I do agree that healthcare industry incentives are super backward and the way that contracts are rewarded is inefficient and borderline corrupt, but I do flinch whenever I read a story about a lone developer building their own version of a public utility. It gives me flashbacks to when every data scientist was publishing their own covid dashboard last year. It sounds like in this particular case, the dev did reach out to the state gov which is a good start but the cynic in me does wonder whether building a new layer on top of a broken system doesn't open up more confusion in the future. https://xkcd.com/927/

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This is a great piece Vicki. Despite the apparent different incentives, the system in the UK works in a very similar way. In fairness, vaccine appointments have been handled reasonably well. But in general the same problems apply. Difference here is that a lone individual would never be allowed to launch a system in the way Olivia did. It would be stamped and never see the light of day. (Full disclosure: I used to be a consulting partner in a big 4 firm - lots of powerpoint and bullshit in my own cv.)

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Feb 11, 2021Liked by Vicki Boykis

I hope you caught this excellent entry: Fork the Government on NPR back in December: https://www.npr.org/2020/12/23/949764249/fork-the-government

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While infuriating, I think it's important to put a few things in perspective.

The US has thus far administered 70% of current vaccine supply. The remaining 30% is not really a fair metric, as some of that represents doses that are still going through each state's supply chain/may be in transit/etc. Some states, NY for example, appear to be perpetually getting much of their weekly shipments at the *end* of the week, which would seem to inflate the denominator. Our appointment system is a mess, but there isn't conclusive evidence that it is meaningfully reducing the number of shots administered, and that stories of shots wasted are noteworthy enough that they usually seem to end up on the national news is a reassuring thing.

It seems that December and the first two weeks of January, the problem was more distribution than supply. Now the limiting factor on shots is more a supply issue than a distribution one. I remember when only about 3-4 weeks ago much of the medical establishment argued that we shouldn't even talk about taking regulatory steps to help with supply and "first doses first" because our distribution utilization was so low. I don't see any of them coming back to reopen the discussion now.

The distributional effects are more concerning, as the system seems clearly designed to favor the moderately more computer savvy boomers over the 80+, the affluent over the poor, etc. States have been taking decisive steps to combat this, in many cases opening centers open only to residents of a particular zipcode or community. These centers often have availability long after other sites are booked. And if the boomers have greater mobility/contacts, the incremental public health benefit may be comparable.

All this is likely/hopefully moot in that it is hard to project any reasonable production scenario that does not result in the US awash in vaccine in the next couple of months, and the situation is improving each week. A month ago, when appointments first opened in our state to >65, my friends marvelled that my parents had gotten appointments. Now the majority of >65's we know have gotten appointments and the state is opening to the next priority group. Amazingly, the expansion to >65 seemingly only happened because of pressure from the prior HHS secretary who urged states to do so the day before the announcement as I recall.

I remember what it was like during the 2009 swine flu. For a short while getting a shot was not easy. Within a couple of months supply was no longer an issue. A year later, the US destroyed 71 million unused vaccines.

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Great article, Vicki. The healthcare system (and many others) has been infused with big companies that are not the optimal organizations to provide the best service or ideas. The small and medium sized companies require a boost to compete with the Big 4 and others. Like you mentioned, putting together an optimal RFP can be a time-consuming enterprise of sifting through hundreds, maybe thousands of opportunities. Then when you find the opportunity that is right for your company, writing the RFP can be daunting. Whether in the healthcare industry or any other, a seasoned and dedicated RFP research team understands precisely how to use technology and the human-touch to provide clients (especially small and medium-sized) with the competitive edge to greater victory. https://www.optimalthinking.com/business-writing-services/find-government-rfp-bids/

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