--:-- Sean Rameswaram: Support for Today Explained comes from BetterHelp. Let me tell you a true story. Last weekend, I got an email from a listener who wanted to discuss their problems with me. And I said, look, I don't think that this is about me personally. At least I hope it's not. Why don't you try BetterHelp.com slash Explained? Absolute truth. As the largest online therapy provider in the world, BetterHelp can provide access to mental health professionals with a diverse variety of expertise. Find the one with BetterHelp. The one is not me, guys. Our listeners get 10% off their first month at BetterHelp.com slash explain. That's BetterHelp.com slash explained.
--:-- Sean Rameswaram: We talk a lot about vaccines on the show. Lately, we've talked mostly about how lots of Americans are refusing to get them and how at this point you can basically walk into any vaccination site in the country and they'll just give you one. But remember when a vaccine was like a golden ticket? Remember when all people talked about was their appointment or their anticipation of their appointment or which shot they were going to get and what that meant? Today's episode is set during that bygone era in Philadelphia, a city that is near and dear to our hearts here at Today Explained.
--:-- Sean Rameswaram: This past winter, Philadelphia entrusted its first vaccine clinics to a nine-month-old organization run by a 22-year-old graduate student with no healthcare experience. I'm going to say that again. The city of Philadelphia entrusted its first vaccine clinics to a nine-month-old organization run by a 22-year-old grad student with no healthcare experience. Nina Feldman has been covering the story for WHYY Public Radio in Philadelphia. Nina, where does this story begin?
--:-- Nina Feldman: Well, it actually starts a couple of months before those clinics first opened when the vaccine became available. Back in the summer of 2020, when the vaccines were still a few months off and what we were really focused on was testing. And back then, this startup group called Philly Fighting COVID had launched testing sites to really fill a need that the city was struggling to fill. It was kind of hard at the time, if you remember, to find testing that was free, that you didn't need a doctor's note for, and that maybe you didn't need symptoms for.
--:-- Nina Feldman: So these kids, college students, got together and launched a testing site that, you know, was easy and accessible. College students. I mean, that sounds exceptional. Yep. And the whole thing was the brainchild of this guy, Andre DeRoshan. He was 22 years old, like he said. He was a graduate student in the psychology program at Drexel University in Philadelphia. And at this point, he was a leader. He was pulling together pre-med students who were looking for a way to help in the pandemic, and there weren't really a lot of options for that.
--:-- Nina Feldman: It was almost like a ticket into schools or a ticket into jobs and stuff like that. Like, if you told them you worked, volunteered there, people would be like, oh, my God, that's amazing. Like, you're a hero, like, all that stuff. You know, Andre had kind of this, like, startup vibe as a boss. He was fun. He was laid back. He wasn't, you know, some hospital administrator. He was a cool guy.
--:-- Nina Feldman: But I remember he didn't pay me. He just gave me a candle of vodka. And I was like, this is lit. Like, I'd come home and be like, guys, look what I got from work. Guy running COVID testing sites is handing out handles of vodka to his employees instead of paying them money. Red flag for sure.
--:-- Sean Rameswaram: Is that how you came to report on this guy, Andre?
--:-- Nina Feldman: Well, I first heard about Philly fighting COVID and Andre a couple months later. It was January of 2021, and the first vaccines had just arrived in Philadelphia. And the city announced that it was working with Philly Fighting COVID to launch the city's first mass vaccination clinic for healthcare workers.
--:-- Sean Rameswaram: So this organization run by young adults will be handling Philly's first vaccination center?
--:-- Nina Feldman: That's right. And I was a little surprised by that. I mean, I have been covering the pandemic since it started and I had vaguely heard of these guys. I mean, I knew that they were operating a testing site, But it did surprise me that, you know, Philly is an eds and meds town. It's a place that is known for its reputable, you know, hospital systems attached to universities.
--:-- Sean Rameswaram: But you know what? I figured it must be a bigger operation than I realized. I'll suspend judgment at this point. But then things started to get a little bit weird.
--:-- Sean Rameswaram: First, I want to thank the Philadelphia Department of Public Health and Philly Fighting COVID for organizing this clinic. Andre gets up on stage at this press kickoff event to, you know, launch the partnership, launch the vaccine clinic. And there are just all these little signals of the way he's talking about this that just doesn't quite seem normal.
--:-- Sean Rameswaram: What you see here is the problem that we've been solving for six months. This is the problem of vaccinating an entire population of people on a scale that has never been seen before in the history of our species. Epic stuff.
--:-- Sean Rameswaram: And there were a few sort of discrepancies with the numbers that he offered, too. Just things that he claimed were true, that I knew were wrong. And they just kind of set off my antenna.
--:-- Sean Rameswaram: So after the press conference, I found Andre. He was standing outside the clinic area with his giant English bulldog, Winston.
--:-- Sean Rameswaram: Oh, he's our head of security. Sorry, his security badge. He goes everywhere with me.
--:-- Sean Rameswaram: I told him I had some questions about costs. Curious about how much it costs to run an event like this per day.
--:-- Sean Rameswaram: I can't actually tell you those specifics. But I can tell you it's a really nice Mercedes.
--:-- Sean Rameswarm: What?
--:-- Sean Rameswaram: And I just had never had anybody answer a question about what I assumed to be a city-funded operation like that before. And so, you know, I pet his bulldog and I packed up my gear and I went home and started poking around.
--:-- Sean Rameswaram: Andre presented himself as sort of a wunderkind. You know, his resume listed him as an entrepreneur, a philanthropist, the director of something called the Rancho Mirage Film Department.
--:-- Sean Rameswaram: But when we started to kind of peel back the surface, none of it really added up.
--:-- Sean Rameswaram: It turned out the videos from the Rancho Mirage Film Department were all on YouTube, and they were made by Andre as a high schooler.
--:-- Sean Rameswaram: Ah, I've heard of you. You're that Marine.
--:-- Sean Rameswaram: Yeah. And I came here for answers.
--:-- Sean Rameswaram: Okay, Nina, how did the city of Philadelphia let this happen? How did it hand over testing and then vaccination to a 22-year-old grad student with a big fancy dog and little to no experience?
--:-- Nina Feldman: Our first instinct in trying to answer that question was to look for a, you know, smoking gun in a pay-to-play scheme. Philadelphia is no stranger to corruption. And we thought it was really possible that there might be somebody in city government who had put this kid on the fast track to vaccines in hopes of getting a kickback later on.
--:-- Sean Rameswaram: So we spent some time looking into that, and it really didn't look like the evidence was there for it.
--:-- Nina Feldman: You know, people wanted to help him, but it was only because they wanted to get Philadelphia vaccinated. I mean, that's a reasonable cause by any measure.
--:-- Sean Rameswaram: So when we really dug into it, while it was a slightly less exciting explanation, what we found is that this happened because of a perfect storm of kind of leadership failures and underfunding of public health.
--:-- Nina Feldman: So the leadership failures came on a number of levels. The commissioner of Philadelphia's health department was found later in an inspector general's report to be deeply disconnected from the decisions being made that slowly elevated this group to power.
--:-- Sean Rameswaram: I don't know when the first conversations were about having them manage vaccination clinics. So that was some of it.
--:-- Nina Feldman: I cannot provide that information today. I want to know as much as you do.
--:-- Sean Rameswaram: But I think you also have to look at like the bigger picture which is that there was a system where somebody whether it was the health commissioner or somebody he delegated to was making these sort of split second decisions in the pressure cooker of a crisis like this to begin with.
--:-- Sean Rameswaram: And the way you get there, the way you get to a situation like that is from chronic underfunding of public health.
--:-- Sean Rameswaram: How could Philadelphia underfund vaccinations? I mean, it's like a big blue major American metropolis. Right. I mean, the city knew that vaccines were coming for months. Why didn't they have a distribution plan earlier on?
--:-- Nina Feldman: The answer to that is a nationwide problem. Public health departments across the country have been systematically underfunded for the past decade. Since 2010, per-person spending for state health departments dropped by 16 percent, and for local health departments by 18 percent.
--:-- Sean Rameswaram: What that means is that even when these big influxes of cash come during a national emergency or something like that, if the capacity isn't there in the department to be able to use that funding in a helpful way, you have to outsource because you don't have enough people. You don't have enough staff.
--:-- Sean Rameswaram: What public health advocates say is that what you need to really prepare for a crisis is you need consistent, sustainable public funding for public health departments. It's like learning how to be a flight attendant and doing the drills for the crashes.
--:-- Sean Rameswaram: I talked to the University of Pennsylvania public health researcher, Alison Buttenheim, and she made this comparison to the airline industry. Like, you want your flight attendants to have practiced an emergency before they get on the plane, and we should expect the same of public health.
--:-- Sean Rameswaram: You know, the reason flight attendants and flight crews get us through those things is they've, like, literally walked through it. They have muscle memory, and they have, you know, very clear cues that remind them, like, I do this, this, and this now, even though my brain is like, you know, firing crazy stuff.
--:-- Sean Rameswaram: We have to practice public health emergencies and our responses to them. Or we'll be slow and we'll be biased in the response.
--:-- Sean Rameswaram: Even so, this is a city with a bunch of reputable universities. Could they really not have done better than this 22-year-old Andre DeRoshan?
--:-- Nina Feldman: Yeah, and a lot of the volunteers and community advocates that we talked to on the ground who had partnered with Philly Fighting COVID to do testing and who were really relying on them to provide services felt really burned that the city made that decision.
--:-- Sean Rameswaram: I mean, they trusted that the city picked Philly Fighting COVID because they were the best option. And so they got into bed with them because they figured they were reliable. It just seemed like a great fit.
--:-- Sean Rameswaram: In retrospect, there were things that I missed, but they said all the right things. We talked to one community advocate, Syria Rivera. She works with a community center in a mostly Puerto Rican neighborhood in Philadelphia.
--:-- Nina Feldman: And, you know, she described how she felt like Philly Fighting COVID said all the right things to her organization to try to help. But then they were unreliable. They didn't show up half the time.
--:-- Sean Rameswaram: Five minutes before they were supposed to be here, I get a message like, sorry, we can't make it today. That was it. That was the conversation.
--:-- Nina Feldman: She really felt like they were using her group to be able to say, oh, we partnered with communities of color. We, you know, did all the right things. You should pick us to be the vaccine provider.
--:-- Sean Rameswaram: And they got this opportunity, you know, on the backs of her community. They used our logo, basically our name and the relationship we've built with their community to say, yeah, we did that, but they didn't do anything.
--:-- Sean Rameswaram: And, you know, it's people like Syria that have had to do the work of rebuilding that trust with Black and Latino communities across Philadelphia.
--:-- Sean Rameswaram: You know, Andre is not doing that work. The health commissioner resigned. He's not doing that work.
--:-- Sean Rameswaram: So it's the people in these community groups who are doing the work of rebuilding that trust, even though they were the ones who were betrayed to begin with.
--:-- Sean Rameswaram: Not to mention that this could have increased vaccine skepticism among, you know, an already skeptical segment of the population.
--:-- Nina Feldman: Do you have any idea if this made people more reluctant to get the shot in the city or the state?
--:-- Sean Rameswaram: It's hard to draw a direct line from the Philly fighting COVID scandal to, you know, people who are feeling hesitant about getting vaccinated now.
--:-- Nina Feldman: But what I think you can say on a broader level is that people rely on their public health agencies and just on government agencies in general to provide them with services and follow through.
--:-- Sean Rameswaram: And when they screw up, the more they screw up, the less confidence people have in those agencies and in the health care system as a whole.
--:-- Sean Rameswaram: A lot of people are probably harboring false beliefs about the vaccine efficacy or safety. And, you know, they're doing that on their own accord.
--:-- Sean Rameswaram: But for some of them, it's probably because they've seen stuff like what happened with Philly fighting COVID. And they say, well, that seems like a sham. And so the more real shams you see, the easier it is to believe that nothing's to be trusted.
--:-- Sean Rameswaram: Nina Feldman is a reporter at WHYY Public Radio in Philadelphia. She hosts a five-part podcast on this very saga. It's out in the world right now. It's called Half Vaxxed. Vaxxed, like V-A-X-X-E-D. Half Vaxxed. You can get all the juicy details we couldn't fit into this episode there.
--:-- Sean Rameswaram: We used music from Half Vaxxed in our episode today. It was composed by Max Marin. Our episode was produced by Miles Bryan. And a little disclosure, Miles is in a long-term relationship with WHYY reporter Nina Feldman. In fact, they just got engaged. Mazel tov.
--:-- Sean Rameswaram: I'm Sean Rameswaram for a more off Monday for Indigenous Peoples Day. Back Tuesday with more Today Explained. Thank you.
