Scaling Up Vaccine Delivery Is Complex and Requires Governance — Let’s Get This Done!

As the global supply of vaccines increases, many jurisdictions are struggling to create the governance and IT infrastructure that needs to be in place to efficiently inoculate the vast majority of their populations. Public health business and IT leaders must urgently come together forming a new working partnership in order to recalibrate their response. The imperative of vaccine management governance is critical in its timing to achieve targets and save lives.

Evidence of these behind-the-scenes struggles and consumers beset by frustrations continue to be highlighted in media reports. Many consumers are frustrated by online systems, unable to register and book appointments although currently eligible. They go so far as to hire “vaccine hunters” to find appointments for them. Although some may blame IT, the underlying issues are actually related to how vaccine management is governed, information flow and an underfunded public health IT infrastructure that was not prepared to tackle this monumental task (see ).

Nations like Israel and the U.K. performed better in the initial rollout phases because they procured vaccine supply early and leveraged existing centralized digital systems that managed their entire patient population. The tools they use include:

• Digitized primary care records for all the population (standardized EMRs/EHRs)

• Immunization registries

• Unique person-level health identifiers

• Internet connectivity at local health provider sites

• Data sharing agreements

In the U.S., states West Virginia, Alaska, Connecticut and North Carolina experienced early success with centralized governor-initiated coordinated strategies utilizing strong local healthcare and pharmacy networks with both low- and high-tech scheduling and web-enabled vaccine management platforms.Many other jurisdictions without a coordinated approach have struggled.

Executive leadership in public and private enterprise, across business units including IT,must avoid a temptation to blame each other because it leads to further fragmentation. Instead, adopt an “all hands on deck” attitude to win back confidence and create common purpose by setting up systems capable of handling the coming supply and demand surge. Here’s how to do it.

Government and business leaders responsible for vaccine management need to bring their IT leaders in as equal partners. Jointly work on a fit-for-purpose governance strategy — an organizational delivery architecture to manage, communicate and administer the vaccine in near real time (see Figure 1).

Together, they must establish governance principles and priorities specifically tied to the public health strategy using co-created principles, such as the following:

• Prioritize at-risk groups and vaccinate as many people as quickly as possible.

• Communicate with transparent and accurate information.

• Address equity, the disadvantaged and underserved with outreach and mobile sites.

• Combat misinformation.

• Engage the consumer (and improve the digital consumer experience).

• Build trust.

• Utilize partners.

• Bring vaccines to communities and businesses quickly and conveniently.

• Use existing tools and networks for scheduling and administration.

Jurisdictions vary widely in where they stand with priority groups and with their immunization registries and online scheduling systems. This has created a “land of many” IT systems, with no single solution meeting all needs and vendor market opportunities. In order to do scale up, business and IT leaders must now orchestrate a contextual ecosystem aligned to accelerate their vaccination targets.

Public health business leaders need to:

• Bring IT to the table and convene an ongoing joint initiative governance mechanism.

• Establish requirements for supply, demand, access and capacity with a consumer engagement focus.

IT leaders need to:

• Elaborate the storyboards and process workflows necessary for websites and applications based on venue types, entry mechanisms (including digital, call center and paper forms) and a way to quickly deal with data quality issues.

• Adapt existing site level (healthcare for instance) tools to the COVID-19 vaccination challenge wherever possible.

• Assess readiness focusing on online and call center capacity for massive fluctuations in demand, accurate scheduling with waiting rooms and preregistration functions.

• Ensure enabling solutions and architecture have the flexibility to rapidly adapt to changing business, clinical and regulatory requirements.

Together:

• Envision the end-to-end ecosystem of what it will take to have data for decision making. Identify decision gates and partners.

• Institute a warning system based on signals for potential trends such as consumer vaccine preference, COVID-19 variants, case hot spots.

• Seek out the underserved utilizing available data sources.

• Deploy machine learning and automated processes for real-time data integration, and utilize graph and advanced analytics to provide continuous intelligence across the entire vaccine management ecosystem (see ).

• Conduct scenario planning exercises utilizing intelligence systems for forecasting and capacity estimates for vaccines and COVID-19 cases.

• Investigate how to use data and “nudge” opportunities to reach those parts of the population that are distrustful and reluctant to accept the vaccine and that could make the difference for achieving herd immunity.

• Identify mitigations with partners to tackle challenges based on analytics with geolocation intelligence, elaborate personas of the population, conduct consumer sentiment analysis and collect data on how consumers access information. Consider what employers are doing around employee vaccination (see ).

A major threat to the successful rollout is failing to match vaccine supply with consumer demand. An equilibrium state requires utilizing data and analytics to achieve operational excellence. Procurements must be timed to precisely coincide with scheduled appointments. Too much supply leads to wastage, and may result in a reduction of supply in future shipments. Too little means having to cancel vaccination appointments, eroding consumer trust. Achieving equilibrium requires a robust intelligent ecosystem with end-to-end visibility and the ability to proactively monitor and identify trends and issues (see Figure 2).

Public health business leaders need to:

• Rely on a project management office (PMO) or assemble a “strike team” to implement the ecosystem and ensure it rolls out as intended, managing staff, contractors, volunteers, partners and vendors.

• Ensure that immunization is achieved locally. Let existing local systems stay and connect if working well.

IT leaders need to:

• Detail an agile IT work plan based on a data and applications architecture ecosystem.

• Elaborate the data exchange mechanisms/interoperability mechanisms.

• Contact trusted vaccine management vendors, noting that the market is highly dynamic.

Together:

• Obtain a holistic view of the data around “who, what, when and where.” With many vaccination venue types, each presents unique challenges and requires a requirements matrix board approach.

• Establish an access rich command and control system analytics platform with input from partners.

Be the visionaries of the future state of public health. Model what financial services have done in digital transformation, and apply this mindset by leapfrogging progress with new consumer applications, information governance, interoperability and security.

Develop a capabilities and competencies model as a key part of the governance strategy (see Figure 3 and ). Create a budgeted reusable, composable data and analytics architecture model with an eye to the horizon. Adult immunization and digital health status requirements — and digital vaccine and health certificates — are here to stay.

In summary, the steps shown in Figure 4 can scale and accelerate the vaccine rollout.

With consumer and public health goals squarely at the center, the long game is building the operational digital capabilities of local health systems in primary and preventive integrated care management systems. This, coupled with data fabric from regional health information exchanges, will provide for digitally enabled care, reporting and early-warning disease detection.

By Donna Medeiros, Rick Howard, Sharon Hakkennes and Daniel Ryntjes

Recommended by the Authors

Endnotes

Vaccine management governance is the orchestration of the people, processes technology and data for the effective distribution, administration and surveillance of vaccines and immunization. It is a complex three-pronged effort of:

See:

• What is Vaccine Hunting?, Vaccine Hunter.

• VaccineFinder.

Some vaccine hunters are working to address reported alleged discrimination (see Residents Allege Racial Discrimination At Some Maryland Vaccination Sites, NPR).

See Israel’s Vaccine Data Has Lessons for All, Bloomberg.

See Amid Vaccination Roll Out, Government, Education, and Enterprise Verticals Embrace Everbridge’s Vaccine Distribution Software, Business Wire.

Challenges in Ensuring Global Access to Covid-19 Vaccines: Production, Affordability, Allocation, and Deployment, the Lancet.

See, for example, the CDC Social Vulnerability Index, ATSDR.

For vaccine acceptance globally and by country, see KAP COVID Dashboards.

Such as Google’s intelligent vaccine impact platform; see Google Launches Data Analytics Solution to Expand Vaccine Access, HealthITAnalytics.

See How GIS Data Can Help Fix Vaccine Distribution, Information Week.

America Could Soon Be Swimming in Covid-19 Vaccines: The Shift from Scarcity to Surplus Could Bring Its Own Problems, USA TODAY.

Other recommended reading is as follows:

Vaccine Speed No Match for Covid Wave Sweeping East Europe, Bloomberg.