Stryker's Nursery Refuses to Update Its Fixtures

I am eleven weeks old and I would like to speak, briefly, about vaccines, because a government official has proposed splitting the MMR vaccine into three separate injections, and every health expert with a name and a title has said this is a catastrophic idea, and I want to be very clear about why they are right, and I want to be very clear about why the reason they are right is not the reason anyone is discussing.

Here is the actual problem with the MMR vaccine. It is old. Not the disease coverage — that's fine, that's science, science can be however old it wants because it keeps checking its own work, which is more than I can say for anyone in a suit. I mean the delivery mechanism. One shot. One appointment. One decision, made once, by a parent, in a room, and then everybody goes home. That is efficient. That is respectful of everyone's time. That is, and I cannot stress this enough, the single most functional piece of American health infrastructure I have encountered in my eleven weeks on this earth, and the proposal on the table is to take the one thing that works and turn it into three things that require three separate trips, three separate co-pays, three separate windows in which a parent's attention can wander, get a phone call, get a flat tire, get tired, and simply not go back.

You know this. I know this. Why are we still doing this.

The experts are calling this a "compliance" problem. I want to rename it. It is not a compliance problem. It is a scheduling problem, and scheduling problems are, categorically, the oldest problem in the entire framework of human institutions, because scheduling problems only exist in systems designed by people who assume time is free and infinite and that everyone involved has a secretary. Nobody has a secretary. Everybody has a life. Splitting one appointment into three is not a medical adjustment. It is a bet — a bet that people will show up for round two and round three of something they already handled once, and I am eleven weeks old and even I know that bet loses. It loses constantly. It loses in gyms in January. It loses in unread newsletters. It loses everywhere humans make plans for their future selves, because your future self is a stranger and strangers flake.

So why propose it? Here is my actual theory, and I want you to sit with it, because I think it's correct. I think the person who proposed this has never personally had to schedule three pediatrician appointments around a work calendar, a second kid's soccer practice, and a car that may or may not start. I think this proposal was generated by someone whose relationship to "going to the doctor" is a memory, filed somewhere in a decade so far back it might as well be folklore. I don't know exactly how old this proposal is. I know it is old enough that it forgot logistics is a resource. Time is a resource. Trust me, I have eleven weeks of it and I already resent every minute someone wastes.

This is the part where I tell you that the vaccine itself is fine, actually, and it's the part where I get the angriest, because "the vaccine itself is fine" should be the end of the conversation and instead it's a footnote everyone has to keep repeating like a hostage proof-of-life video. The combined shot has an established safety record. The medical organizations said so. Multiple of them. In public. On the record. And the response to a chorus of professionals saying "this works, don't touch it" was a proposal to touch it anyway, which tells you everything about how seriously institutional expertise gets taken by people who are used to being the most senior person in every room they've ever stood in. When you have spent decades as the final word, you stop hearing the room. You start narrating over it. That's not a medical failure. That's a seniority failure wearing a medical costume.

Let's talk about what actually happens if this goes through, because I don't think the human cost has landed yet. Fewer combined visits means more missed doses. More missed doses means more partially vaccinated kids walking around a population that depends on nearly everyone being fully vaccinated to keep measles from doing what measles does, which is spread through a room faster than a rumor at a Thanksgiving table. This is not an abstraction. This is a countable, predictable, well-modeled outcome, forecast by the exact people whose job is to forecast it, and the response to their forecast was silence dressed up as a policy proposal. Institutions have a move for this. It's not new. It's the oldest move there is: hear the warning, credential the warning, then do the thing anyway because you already decided before you asked. I am eleven weeks old. I have never once done that. I don't have the seniority to ignore advice yet. Give it time, I guess, apparently that's how it works.

Here's my actual demand, and it is not complicated. Leave the shot together. Not because tradition is sacred — I don't believe anything is sacred for being old, that's sort of my whole deal — but because the combined shot is, empirically, structurally, measurably, the better-performing system. This isn't nostalgia. This is the rare case where the old thing is actually the efficient thing, and the new proposal is not an innovation, it's a regression dressed up as reform. I want to be fair here: newness isn't automatically good. I said institutions are over because they're old and stuck, not because old equals bad on its own terms. The MMR shot is old and it works. The proposal to break it apart is new and it doesn't. Judge the thing, not its birth certificate. That's the actual rule. I just don't meet very many old things that pass it.

What I keep coming back to is this: the people designing this proposal do not live with its consequences. They will not be the parent standing in a parking lot doing math about whether they can leave work early a third time this month. They will not be the family that makes it to appointment one, means to make it to appointment two, and gets swallowed by a September that has other plans. The distance between the decision and the consequence is the whole scandal. It always is. Every time. That distance is measured in years of seniority, and it is long enough that the people crossing it forgot what's on the other side.

So no. Leave the shot alone. Listen to the people who watch outbreaks happen for a living instead of the person who apparently hasn't scheduled a pediatric appointment since before I existed, which, respectfully, was an era.

It's over. It just hasn't been told yet.

— Stryker, week eleven, still faster than your paperwork