We are seeing our state governments doing a poor job -- yes a very poor job --distributing the vaccine.  You can take this as evidence for various theories of bureaucratic dysfunctionality and it is.  But still at the end of the day, always ask about the cross-sectional variation!

Virginia runs prisons, schools, maintains roads, has a Medicaid program, and various state-level functions, such as hiring staff for the governor, some of those in conjunction with other levels of government.  Maybe those services are not productivity marvels, but they work OK -- I've lived here for a long time.  So why the differences?  Here are a few hypotheses, not all of which need be true:

1. Learning curves are steep.  Most of what governments do is just terrible at the beginning, but eventually there is learning and improvement.  What is different here is simply the hurry.

2. Interest groups make everything run. It is clear who benefits from state-level Medicaid programs, and those constituencies keep the programs on track.  In contrast, the beneficiaries from rapid Covid vaccination are quite diffuse and are not represented by strong, exclusive organizations.

3. Too many layers of government (and society) are involved.  The states are waiting for the local public health authorities, who are waiting for the counties, who are waiting for the Feds, and so on.  The private sector is involved too, through CVS and the like.  No one is picking up the ball and running with it.  No one was told who moves first.  In contrast, the lines of responsbility for running roads, schools, and the like are fairly clear.

4. The real problem is the citizenry.  The lines to get these vaccines for the 1A group are not long.  Government made one mistake of assuming the first round of take-up would be rapid, but the real problem is the sluggishness of the demanders. And things will be OK once we get past the 1A group and open up distribution more broadly.

5. Logistics mentality is lacking.  Our state governments have specialized in Medicaid, while contracting our schools to the localities and road construction and repair to the private sector.  There is perhaps not a strong enough core of logistic expertise and logistics culture in most state governments.

What else?  And what are the relative weights on the truth of these hypotheses?  To what extent can we use these and other hypotheses to explain cross-sectional variation across the states?  Why are West Virginia and the Dakotas doing relatively well in vaccine distribution so far, when those are not typically considered the most effective state governments?

Again, always ask about the cross-sectional variation!