Brief # 95 Health Policy

Our Decentralized Health System Creates Vaccine Rollout Challenges

By Erin McNemar

February 11, 2021


Confusion. Disorganization. Decentralization. All across the country, states are struggling with the vaccination process. From deciding who should be a priority to simply not having enough vaccines, many states are facing criticism for what seems like a failure to plan. These issues are due to the decentralized health system present in the United States.

According to the World Health Organization, “Health systems decentralization involves moving decision making away from centralized control and closer to the users of health services. Many countries have embarked on a process to decentralize their health systems as a means to improve their responsiveness and performance.”


While this idea of allowing the people that are affected and impacted to make decisions seems just, it has proven to be problematic when facing the current pandemic. Due to the decentralized approach in the United States, the nation is trailing behind other countries in terms of the vaccination process. According to the University of Oxford, the United KIngdom’s centralized health system has been able to vaccinate 13.7 percent of the population compared to the United State’s 7.8 percent.

Part of this major issue is lack of preparation. According to CNN, in the final weeks of his administration former President Trump did little to nothing to develop a plan to distribute vaccines to states; even after vaccines were approved to be administered. When President Biden came into office, his team claimed that they had to work on developing a plan from scratch; which is also prolonging  the process.

The frustrating  vaccination process comes down to a lack of organization stemming from the federal level. Rather than creating a comprehensive plan that all states are required to follow, each state is responsible for coming up with their own plan for vaccinations. Governors have to ask, how will the vaccines be distributed? What groups of people should be prioritized? How will individuals register to get the vaccine? While these decisions are happening on a state-by-state basis in the United States, countries with centralized health systems are able to move quicker.

These countries only have to come up with one vaccination rollout plan. There isn’t a battle for resources and those disrupting the vaccine are able to focus on administering it to as many people as possible; rather than worrying about the politics of the situation. Additionally, the decentralized approach can create issues among the total percentage of individuals vaccinated across the nation. For example, if West Virginia is effectively vaccinating their population but Massachusetts is struggling, it’s not going to be beneficial to the country as a whole in stopping the spread.

While a decentralized health system has benefits in everyday life, addressing a pandemic response requires a more centralized approach. Evidence shows that with unified planning coming from a federal level, more vaccines would be efficiently distributed to the public. After a rocky start to the vaccine rollout process, it could be several months until the vaccine hits the general public and even longer until we see life begin to return to normal.

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