Throughput trumps prioritization

One thing I've been reflecting on a lot as I read about various "theories of vaccination" is the key philosophical distinction between people and their proclivity to think temporally - to make decisions in the present which reflect a belief that the future is both predictable and mutable.

This comes up in a lot of theories of innovation: growing the pie vs slicing the pie, centralized management structures focused on "efficiency" versus artist colonies focused on "creativity," Thiel's "determinate optimism" vs "indeterminate pessimism," focuses on journey versus destination, and whether to emphasize economic growth over economic redistribution.

In this case, we see a fundamental tension between throughput and priority, between efficiency and effectiveness, between theory and data, and between the present and the future.

Like with most dialectics, I suspect there is merit on both sides, but by focusing so heavily on how to most efficiently distribute the vaccine we have now, knowing what we know now, to do the most good, we're missing the point - our goal should be to develop a decision-making framework that engages with an uncertain, but predictable, future in order to do the most good over the next 12 months.

More importantly - good prioritization with low throughput is almost always far worse than high throughput with bad prioritization.

• High-throughput systems can avoid decisions - rather than deciding between two high-priority goals, a high throughput systems can do both.
• High-throughput systems can pivot faster as priorities change - forward momentum is almost always easier to redirect than the inertia of a system at rest.
• High-throughput systems produce more information - because the system is doing more, it has the capacity to learn more quickly. It spends less time in an ivory tower, more time tinkering.
• High-throughput systems are more fun for the participants - every member of a high-throughput system matters and can individually impact the goal of doing more and moving faster. Rather than simply waiting for orders from above, when the system is focused on throughput, every participant can help on the margin.

In other words - when you don't know what to do, doing anything is better than doing nothing, and building a culture of "doing" is far more important than building a culture of "waiting." Maybe people get a few extra shots, maybe we accidentally miss a few second doses, maybe we accidentally give the vaccine to someone who didn't "need it." But vaccinating the population as quickly as possible is the goal, and we should be spending as many of our human, scientific, and financial resources to get that done faster, even if that introduces some randomness and inefficiency along the way.