‘Where Was the Strategy for Getting People Ready to Start Taking the Vaccine?’

Gus Perna is a national hero, and no one talks about it. The now-retired Army four-star general served as chief operating officer for Operation Warp Speed, the Trump administration’s massive public-private effort to develop, approve and distribute a Covid-19 vaccine in the record time of less than a year. (The prior record, for the mumps vaccine, was more than four years.) At a time when U.S. generals are mostly famous for losing wars, Perna helped lead a mission that has saved easily a million American lives. Can any other recent endeavor involving the U.S. military say that?

One reason Perna’s not a household name is that Perna himself has laid pretty low since quietly retiring last summer, by which point the Biden administration had restructured and rebranded OWS as the Countermeasures Acceleration Group. Perna rarely speaks to the media these days and has largely avoided criticizing past or current U.S. leadership. But now, nearly two years after OWS launched on May 15, 2020 — with less than half of eligible Americans fully vaxxed and boosted, vaccine-evading variants circulating, confusing messaging on boosters and no OWS-like program speeding up the development of pan-coronavirus vaccines — Perna’s insights, which he offered POLITICO in a rare phone interview from his home outside Birmingham, Ala., are essential. He knows what makes supply chains work or not; and he’s seen America achieve a near-impossible scientific and logistical feat only to fumble the messaging.

Consider that Perna, along with a team of about 100 people drawn mostly from the Defense Department and the Department of Health and Human Services, managed ultimately to set up a network of 70,000 sites across 64 jurisdictions around the country and get millions of doses of safe and effective vaccines to them — without knowing ahead of time which vaccines would be authorized and when, or, as it happened, how many doses would actually be available. As he publicly acknowledged, initial targets fell short, but deliveries scaled up rapidly, to the point that 100 million doses had been administered across the country by mid-March 2021, and by the time Perna retired in July, the Biden administration had just barely missed its goal to get at least a first dose to 70 percent of American adults.

Perna said he’s no longer monitoring the numbers, which are discouraging: Tens of millions of eligible Americans remain unvaccinated as Covid deaths continue to climb past1 million. But he described his biggest frustration of the Warp Speed enterprise: “Where was the long-term strategy for getting people ready to start taking the vaccine? … That was not part of the OWS portfolio. It’s a personal choice to get the vaccine or not. But where was the presentation to inform everybody, so that they could make the best decision? Where was the responsibility to not let this get politicized? … It just didn’t exist.”

This interview was edited for length and clarity.

Kathy Gilsinan: You had decades of experience with logistics in the Army. But I’m curious what the key differences are in approach between getting, say, materiel into Poland or out of Iraq versus getting a vaccine shot from a conveyor belt to a pharmacy.

Gustave Perna: It’s the same principles. You have to just focus on the purpose of what you're doing. Always purpose first. On the battlefield, if you don’t get something there, where it needs to be, then there's soldiers’ lives at risk. You don't get them bullets on time, you don’t get them gasoline on time — it's really [a] tremendous impact. Getting things before they need them, where they need them, so that they can exploit success, that’s what you’re really working for on the battlefield. The key is that the battlefield is very fluid, and you really don’t know where the enemy is, and where the friendly situation is going to be. So it takes a lot of intuition.

Gilsinan: I don’t know if this is different from what you would deal with in a battlefield context, but you have numbers moving around all over the place as to how many vaccine doses are even going to be available at certain times. How do you plan against that kind of uncertainty?

Perna: The great team that I had working with me — hand-selected people with talents in acquisition, contracting, supply chain, ERPs [Enterprise Resource Planning], communications — we were all focused on the delivery and distribution of the vaccine. That was our primary effort. It expanded from there. We had to do a lot of work to help expand manufacturing, to help sustain the supply chain. We implemented 19 Defense Production Acts — for minerals, for materials, for consumables, for equipment. Our real success was we took this flat organization of less than 100 people, and we partnered with industry: McKesson Trucking, UPS, FedEx, Pfizer. And we collaborated and developed a distribution plan that allowed us to execute under certain tenets.

One, we were going to deliver vaccine across the United States simultaneously to everybody allowed [subject to] the amount of vaccine that was available. So we went all the way to the Pacific Territories, Alaska, Puerto Rico. We were over in Europe, delivering to U.S. bases, South Korea. Anywhere there was U.S. personnel, we developed a system that allowed us to deliver vaccines.

We were constrained with the amount of vaccine that was coming off the conveyor belt at a time. We understood this. We knew that on the day that we had EUA [Emergency Use Authorization], we were only going to have a certain amount of doses. We developed a formula based on population, which allowed us to discern a percentage of that vaccine which would be delivered. Every week after the first week that number went up.

But the system we set up was based on the foundation and the collaboration of local and federal government and industry. We did this, really, with almost perfection. Never been done before. We opened up over 70,000 locations across the country that could receive and administer vaccine. We had to create data-use agreements with the states in order to put an ERP in place to track the vaccine. Then we had to validate the 70,000 locations through the CDC, so that they could receive it and administer it. Because our goal was, we wanted people to have access in places they were comfortable being: a local doctor’s office, a hospital, CVS, Walgreens, Wal-Mart.

Gilsinan: They say plans don’t survive first contact with the enemy. I’m curious what adjustments became warranted in those first few weeks and why.

Perna: That plan worked. We brought in Palantir. Palantir created a system that allowed us to see ourselves from manufacturing all the way down to the distribution sites. We had a very elaborate system up and running, to make sure nobody nefarious was trying to do anything. We had local security. We had cyber security. And then we did have to make some adjustments because of the environment. Two major snowstorms hit us within 30 days of our distribution. The first one we kind of worked around, no issues. The second one shut down our distribution hubs for about five days.

Leaders like Major General Chris Sharpsten and the personal leadership from McKesson, UPS and FedEx were involved. They just came up with solutions. We doubled the workload, and we administered everything out the following week. So, we doubled delivery. States and local governments were setting up hospitals, doctors’ offices, local sites to bring people in. Vaccine needed to be there. We couldn’t just [say] ‘Okay, we’ll get you that next week.’ We had to figure out how to get it to them when they needed it.

Gilsinan: What assumptions did you make in the planning that turned out to be bad assumptions?

Perna: Manufacturing vaccine is a very difficult and well-regulated, rightly so, process. We’re taking a vaccine and we’re going to shoot it into a human body. We ought to be very proud as a country, we have the greatest system in the world by far. The FDA is magnificent. The pharmaceutical companies are magnificent in execution. And I’m a big believer in these organizations and the regulations and the accountability to them.

With that said, we had predictions of what we thought [was] going to come off the conveyor belt at certain times. Well, truth in lending, sometimes as much as we thought was coming off, did not come off, because of the regulated process and approval. So one of the assumptions that I made was, if they said, ‘Hey, General, you’re going to get 5 million doses this week,’ I pretty much believed we were going to get 5 million doses. Now, based on inspections and regulations, we happened to get maybe 3 million. Well, 3 million versus 5 million is still good. But it’s not all that we thought we were going to get.

We told people what numbers were forecast. We used the word “forecast.” And then when the numbers came to fruition, they weren’t the same. Now, okay, we can go digging in and figuring out why that was. But here’s the end of the deal. We wanted safe and effective vaccines. We weren't going to challenge the system to that end. We believe in the regulation and the approval process. But what that meant is the planning assumptions, that we were going to get 5 million, didn’t come to fruition. And so I refused to let that stifle everything that was going so well.

So it became very easy: “It’s my fault.” [At a press conference in December 2020, Perna took responsibility for what he called the “miscommunication” surrounding how many vaccine doses would be available early in the vaccine rollout.]

Gilsinan: You mentioned in your Defense Newsinterview that the key thing to go wrong was the communications strategy. Can you tell me about what you think should have been done differently, by you or anybody else?

Perna: At the tactical level, I’m very proud of what we did. I’m very proud of how open and transparent we were with the media. We presented facts every week. We answered hundreds of questions to the best of our knowledge, based on what was going on, number one. Number two, we had weekly sessions with states, and jurisdictions, and [the] federal government, where we held meetings at my level, and we went through everything that was going on.

What I get frustrated on was: Where was the long-term strategy for getting people ready to start taking the vaccine? The vaccine was going to come. The vaccine’s safe and effective. We didn’t cut any corners. The vaccine, it’s going to save lives. Where was that strategy? That was not part of the OWS portfolio. It’s a personal choice to get the vaccine or not. But where was the presentation to inform everybody, so that they could make the best decision? Where was the responsibility to not let this get politicized? Where was the access to knowledge that everybody could listen to, question, read more about, so that when the vaccine came out it was just time to make a choice, you either get it or you don’t? Where was all that? It just didn’t exist. That’s the frustration I’m talking about.

Gilsinan: You had mentioned also on “60 Minutes” that your worst nightmare was we’d get a vaccine and people won’t take it. You said, “shame on us” if so. Surveying the U.S. now, has your worst nightmare come true, or do you have a different one now?

Perna: Quite frankly, I am not paying attention to where the numbers are today, so I don't know the answer to that definitively. I am disappointed that we knew the projections of the numbers when the vaccine would be available, and how much would be available. We knew that by March, that there would be enough vaccine for anybody who wanted the vaccine. Pretty frickin’ amazing. At that point, I was a little bit taken aback by how many people were not taking the vaccine. Again, a personal choice. And I think everybody ought to have that personal choice.

Gilsinan What can we learn from the OWS approach when it comes to vaccinating against variants? Is there a role for DOD now?

Perna: Here’s why we were successful, can I start there? We were successful because we had clearly defined purpose: safe and effective vaccines and therapeutics for the American people. We had absolute priority and resources to achieve that purpose. Both administrations gave me priority and resources to that end. We had a unity of effort. We had the federal government, we had industry, and we had academia all rowing to solve this problem.

So, clearly defined purpose, priority of resources, and a unity of effort. That’s why we were successful. So the question is, is do we need that now? I don’t know. Is there still a national emergency and we have to figure out an approach to solve that problem? I’m not informed enough to answer that.

Gilsinan: What do you wish more people understood about the scale of what happened here?

Perna: My father had something hanging on his wall. Many people know the thing, but it generally says, you can get a lot of things accomplished as a team if you’re not worried about who gets the credit. And so, I saw that when I was a kid. When my father passed away, I took that and hung it in my offices for the last 25-plus years. And it’s the approach on everything I’ve done. The team that that we assembled was with experts who didn’t care about getting any credit; all they worked on was getting [it] done. I know that’s not what you asked me, but I feel it’s important.

We did this because we were focused on our purpose, and we went to work every day, working 20-hour days, seven days a week, from 15 May [2020] all the way through when I retired on 2 July [2021]. It was just brutal. And the people that did things, the Kim Hansons, the Paul Ostrowskis, the Deacon Maddoxes, the R.J. Mikeshes, the Mike Posts. I mean, I just rattled off seven names, there's 93 other people who just went home, took a shower, shoved something in their face, kissed their wives, hugged their children and came back to work, so they could get this done. Do I think America knows that? No. I think our families know, and our families are proud of us. And our friends are proud of us. But America doesn’t know. Now, I don’t know the reason. I don’t care. I don’t lose any sleep over it. I did what I was asked to do. I’m proud of it. I’m proud of the team.

Gilsinan: What does your experience in Warp Speed and throughout your career teach us about supply-chain management and supply-chain difficulties? Are there any lessons you could give us amateur supply-chain watchers, either for understanding or fixing some of our commercial supply-chain issues these days?

Perna: All this “supply chain, supply chain, supply chain” — it is a reflection of leadership decisions. And all the problems that are going on now are because leaders made certain decisions. If you make decisions that you want things manufactured overseas because it’s cheaper, well then, the result of not being able to transport [them] because harbors and airfields are crowded [is] something you have to live with.

There is a way to make sure that your supply chain is what you want. It just depends on your purpose, if it’s about being better than your competitors, if it’s about being an innovative leader in the supply chain. Or is it about saving every single penny, because of cash flow or revenue, quarterly spreadsheets, annual earnings? I am convinced there’s companies out there who made the right decisions. I’m pretty proud of the Army. I believe we made the right decisions. The Army is way ahead of the curve on making sure that they have everything they need because of the hard decisions we made to make sure readiness was our number one priority. That’s why our supply chain works. Others don’t because they made different decisions.

So, the BLUF [Bottom line up front]: leader responsibility. You get effects based on your decisions. And the supply chain can be managed to those effects with the right decisions. Over.

Gilsinan: Are you talking about private sector leaders or public sector leaders?

Perna: Both. It’s a leadership problem.

Gilsinan: Do you want to name any names?

Perna: There was one time, I’m not going to tell you when, but there was a time when we made a decision [on] Army repair parts. The metric was how much money we could spend. And so we made a decision that a certain performance was acceptable. I disagreed with that. I went to the leadership. And our metrics changed, and we paid more money, but we had what we needed when we needed it.

Gilsinan: What’s next for you?

Perna: I’m working my way through that. I was blessed to serve our nation. No other country in the world takes an oath to the Constitution like we do. I loved every minute of it. There [were] good and bad days, but I love serving. And I’m really proud of it. Our Army is great. We have great leaders that we spend a lot of time developing through coaching, teaching and mentoring. And those leaders take our places, and they’re going to take our Army to the next level.

So I’m ready to go do something else. There’s a lot of things that I wish I did better with being where I needed to be with my family. I got lucky. My wife and I have been married for 38-plus years. She raised our sons; they’re wonderful young men who both serve today. And she’s taking great care of me. So now I’m just trying to figure out how to contribute back to that family circle.

So, we’ll see. I’m doing some speaking, I’m doing some consulting, some board work. I’m waiting for the phone call for like an NFL or MLB team to call me, and I'll go be the president of the team or something.[Laughs] But otherwise, I’m just working at home, and I’m good. I'm working out, I’m sleeping, I don’t take the phone in the bedroom with me. I am no longer responsible for anybody else’s life besides myself, my wife and my sons and their families. I am not answering the phone at 3 in the morning.

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By: Kathy Gilsinan
Title: ‘Where Was the Strategy for Getting People Ready to Start Taking the Vaccine?’
Sourced From: www.politico.com/news/magazine/2022/05/12/gus-perna-vaccines-education-deaths-public-00032098
Published Date: Thu, 12 May 2022 12:37:52 EST

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