’m not particularly against that (schools already should only allow vaccinated kids to attend going back decades now) but obviously people will be.

How do you bridge that resistance?

Also: part of the communication challenge is why anyone would willingly share the info to peers of how to sign up if it means deprioritizing themselves or their families. Selfish but understandable

techreview2 karma

Hi - The idea of a technological solution for proving you've been vaccinated is an interesting one, and for a place like the US without a unified medical system, there are a lot of roadblocks. My colleague Cat Ferguson and I wrote a little bit about those here:

The tl;dr is that there are a bunch of players who'd like to make this happen, but they all face similar challenges around getting various data systems to "talk" to each other, while also protecting privacy, while also not requiring you to carry around one be-all-end-all credential on something like a phone (which you could easily lose). It's a work in progress, at the moment, and solutions are springing up (i.e., airlines requiring some kind of proof) but they are not universal in the US.

My colleague Mia Sato learned about the ethics of vaccination proof in a Q&A with Nita Farahany, a leading expert on how technology and bioscience affects society. She suggests that requiring widespread proof of vaccination should not be widespread. At least, she says, "Not yet. Not now." Her whole Q&A is really fascinating, and I'll drop it here in case you're interested in more on this, even though some of what she says is tangential to your question.

Thank you for asking!


Glad_Lengthiness66952 karma

Do you think having different states having different priorities is making the rollout worse? For instance I’m young, but considered high risk, so I would be able to be vaccinated in Pennsylvania, but not in my home state of Michigan. On a similar subject, does not having specific enough (or flexible enough) definitions of who is at a higher risk make distributing the vaccine to those people more difficult? I’m probably high risk, I have the heart function almost as bad as someone with heart failure, but it’s not listed as one of the high risk conditions so it’s not clear what group I’m even in.

Do you think it makes more sense to prioritize high-risk people under 65 or essential workers under 65? That seems to be one of the big difference in different state guidelines and California seems to be getting rid of the group all together and doing everything based on age (I think).

techreview3 karma

I definitely think consistent eligibility standards would make it much easier for everyone involved, but there are political/legal/Constitutional limits on the CDC dictating those standards for states.

Short of a controlled trial, it's really hard for anyone to say the best way to prioritize vaccines for people under 65. We do know 80% of all people who have died from covid were over 65, and 60% were over 75, so that's the clearest priority to me right now. It's also clear that, among younger people, the ones catching and dying of covid are Black and Latinx people working in the food, agriculture, and transportation/logistics industries. So on a gut level (opinions are my own, etc), I think we should be vaccinating people who need to risk exposure, before we vaccinate people who can safely stay home.

I know it's really scary and frustrating to be navigating this clusterfuck, especially if you're at high risk of complications. As I keep reminding myself, the U.S. is not going to be playing this zero-sum game forever. (But, going back to 'consistent standards = consistent messaging,' the wait would be a lot easier if I knew how long it will be until I can meet my niece and hug my mom.)


Checker5552 karma

Why are we using the healthcare system to distribute the vaccine? The healthcare system is completely overwhelmed. Why isn't this a military operation? FEMA? A D-Day plan. I want Humvees rolling through my neighborhood directing me to field tents set up in High School parking lots. We should do this thing Greatest Generation style. Get it all done in the fastest way possible. Could be an incredible opportunity for us to come together behind a national effort and regain some trust in institutions. Why aren't we doing that?

techreview3 karma

Biden did just announce FEMA will be paying states back for National Guard mobilization; most of his other funding goals will require Congressional approval. We've only had a competent president for two weeks, so who knows what will happen -- but the kind of thing you're talking about will work a lot better once we've got enough vaccines to stop haggling a teacher's life for a factory worker's.


load_more_comets1 karma

Wouldn't it be just as simple as having a count of how many vaccines we have vs how many are going out to the different states and when?

techreview3 karma

You'd think so! But not quite.

There have been myriad stumbling blocks in even figuring out how vaccines we have. For one, both the Pfizer and Moderna vaccines use mRNA, a biotechnology that’s never been produced at scale before. So there are a lot of fluctuations in their production, which can make it difficult for the federal and state governments to know how many vaccines will be available, and therefore plan how to distribute them.

For another, there are quite a number of systems that have to be weaved together to track where vaccines are going and when. Fortunately, this has probably been one of the smoother parts of the process. The federal government uses the platform Tiberius, built by Palantir, to integrate a number of data feeds from Pfizer, Moderna, FedEx, UPS, and others to actually understand this question. But then getting that data into other systems is a highly manual process. In order for a state to order the vaccines, they need to use a different system called VTrcKS, and Tiberius doesn't directly communicate with VTrcKS about how many vaccines there are at any given moment. It requires someone at the Department of Health and Human Services to download a file from Tiberius, send it to the CDC, and have a different person at the CDC then upload that file to VTrcKS. Obviously this can introduce data lags and errors.

On top of that, even if you know where your vaccines are going when, it doesn't solve the last-mile delivery step of getting the vaccines into people's arms. It's been a huge mess for states without proper tech solutions to schedule vaccine appointments, track who should get and who already has gotten vaccinated, and which vaccine they've received.

So anyway, yes, it is ultimately about "having a count of how many vaccines we have vs how many are going out to the different states and when"—but it's not so simple.

You can read more about the various challenges in our step by step explanation here:


darrylthedudeWayne1 karma

Hi, I have a question. With there being delays for the rollouts in Canada and knowing how many people need to be vaccinated, How long will it take for things to get back normal or something close to normal?

Thank you have a good day.

techreview2 karma

We would all love to know the answer to this question. 😫 To be honest, no one really knows. But scientists are deeply concerned that if we don't vaccinate people fast enough, it will give the virus more time to mutate, reduce the efficacy of our current vaccines, and prolong the pandemic. So you're right that delays in rollout could affect how long it takes us to get back to normal.


Teddy_Nobs1 karma

With these new "variants" in the virus, that is being categorized from certain countries and which we're being told that it potentially makes the virus more contagious but also a bigger threat. How in the heck can a 1 vaccine be made to protect a virus that's constantly mutating and has a increasing number of "variants" ?

techreview12 karma

We already do this every year for the flu vaccine! There's a ton of research being done right now on updating different covid vaccines to maintain efficacy against different variants. There are huge challenges ahead, but it's definitely not unprecedented. This article goes into a lot more detail, if you're interested.


caveman_chubs1 karma

My wife is a nurse practitioner and I live with my mother in law who is high risk in contracting.

They mentioned that I can fill out some form online to get the vaccine quicker than normal because of these two factors.

Is that bullshit?

techreview2 karma

Haven't heard of this, but it varies widely by jurisdiction. You'll have to check with your local authorities.


StayAnonymous71 karma

If you’re able to comment on state specific issues, why is my state of Kansas dead last (or some days 47th. 48th) in administration? What can we urge the state to do better?

techreview2 karma

Definitely a good question; we have not specifically looked into Kansas yet. There are many, many possible bottlenecks, and because of a lack of coordinated federal response at the outset of the vaccine rollout, states were mostly left to make important decisions about distribution on their own. There are many moving pieces, to this, and a lot of them were outlined in this story written by my colleagues, for a little bit more context:

We'd like to come back to this question if we can. - Lindsay

techreview2 karma

I should also add, West Virginia is so far doing pretty well, and some news articles that breakdown WV's success have some pointers for what other states can do, including partnering with local pharmacies. It's not true, of course, that every strategy can work everywhere, but would be a decent place to start. - Lindsay

Caddlli0 karma

How can the nation address racial and socioeconomic disparities in vaccine distribution? What should be done?

techreview8 karma

America is a hugely diverse country, so we need a lot of diverse solutions, aimed specifically at the people who need vaccines most (elderly people; Black, Latinx, and Indigenous communities; and anyone with a job that requires being in close quarters with other people). It’s important that we think about where people live, what access they have to transportation, and what technology they have available. Putting a mass vaccination site at a stadium way out of town works great if you drive, but not if you rely on the bus (and putting a bunch of people on a bus negates the value of a drive-through site). Rural communities might be best-served by mobile clinics; urban communities might be better served by walk-up sites. To build trust in vaccines, health departments may consider opening clinics at churches and community centers and staffing them with locals who can talk to their vaccine-hesitant neighbors.

Another thing to consider is how not having access to vaccines could further entrench disparities going forward. There are already proposals and plans for “vaccine passports,” which would require a person to show proof of vaccination to travel. And among bioethicists, there are fears that governments could extend this pass system to other aspects of our lives: dining, using public space, getting jobs, keeping jobs, etc. With vaccines being so difficult to get, especially if you’re poor and/or a person of color, you can see how disparities in vaccine rollout could make existing inequities even worse.

Nita Farahany, a professor at Duke University and a leading scholar on technology and bioscience, told me governments need to resist the urge to open things up to people based on their vaccination status—at least until the vaccine is more widely available. (There may be some caveats, like if you’re a healthcare worker.)

“The people who are willing to take the vaccine and who have higher levels of trust or who had earlier access because of wealth, or networks, are the ones who would have first crack at jobs as businesses reopen. … You end up with a much longer-term impact of entrenchment of these inequalities that have arisen as part of the pandemic,” Farahany told me.

—Cat Ferguson and Mia Sato, reporters

sharklasers_email0 karma

Hey, thanks for the AMA.

America seems to be producing vaccines awfully slowly... Why are there only ~30 million doses produced here, while a country without an advanced economy, like India, is able to produce 70 million doses a month and send them out to a bunch of other countries?

techreview1 karma

Hi! This is a good question, and it's somewhat out of the wheelhouse of this _particular_ AMA, although we're answering some similar questions where we can. I've asked my colleagues for some resources, and they've pointed me to news that India is making a different vaccine than the US. These two countries also have very different vaccine plans and capacities just because, of course, there are lots of things that are super different about their supply chains and economies, etc. We hope to write more about India's vaccine rollout, but in the meantime I think this NY Times article is an interesting look at what's happening there.

To read more about how we've compared vaccine rollouts in the past between countries, this one by my colleague Eileen Guo is really informative, although not specifically on India:

And then this Q&A that I did with a bioethicist about global vaccination supply has some interesting thoughts about why countries send bunches of doses out:

I realize you were probably hoping for a more nuanced response, but we're going to have to come back to this one with future reporting. Thank you so much for the question!


coryrenton0 karma

there were articles about how dipping dots ice cream were a good example of the logistics chain already set up to handle storing and distribution of vaccines -- how feasible would it have been to commandeer the existing dipping dots infrastructure?

techreview3 karma

Much as I love Dippin Dots, it's a stretch to say they're set up to handle vaccines -- for one, there are different handling requirements for ice cream blobs and glass vials of vaccine. But you'd also run into the same problems trying to ship Dippin Dots at this scale (even if you fix the dry ice shortages, it's really dangerous to fly too much dry ice on one plane).

Our other big stumbling blocks have been a) making the damn things and b) localized logistics of setting up clinics and getting people to them while maintaining social distancing, aka the "last mile." On that front, since some Dippin Dots freezer models are cold enough to store the mRNA vaccines, they've been in touch with HHS and FEMA about sending freezers to Guam and other U.S. territories.

For anyone curious, here's a link to the PopSci article that first brought this up.


AnxiousAnthrax0 karma

How is your team dealing with the grave issue of needles hurting?

techreview4 karma

Don't worry, this doc's got us covered: