Gartner Research

Top Actions to Manage the Vaccine Rollout in U.S. State and Local Government

Published: 12 March 2021

Summary

The chaotic U.S. rollout of the COVID-19 vaccine, in many cases, has overwhelmed the ability of public health organizations to get many vaccinated quickly. Government CIOs can leverage our three-phased approach to overcome challenges of vaccine management and achieve results.

Overview

Impacts
  • The operational capacity of U.S. public health organizations was, initially, overwhelmed by the speed, complexityand scale of COVID-19 vaccine deployment. This impeded the effectiveness, efficiency and equity goals of vaccine management programs.

  • Vendors are actively marketing technology solutions intended to manage all stages of vaccine distribution and administration. But time, resource and budget constraints slow the procurement and implementation of these solutions.

  • Fatigue in the public health workforce may compromise its ability to effectivelymanage the vaccine rollout as it enters the larger general population phase.

Recommendations

Government CIOs involved with government technology optimization and modernization should:

  • Scale and sustain your vaccine management response by adopting an incident management approach to make faster decisions and improve coordination among partners.

  • Assess gaps in your vaccine management program by using a capability model, such as Gartner’s Vaccine Management Capability Model, to prioritize and expedite the acquisition of the most Critical Capabilities.

  • Secure and maximize available U.S. federal government funding and technical assistance by working with key partners to produce an integrated vaccine management plan that sets specific immunization goals and dates.

  • Develop a resource and capacity plan that maintains an optimal pace to achieve immunization goals by using newly available federal funding to increase capacity for vaccine distribution as determined by the plan.

Analysis

With the arrival of emergency-approved COVID-19 vaccines in the United States, the era of mass vaccination distribution, administration and surveillance has begun. State, local and tribal governments are scrambling to close the “last mile” between the end of the vaccine supply chain, and vaccinating people who are eligible to receive the shot (see Note 1).

As the general U.S. population becomes eligible for vaccination, the capacity and capabilities of state and local government agencies — along with their healthcare provider partners — are being tested as never before. Ultimately, the path to achieve herd immunity will be determined by how well local jurisdictions manage their vaccine program through the strategic deployment of people, processes, technology and data.

Every jurisdiction is unique. Demographics and population characteristics, the prevailing social determinants of health, local sentiment, geographic conditions, and healthcare provider and payer networks vary considerably. Based on Gartner’s extensive interactions with U.S. government clients, vaccine management solution vendors and on-the-ground consulting engagements, we have noted a number of similarities among early lessons, emerging practices and future needs. We offer CIOs and health administrators this three-phased approach to succeed:

  • Perform now.

  • Prepare for the mid- and long-term.

  • Pace the allocation of resources to remain effective for the response duration (see Table 1).

Impacts and Recommendations

. The immediate, tactical decisions and interim processes established in the first months of vaccine distribution are necessary, but they are also unsustainable. As the scale and scope of vaccine management expands, government leaders must supplement tactical actions with strategic intent.

All levels of government are currently confronting the challenges presented by the manufacturing, availability, supply chain logistics, storage, handling and administration necessary for the safe use of different vaccines. At the local level, administering multiple vaccines at scale requires effective systems and clear protocols to manage the data needed to track the demographic attributes of those receiving the vaccine, and follow up on any potential adverse reaction.

Timely coordination across the healthcare delivery network and clear communication with the public are proving critical to ensure the equitable distribution of vaccines among eligible population groups and to avoid wasted shots. But conflicting messages from different government agencies, unpredictable weekly vaccine supply and the shifting prioritization of eligible groups have added to the challenging roll out. The so-called “misinformation epidemic” further adds these challenges (see ).

To effectively mitigate the short-term risks that emerged in the first months of the vaccine rollout requires a command-and-control mode of operation. While approaches vary considerably, state and local governments that have adopted an incident command structure to manage the laborious response to a public health crisis can quickly respond and adapt to rapid changes as they unfold.State and local governments that deactivated their COVID-19 emergency operations center prior to the availability of vaccines should reactivate it until a majority of the general population in their jurisdiction is vaccinated.

This command center approach supports effective decision making, facilitates information sharing and provides dashboards to monitor vaccine deployment efficiency (see ).

Recommendations:

  • Adopt an incident management approach to sustain your vaccine management response, make faster decisions and improve coordination among partners.

  • Improve vaccine management program agility by adopting practices that increase real-time operational adaptability, such as identifying and proactively mitigating risks that disrupt vaccine distribution and administration.

  • Accelerate data and analytics actions that provide the incident management team or equivalent with visibility over the entire vaccine management process and provide access to real-time and predictive information to enable data-driven decision making.

. To adequately scale vaccine management operations when doses are more widely available will require an expansion of capacity and extensions of the healthcare network into medical offices, pharmacies and retail locations. This includes the deployment of mobile clinics to rural or underserved areas and temporary, large-scale mass vaccination sites in high-density urban environments. Venues such as sports stadiums, vacant storefronts, military facilities and schools are already serving as sites during the current vaccine management phase.

A broad portfolio of vaccine management program capabilities is needed to efficiently and equitably distribute the vaccine, immunize people and monitor progress in such a distributed environment with multiple entities (see Figure 1 and Note 2).

Figure 1. The Gartner Vaccine Management Capability Model

In the early stages of vaccine distribution, most state and local public health departments, healthcare provider networks and nongovernmental organizations did not have, or necessarily need, the complete suite of capabilities that come with most vendor solutions. Instead, gaps in process were bridged with cumbersome workarounds.

At the same time, technology solutions and service providers rushed into the market, with some offering fully featured, end-to-end vaccine management solutions. But because this is a brand new area and the market is still immature, it is also taking significant time and effort to work as promised.This has resulted in delayed uptake among potential buyers, and frustration, especially among cash-strapped and already overwhelmed small to midsize jurisdictions.

Additionally, in the absence of an incident command structure, it is often unclear who the “buyer” of a vaccine management system or services is. The distinct roles and responsibilities of federal, state and local governments dictated, out of necessity, which capabilities could or should be centrally managed, and which ones should be devolved, delegated or outsourced. The risk and cost of managing a fragmented vaccine management operating model are compounded by low interoperability among systems, limiting information sharing and coordination throughout the vaccine management ecosystem (see ).

However, with the anticipated surge of vaccines arriving for the general population, this ad hoc approach must be replaced with a better plan. By using Garner’s Vaccine Management Capability Model, state and local government leaders can evaluate and prioritize which capabilities are absolutely critical to scale and sustain vaccine distribution, administration and surveillance in their jurisdictions.

For example, capabilities such as scheduling vaccination appointments, updating immunization registries or integrating with provider data and technologies has, thus far, proven extremely problematic for many. On the immediate horizon, providing vaccination certification, such as the Excelsior Pass now being piloted by New York State, is an essential capability required to safely and confidently reopen society (see ).

Conducting a capabilities analysis serves multiple purposes to:

  • Establish the scope of vaccine management services to be provided by federal, state, county or city governments, as well as healthcare providers and other vaccine points of dispensing.

  • Determine the extent of interoperability, integration and data exchange needed among partners in the vaccine management ecosystem.

  • Develop a vaccine management capabilities acquisition roadmap that is specific to your jurisdiction’s most pressing needs.

  • Further elaborate jurisdictional contextual requirements, and evaluate and acquire vaccine management technology solutions and services based on those needs.

  • Assure federal agencies that all monies distributed to your jurisdiction under the American Rescue Plan Act of 2021 will be used effectively and efficiently to “carry out activities to plan, prepare for, promote, distribute, administer, monitor and track COVID-19 vaccines.”

Recommendations:

  • Assess gaps in your vaccine management program by using a capability model to create a prioritized list of vaccine management requirements and modules that must be developed or acquired. Expedite procurement of the most Critical Capabilities.

  • Secure and maximize available U.S. federal government funding and technical assistance by working with key partners to produce an integrated vaccine management plan that sets specific vaccination targets for your jurisdiction. An integrated plan should list the information management and technology investments necessary to achieve and maintain equity, improve data-driven decision making, and increase vaccine confidence among citizens.

. For the past year, the COVID-19 pandemic has been defined by its “surges” — surges in infection, hospitalization, unemployment, federal funding, and now, vaccine availability. But government processes and systems were not designed to handle these recurring and concurrent surges. When public health and healthcare systems became overwhelmed, additional workloads shifted to people who were frequently stretching themselves beyond sustainable capacity. Now, those who have worked with single-minded purpose for the duration of the pandemic are at an increased risk of burning out in its final phase.

If the government is to continue meeting its responsibilities as a purchaser, provider and regulator of public health services, government leaders must also safeguard the health, safety and well-being of its workforce. Setting a cadence that meets this obligation, while helping workers make it over the “finish line,” requires reassessing organizational readiness, roles and responsibilities (see ).

By identifying the drivers of change fatigue, government leaders can develop the resource and capacity plans needed to actively mitigate the risks associated with change fatigue (see ). Gartner defines “change fatigue” as any single or combination of negative employee responses to change that harms organizational outcomes. Burnout is one such response.

Change fatigue is not simply a product of frequent change. It is driven by three key factors:

  • Change volume — The number of changes an employee has experienced

  • Change exertion The nondiscretionary effort an employee needs to expend because of change (e.g., coming in on the weekends or canceling personal plans)

  • Change disruptionThe extent to which changes have a personal impact on employees and interfere with their day-to-day tasks (e.g., having to work with more or different people to complete a task or systems changes)

Actively managing the volume, exertion and disruption of pandemic-induced change will demonstrate support for employees who are struggling with the daily demands of a chaotic vaccine management response. Sharing your plan to increase program resources and capacity provides them with the reassurance that help is on the way.

Recommendations:

  • Develop a resource and capacity plan that maintains an optimal pace to achieve immunization goals. Use newly available federal funding to increase capacity for vaccine distribution as determined by the plan.

  • Sustain long-term vaccine management program performance by using voice-of-the-employee technologies to identify and address the underlying triggers linked to employee burnout and fatigue in the workplace (see ).

  • Enlist and maintain a rotating cadre of volunteers with medical training or certification, including pre-med students and retired healthcare providers, to supplement your workforce.

Gartner Recommended Reading

Evidence

The State of Tennessee Unified Command Group conducts community outreach to provide timely and consistent information. The Los Angeles County Emergency Operations Center provides regular COVID-19 incident updates. The National Association of County Health Officials (NACCHO) is making the transition from an Incident Command System (ICS) structure to a modified Incident Management Team structure.

The Nashville Metro Coronavirus Task Force supported the partnerships and communications channels necessary to make fast decisions to reallocate 500 doses of vaccine — and avoid waste — during the February 2021 winter storm.

Refer to Sec. 2301. Funding for COVID-19 Vaccine Activities at the Centers for Disease Control and Prevention of the American Rescue Plan Act of 2021.

See the following:

Note 1: State and Local Government

While we refer to “state and local government” throughout, we include tribal governments and U.S. territories in this designation. Additionally, Gartner notes Canadian provinces and municipalities are dealing with many of the same vaccine program management challenges highlighted in this research. They would also benefit from the analysis and recommendations we have provided.

Note 2: The Garner Vaccine Management Capability Model

This model was developed by Gartner Consulting using the CDC’s COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations and its Annex as a foundation. It is designed to identify Critical Capabilities required for all dimensions of vaccine management including distribution, administration and surveillance. Behind these capabilities are the technology, process and human resources needed to successfully deploy each capability in the context of a public-sector-managed COVID-19 vaccination program.

Analyst(s): Rick Howard Donna Medeiros Anthony Hollingworth

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