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COVID and Biden's test kit challenge – it's not too late to learn from Operation Warp Speed

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When in the context of the COVID test kit challenge President Biden uttered the phrase last week, “There is no federal solution. This gets solved at the state level,” he did so as an admission of failure. If the Operation Warp Speed team had uttered the same phrase in the summer of 2020, it would have done so as a precondition for success 

The ideological differences between the Trump and Biden administrations stand in stark contrast, which is why we distributed millions of safe and effective vaccines flawlessly to tens of thousands of locations 24 hours after their authorization by the FDA in December 2020, and why the current administration has not even signed a contract for the at-home testing kits yet, close to two weeks after it announced the program. 

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We signed contracts on July 22, 2020, (Pfizer) and Aug. 11, 2020, (Moderna and J&J) many months before their clinical trials had been completed. We did this because we knew the most challenging aspect of getting vaccines to the American people as quickly as possible would be manufacturing them at scale. This is precisely the issue the Biden folks are struggling with today.

The Operation Warp Speed team intentionally limited the federal government’s role by adhering to two key principles. First, the federal government should never perform any activity the private sector could perform better and, second, never let the federal government’s “reach exceed its grasp.” We ENABLED success, but the private sector and local public health jurisdictions DELIVERED that success.

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Coming back to the current COVID testing challenge, there are five glaring shortcomings to the Biden team’s approach. The first two are already evident. Delivering 500 million test kits “sometime in January” is the definition of too little too late. The omicron variant’s spread will likely have peaked by then and several public health experts such as Dr. Brett Giroir, have asserted we would need at least 1 billion per month to meet demand. 

There are three additional, yet equally serious, shortcomings associated with the Biden plan: 1) the likelihood that relatively few of the at-home test results will ever be reported to the public health authorities; 2) that even at ratings of 98-99% sensitivity and specificity (both measures of test result accuracy), the at-home tests administered to a high number of asymptomatic persons are likely to produce millions of false positive and false negative test results; and 3) a program granting test kit access to anyone desiring one through a federal government website will surely divert valuable resources away from those for whom the test kits should be prioritized (e.g., “test and stay” programs to keep kids in school).

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The current administration cannot turn back time as much as it wishes it could, so we are very likely to be facing test kit supply-demand imbalances for several weeks. But there are a number of ways to avoid exacerbating an already bad situation: 

First, when vaccine dose supply could not meet demand during the first few weeks of distribution in late 2020, we made weekly allocations to each of the 64 public health jurisdictions (i.e., governors, mayors, territory leaders) and let them determine who would be prioritized for vaccination within those jurisdictions. 

Some jurisdictions chose front-line health care workers, some chose teachers, and some chose nursing homes. We acknowledged the fact that these local leaders understood better than we could from Washington, D.C., how to best impact the pandemic in their respective jurisdictions. Our allocations were made proportionately based on the population of each jurisdiction. Not a perfect system, but an equitable one. 
 
Second, the vaccine distribution software system developed by Palantir has over 50,000 distribution sites in it to include virtually every retail CVS and Walgreens pharmacy site in the country, sites from 17 other grocery and pharmacy chains such as Walmart, every hospital, thousands of community health centers, and many other care provider locations. 

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This system could very likely be adapted to distribute home testing kits within days. Why not use these as key points of controlled distribution rather than letting any American household to order at will? 

The governors told us how much of their allocations they wanted delivered to each of these sites and we did it within 24 hours. They established priorities for who should be first in line and the retail outlets adhered to these priorities.

Whether intentional or not, President Biden may have finally acknowledged what the Operation Warp Speed knew all along. The government that governs least, governs best. 

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To that point, Operation Warp Speed’s role was clear: assume the financial risks the private sector finds prohibitive in order to manufacture at scale before demand exceeds supply, avoid engaging in any activity the private sector can perform better (e.g., in all cases avoid an in-house developed, one-size fits all federal government website for test kit distribution), and let those local leaders who best understand their respective public health jurisdictions make decisions about priorities when supply is constrained. 

Let’s hope the Biden administration can embrace this less authoritarian, more effective role. And quickly.

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