A modest proposal to fix Washington’s unbearably confusing vaccine phases

If you’re anything like me, you’ve probably looked at Washington’s roadmap for vaccine phases and wondered what cruel designer wove together the veritable labyrinth of phases, tiers, sub-tiers, and sub-tiers for those sub-tiers.

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As it stands right now, this is how the state is deciding who gets vaccinated when in Washington:

• Phase 1A, Tier 1 (Dec. 2020 – present): High-risk health care workers and first responders
• Phase 1A, Tier 2 (also Dec. 2020 – present): Long term care facility residents, other workers in health care settings
• Phase 1B, Tier 1 (also, also Dec. 2020 to present): Everyone over the age of 65, over 50 in multi-generational households, school staff and educators, and child care providers
• Phase 1B, Tier 2 (March 17): High risk workers in congregate settings, people over 16 who or pregnant or have a disability that puts them at risk for severe illness
• Phase 1B, Tier 3, Part 1 (estimated April 12): People over the age of 50 with two or more co-morbidities or underlying conditions
• Phase 1B, Tier 3, Part 2 (estimated April 26): People over the age of 16 with two or more co-morbidities or underlying conditions
• Phase 1B, Tier 4 (also estimated April 26): People, staff, and volunteers in congregate living settings
• Phases 2, 3, and 4: Coming soon

Pretty simple, right? All you have to do is figure out if you’re in Phase 1. If the answer is “yes,” then all you need to know is whether you’re in Phase 1A or Phase 1B. Once you do that, all that’s left is determining what tier of Phase 1A or Phase 1B you’re in, unless you’re in Phase 1B, Tier 3, in which case you need to know whether you’re in Part 1 or Part 2. Is your head spinning yet?

Now, before I continue, let me clarify that I have the utmost respect for the Washington State Department of Health and its team of doctors, modelers, researchers, and everything in between. Given that the state boasts some of the lowest rates of deaths and cases in the country over the course of the entire pandemic, I think it’s safe to say the department has done a stellar job given the hand it was dealt.

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And in some ways, I really can understand how these phases and tiers got out of hand quickly. That’s abundantly clear based on the reasoning the DOH gave me when I asked why they designed the vaccine roadmap the way they did:

The framework for DOH’s vaccine phases plan was created to include four phases of vaccine eligibility. It’s important vaccine is distributed in an equitable way to those who are at highest risk. As data was collected and the state learned more about COVID-19, the plan was expanded to include tiers inside the phases. This approach helped ensure we did not create countless phases, while still putting those most at risk in early tiers, such as long-term care residents, high-risk health care workers and first responders, people age 65 and older, and more.

Or put more simply, the state had its heart set on four phases, and a near-constant stream of new data caused them to subdivide, and subdivide, and subdivide, until eventually we were left with something that makes the Gordian knot look like a straight piece of rope.

But if the goal really was to avoid a complicated, ever-escalating system of vaccine phases, why do it this way? Why have four separate tiers for Phase 1B? Why have “Part 2” of Tier 3 of 1B open up on the same day as the next tier, when you could just group them together?

It’s hard not to feel like every single decision that led to one phase being divided into seven separate stages was made for the express purpose of making this process as complicated and convoluted as humanly possible. And that’s all without figuring for the fact that we haven’t even gotten to Phase 2 yet.

Given that, I have a simple proposal:

Six phases. That’s it. And yes, a couple sub-divisions because sometimes we will need to break out a phase into more than one stage — on that point, the DOH is correct. But there are better, simpler ways to mitigate against that without turning a single phase into a vaccine turducken.

If we get to “Phase 6” and we need an additional three stages like the DOH predicts we will, it’s still easy: Phase 6A, Phase 6B, Phase 6C. No additional sub-tiers, just on to the next letter until we’re finished putting doses in arms.

The end result is that we get exactly two more phases than the DOH originally planned for. Then that way, when someone asks you what phase you’re in, you won’t have to answer that question with a series of red yarn lines on a corkboard.

Questions, comments, or feedback? Follow Nick Bowman on Twitter at @NickNorthwest to weigh in, or reach him by email at nbowman@bonneville.com.

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