22 Feb Current vaccine management challenges and how to solve them
by Dr. Suman De
When approved COVID-19 vaccines first started rolling out late in 2020, Health and Human Services Secretary Alex Azar and other top officials predicted 20 million people would be immunized by December 31st. Unfortunately, that goal was missed, and still, only 63.1 million people have been vaccinated to date in the United States. There has been extensive coverage of the slow, complicated, and mismanaged vaccination effort, and the problems seem to be as infectious as COVID-19 itself. But ultimately, as the Harvard Business Review noted, these problems all go back to one theme: the coronavirus vaccination effort is a massive IT undertaking. And one most organizations were clearly unprepared for
There are three key categories of vaccination challenges we’ve witnessed during the past few months. More importantly, however, I also want to illustrate how a proper, end-to-end technology platform can alleviate these pain points and pave a better path forward for the ultimate herd immunity goal.
The massive scale of immunization
Most of the vaccines that have been distributed have not been properly administered. In addition, many vaccines are sitting on the shelf. Why is this? Because of the sheer size of the United States’ immunization effort. The program is trying to immunize 70–80 percent of the population, a first in kind experience with an unarguable complex immunization that is nowhere near the same as the flu immunization, like many thought it would be. There is no firm, agreed-upon standard for this vaccine distribution, which means each state, each county, and each town is going on their own. It’s much like there was a lack of micro-plans for effective distribution and administration of the vaccines at the local and state level. And, we’ve already witnessed how poorly this rogue approach is working: states such as North Carolina and Connecticut, and many others, have not been able to make their target numbers due to the extensive operational challenges.
An underlying issue behind the scale of the immunization program is a lack of understanding. Many people do not understand the scope and gravity of vaccinating over 80 percent of the United States population—much less the challenge of reaching that coverage rate as quickly as possible. The country’s infrastructure has yet to be tested like this before, and the COVID-19 vaccination is highlighting our extensive public health weaknesses. This leads to websites crashing when too many people are driving to a single registration site, ending up with unmanaged queues. Lack of adequate security setup makes it easy for individuals to game with the appointment and scheduling systems, leading to multiple holdings of slots and overbooking of appointments. Lack of documentation and multilingual support make the registration sites confusing and difficult to navigate. Long waits to access any helpline, poor waitlist management, and systemic equality challenges make vulnerable populations harder to reach and access the vaccine. And, in quite a few cases, the vaccine systems have broken down. These are serious issues that expose problems at the most fundamental level, leading to significant disruptions and a slowdown in the rollout of vaccines across the nation. The ability to scale to immunize tens of millions of people in phase two and phase three will be even harder and more challenging to manage.
Finding and booking a slot should be as easy as booking tickets for your favorite movie. The site should offer robust search and automated navigation for people who get stuck. For the marginalized population, sitting on the other side of the digital divide, the simplest and the best way to schedule appointments would be to call, talk, or text. An intuitively designed, scalable registration and scheduling system, backed up by robocalls, voice assistants, chatbots, free texting, and FAQs available in multiple languages, will be essential. This can address patient apprehension and misinformation. Through complete self-service, we should simply put the vaccine eligibility screening and registration tools in the hands of the people with easy access to reliable information and a clear call to action. Geo-based self eligibility assessment and prioritization, virtual queuing technique, automated reminders, notifications, alerts, etc. will reduce inbound calls to already overwhelmed clinic staff and call centers.
The existing registration and scheduling systems need to be able to scale fast enough to handle high capacity booking and the incoming mega-vaccination event as well as have the ability to manage the clinic’s peak workloads. Beyond scalability, the systems should have the underlying mechanism to validate and check each registration entry to not only validate the eligibility criteria of the registrants but also ensure clean data (by flagging missing data, incorrect data, duplicates, etc) gets stored in the system for correct operational and compliance reporting to the public health authorities. Through well-defined user management functionalities, the system should ensure reduced access complexities and simplify the users’ access to multiple portals, reducing any experience frustrations.
It’s all about contextualizing the engagement approach based on the people that are being targeted: What works in an urban, digitally-connected community will differ from what’s effective for a rural, digitally-constrained one. State registration and scheduling systems should adapt. Real-time evaluation of demand will help optimize scheduling and manage waiting lines. Automated reminders through different channels like phone, email, etc. will help compliance with dosage requirements.
Infosys Public Services and Simplus have worked hand in hand to develop the Infosys Vaccine Management solution, a platform built entirely on Salesforce and designed end-to-end for COVID-19 vaccine distribution. Our team has worked to make it adaptable, scalable, experience-driven, and reliable for public health organizations, county and state governments, residents, and providers to leverage in the way best fit for their needs. Most importantly, it’s made to handle this size of immunization and ease of use.
Social skepticism and lack of consensus
There is an abundance of mistrust and misconceptions surrounding vaccines, and especially the COVID-19 vaccine. In addition to that, even for those who would eagerly and willingly register for a vaccine, very few know the necessary steps to do so. There is no standard process, and organizations are not abiding by one single approach. This leaves large groups of the population wondering who is eligible first, when they can receive a vaccination, and how to sign up to receive it.
Additionally, there are misconceptions surrounding vaccine coverage and prioritization criteria. Many are comparing the COVID-19 immunization effort to the flu; however, this comparison is misleading, because the flu vaccination program operates on a target coverage of 30–40 percent. But for the novel coronavirus, we need upwards of 80 percent, if not more. This means the vaccination program, at its ideal pace, is going to look drastically different than the typical flu shot many citizens are acquainted with.
Likewise, there is not a standard agreement on what prioritization criteria should be utilized. The phased rollout and constantly changing guidelines have made things more confusing. There’s information overload in many cases and sometimes no information at all. Many are going based on the occupational category, which may be effective for some high-exposure healthcare workers, but this leaves out important factors such as age and personal risk of mortality due to existing conditions. Some healthcare workers are not high-risk, and yet in some cases, they are being vaccinated long before the elderly and immuno-compromised are in the same region.
COVID-19 vulnerability and vaccination coverage target rates are two key areas that are commonly misunderstood, and the ensuing misinformation is only making the immunization effort more cumbersome. The proper technology platform, however, can mediate these challenges by providing clear prioritization requirements and analyzing the population’s COVID vulnerability and mortality risk, ensuring timely communications, providing quick access to scientific updates on the EUA vaccine drugs, forecasting coverage based on supply and demand, and promoting accurate public health education and awareness campaigns to encourage more participation. The Infosys Vaccine Management solution is equipped with all of these features.
Confusion surrounding inventory management and dose accounting
Finally, and perhaps most importantly, there are extensive concerns regarding the inventory management of COVID-19 vaccines, accurate data capture, and timely vaccination reporting.
Vaccination data capture is barely digitized. Each vaccination event generates a paper record. This must be entered, one at a time, into another electronic system. And all this information is transmitted to the state’s immunization registry and mandated to be reported back to the CDC within a 24-hour window. Staff members are spending hours each week manually entering data to meet CDC, state, and city requirements while running the vaccine clinics themselves—already challenged with the ongoing registration and scheduling issues. This is leading to a delay in reporting. A shot that’s in someone’s arm is, according to many reports, still sitting in a freezer.
With more manual activities involved in this operation, there are more chances of errors. For example, a person may receive the Moderna vaccine but may get listed as having received the Pfizer shot, or the vaccine administration date field may contain the date of birth instead, or important demographic details like race and ethnicity data may not get captured at all. Due to the lack of interoperability between the state immunization registries and the systems that providers use, some of the vaccine systems remain inefficient for properly tracking and timely reporting the shots that are administered. These issues are causing under-reporting or incorrect reporting of the vaccine administration numbers.
Additionally, existing doses need very particular storage and care to retain their effectiveness. The two-part nature of the existing vaccines means vaccine administrators need to take special care to set aside and reserve the second booster for specific registrants who have already had the first dose. There have already been countless cases of this process being mismanaged, which risks both the overall safety of the population and the individual’s immunity.
Vaccine storage handlers ought to be using smart technology, like IoT devices and countdown timers, to properly track the storage and efficacy of vaccine doses, monitor the vaccine viability when they come out of the freezer, administer the vaccines through physical stockpiles, manage the handling and inventory of individual procedural components (e.g., vials, reagents, syringes, prefilled injectors, swabs, etc.), and ensure traceability of the doses linked to the patients. The system needs to provide accurate, real-time information regarding the specific supply of vaccines—both the initial and follow-on booster doses—and automatically capture details of the vaccine products (Lot#, manufacturer name, expiry date, beyond-use date, site of injection, date of administration, etc.), as well as update and exchange these data (through HL7 messages and FHIR model compatibility) between the immunization registries and the provider systems
All this can and should be done based on a simpler, daily reporting system that only takes a few keystrokes to capture and share. In-built data quality checks will ensure the records are valid before they are pushed to the registries and can fix any data issues. This will also help organizations provide better, quality reporting to their governing agencies and suppliers, so they can request new doses at the appropriate time to maintain supply without creating a wasteful overabundance. All of this will help improve insight into who received the vaccine, ensuring vaccine administration is being accounted for accurately, managed equitably, and without the waste of valuable drugs.
Again, the award-winning Infosys Vaccine Management solution is built with digital supply chain management and automated data capture and reporting set up in mind. The built-in integrations are designed to offer administrators a 360-degree view of their reserves, distribution details, shipping information, and registrants in line for follow-on boosters and ensuring each dosage accountability and clean reporting.
What we are seeing now are just some smaller indications of a bigger problem. Beyond the registration and scheduling hassles, the logistics/supply chain breaks and dose accounting issues, the data reporting inconsistency, and the system integration challenges, the ongoing vaccine program is likely to be further challenged with more operational factors: pent up demand versus supply while opening up phases for all, managing multiple vaccine product protocols with new drugs approved for emergency use, virus mutation that might trigger new policies, etc.
Infosys Public Services, Simplus, and Salesforce have developed a vaccine management solution to keep pace with these changes and unforeseen challenges. By virtue of its modular design, lego-based architecture, and clinic in a box set up, it allows governments to quickly configure new guidelines/requirements and enable an effective mass vaccination program through scalability, advanced analytics (machine learning), data reporting, tailored campaign and outreach management, and end-to-end inventory management. It’s flexible enough to address any situation/scenario at a rapid scale and pace and can also support other ongoing vaccination programs. I’d love to share more about the Infosys Vaccine Management solution. With its comprehensive design and secure integrations, it is fit for any size organization and equipped to handle the pandemic’s vaccination challenges over time.
Please reach out to Simplus or Infosys Public Services to get started with an expert consultation today and take the first step to better vaccine management.
Dr. De is Infosys Public Services’ Head for Government Healthcare Solutions. In this capacity, he is responsible for the ideation and development of next-generation solutions for public health agencies. He has vast experience in the public health domain, and his previous work experience ranges from involvement with Govt. of India’s National pulse polio immunization program in collaboration with the World Health Organization and various other public health projects conducted by international organizations like UNICEF, Indian Public Health Association, etc. He has been recognized as a subject matter expert (SME) in healthcare for his contribution to the industry through thought leadership, points of view, articles, workshops, running webinars, and speaking sessions. Dr. De is a graduate in medicine from India and holds a Master’s in Healthcare Administration from a premier business school in India. He is the recipient of several awards of excellence in recognition of his work for the healthcare industry.