The Strange Case of The Amarillo Option

How did COVID vaccine availability information remain so asymmetric for so long?

In mid-January 2021, at the height of the COVID-19 vaccination craze in Texas, it was impossible to get jabbed. The website for vaccine scheduling in my area was hastily built, crashed constantly, and was flooded with traffic; it took 30 seconds to serve you a response on a good day, and actual appointments basically didn't exist.

The same was true in other jurisdictions near me: Houston, Dallas, San Antonio. Each received between 12,000 and 25,000 vaccines per week in those days, equating to a tiny 0.5% of the metro area's population at best. Everyone I know was trying to get a vaccine slot for themselves or their parents, to no avail. There were also a lot of scams; at one point, around half a dozen people I know, myself included, fell for a fake signup form likely designed to steal personal information. The few people I knew who got actual appointments were doctors or had some doctors in the family, which didn't garner them any good will.

The one glaring exception was Amarillo, Texas.

Amarillo is a small city in the Texas panhandle of the sort that most people forget about. Its population hovers around 200,000, a tenth the size of Austin. It's a conservative-leaning desert town, those with wealth mostly got it from oil and gas, and it's hundreds of miles from the nearest major city (Oklahoma City). Like neighboring Lubbock, it was also hit quite hard by the pandemic due to its relatively aging population: by November 2020, a third of positive cases (34.7%) were hospitalized even before the subsequent winter spike. In an area without much infrastructure, this hospitalization rate is a big deal.

Consequently, when vaccines became available an outsize portion of them were diverted to Amarillo and other panhandle towns. At the relevant time (January) when I was desperate for my own vaccine appointment and looking at vaccine distribution stats, Amarillo was receiving 6,000 first doses of Moderna per week.

Wait, what? Relative to population, that's five times more than the more populous Texas cities. Throughout this time, the vaccine allocation was handled centrally by the Texas Department of State Health Services (DSHS). It's not like hospitals in other cities weren't overwhelmed—how did they justify this?

As far as I can tell, nobody talked about it. Nobody really talked about it even though, as I came to learn, the city of Amarillo was actually overwhelmed with its own vaccine supply and was desperate to use it. Either they stopped scheduling appointments after a couple weeks, or they never did, opting instead to accept walk-ins without proof of residency either of the city or the state. I called their health department on the 26th of January and asked about availability; they told me it was a "slow week", which they explained to mean they had no expectation of running out of vaccines before their next shipment.

That evening, my girlfriend and I (both eligible under 1B and, given my girlfriend is a schoolteacher with a preexisting condition, quite concerned for our health) set out on the 9-hour drive from Austin to Amarillo. We arrived at around 2:00a on the 27th, slept for around five hours, and got in line outside the civic center at 7:45a. Two hours-later, we were given our first dose and given a time frame (not an appointment, but a three-week time-frame) to come back for our second doses.

Some highlights:

  1. At the door, they briefly asked if we were eligible—we both said yes, which was truthful, but they asked for no verification and didn't even wait for me to explain how I was eligible. It was very casual.

  2. When we got to the front of the line and met with our nurse, she told us that they were seeing people driving to Amarillo from as far as Seattle (an over-1,700 mile drive) to get vaccinated.

  3. Just before our departure, a member of the staff expressed concern that they had a surplus of vaccines and asked us to please find more people to refer to Amarillo for their doses.

The latter two points on this list floored me. Amarillo was (is?) the one place in the US with a legitimate surplus of vaccines, and they were having trouble performing the outreach needed to use them. This was in late January 2021, when millions of people were desperate to get a vaccine as quickly as possible and actively searching for options.

Simply: this is a massive case of asymmetric information at a time when people across the country are desperate for this information. This is unfortunate, and also highly curious: exactly how has this information remained so asymmetric for so long?

I have some preliminary thoughts.

The internet is terrible at differentiating true information from conspiracy

When I first heard about the possibility of going to Amarillo for a vaccine, it was from a tweet. The tweet in question was from a new user with barely any activity on the platform and no profile picture. Naturally I looked for other sources. After perhaps another hour I found the correct website, amarilloalerts.com. Subsequent sources were Facebook posts, with which I found a drive-in clinic occurring in Dalhart, Texas, a tiny community even farther away from Austin than Amarillo is, various further scams, and a curious link from Curative for what turned out to be a phase 1A-only (meaning healthcare workers only) vaccination drive in Dallas.

This is not a part of the internet with all that much legitimacy. How does one accurately determine what is true? For my part, I gave up and eventually decided to call the public health authority, but even on that front I was careful. The genuine number, it turned out, had no automated message and no receptionist. Instead you were just immediately put on the phone with whichever member of their public health department happened to be near the phone that day. Having been burned by previous elaborate vaccine scams, I didn't trust the call connected me to the right place either until I triple-checked that the number was correct and called back a few extra times to ask for more details.

A central question: why was this so hard?

I believe the answer is that it's a consequence of decentralization in the US government. Every city, county and state was required to put together their own waitlist, their own signup page and a tech stack to match. There was no good way to communicate to the public where they should sign up, or where they might have the option to go, because each public health authority was only able to point their meager outreach resources to their own community. Outside one's own community, what was happening in Amarillo was indistinguishable from noise.

Contrarily, had there been a widely-adopted national vaccine website, availability in various different regions would've been clear, and people would've been able to make informed choices about where to go.

To be sure, nine hours is a long way to drive—to say nothing of whoever drove from Seattle—so I'm sure a certain proportion of people would always be "priced out" of the Amarillo option due to their unwillingness or inability to drive so far. But, per the direct request of their health department, I evangelized about this like nothing else: I referred every eligible person I know to Amarillo, and most of them (perhaps two dozen people, or around 2/3 of them, of various ages and health conditions) did the drive. Most of those lived in Austin or Houston, and starting in Houston adds another three hours to the timetable!

So I'm led to the conclusion that the internet was flooded with useless drivel about the vaccines so severely that the actual effective option escaped notice. I reached out to friends in other states like California, New York, and Michigan; no one knew of something comparable to this happening in their state. It's possible there were other pockets of surplus elsewhere, but just as it was so difficult for me, a Texan, to learn of the Amarillo option, I'm not convinced it's realistic for the average Washingtonian to learn of a hypothetical Spokane option or whatever—and if they did, it would be flooded with people from all over the region and the option would quickly go away.

Or... would it?

The press is too busy fear-mongering to report helpful information

There are articles about this sometimes, but none from the New York Times. None from the Texas Tribune. None from a commonly-read state- or national-level publication. And there were zero back in January outside the Amarillo and Lubbock local news orbits. Articles that do exist sometimes try to implicitly argue there is something immoral about giving vaccine doses from one state to the people in another. I didn't realize that human lives in one state were worth more than lives in another, but whatever.

As everyone is surely aware, there is no shortage of useless attention-grabbing headlines about how we will supposedly never get out of lockdown, or how variants will ruin our lives, or how the vaccines aren't as effective as we think. All this is vacuous. The vaccines are all extremely effective, even against variants, to the point where they are miracles. After vaccinating the most vulnerable part of the population, COVID risk is or will soon decline below flu risk for most people. And let's not forget the time that the Daily Mail reported we might have to wait 16 years for a vaccine in the first place! Sometimes the pessimists are wrong.

Lost amidst all this is the actual useful information that the press could report, like where the extra vaccines are and how to get them. If getting out of the pandemic is such a big deal, perhaps they should disseminate the information that would actually make the greatest impact, like where doses are going to waste? I don't know whether Amarillo's health department had to actually throw any doses away, but when I spoke to them they were very nervous that they'd have to soon, and that was months ago, so I'm not sure.

No doubt some reporters did try to talk about this. But it never made it into the ubiquitous national news cycle where it would've been useful—not enough room for it in the face of scaring people into locking down for as much of the next decade as possible, arguing masks should never go away, etc.

In short: because there was no obstacle other than distance for anyone in the country to use the Amarillo option, and because vaccine availability among vulnerable groups was (and in some places, remains) so low that the Amarillo option reduces deaths, the fourth estate had a responsibility to report on it as widely as possible. They didn't do this. The national news orbit is probably the only remaining way that information enters the universal cultural zeitgeist—as discussed above, the internet can't do it organically—but they're wasting it!

This is an asymmetric information problem. Some people like myself did hear about the Amarillo option and acted on it. Some people, through no fault of their own, didn't. So there is some arbitrary subgroup of people who had an advantage toward the goal of getting jabbed, which is a shame.

Getting jabbed as entry into an exclusive club

Another curious effect: some (at least three, or at least 1/12) of the people I told about the Amarillo option said they advised their families not to tell anyone or the surplus there might go away. This is a serious moral failure. Again, our shared goal here is getting society vaccinated as quickly as possible, so the surplus in Amarillo going away is obviously a good thing. I can maybe understand someone waiting to tell people until they have been vaccinated themselves, but surely after one has taken care of them and their own, one can turn their attention to helping their neighbor?

Straining myself, one argument for hoarding the information might be:

  • (a) The Amarillo option allows anyone in the country to get vaccinated if they truly need it;

  • (b) Most parts of the country don't have enough vaccines, or have bizarre waitlists that favor young people familiar with technology; therefore

  • (c) The Amarillo option should be preserved.

This seems clearly fallacious to me because overall vaccine supply is not a function of how many people exercise the Amarillo option, and if Amarillo has too much of a surplus, they'll throw vaccines away. Therefore we have fewer net vaccines. If you share the information, people make informed choices about whether to go there or not, but either the same or more people will definitely go, meaning you've helped the vaccination process along. Plus, obviously, the Amarillo option won't be relevant forever as vaccine supply massively improves in the coming weeks.

Still, it makes me sad that some chose to take the knowledge I freely gave to them and respond by withholding the same knowledge from others. I will be fascinated and disappointed by the psychology of this for a long time.