When the COVID-19 vaccine becomes available, it needs to be distributed as quickly as possible to not just some but likely all of the population. And that can't be organized overnight. Plans and strategies on how best to distribute the vaccine equitably and efficiently, and to which priority groups, must be built and honed now. Most important to realize is that reaching out to individuals with education, scheduling, and location choices can build confidence and trust and create a calming force among the public.
The Health and Human Services Pandemic Influenza Plan outlines the public sector pandemic response as well as methods for distributing vaccines. But according to an educational resource by the College of Physicians of Philadelphia, there will need to be revised national guidelines to public health coordinators prioritizing who should be vaccinated, while state and local health departments will develop modifications to the guidelines based on their area logistics.
The same online resource cited that “...distribution plans primarily relied on public entities, such as public health departments and hospitals, to receive vaccines and vaccinate most of the targeted population.” However, according to a study published in JAMA Network, “...developing a framework for fair and equitable distribution of COVID-19 vaccines and therapeutics is far more complex and will require coordination of multiple institutions, funders, governments, and pharmaceutical companies.”
Immunization experts say that even if a COVID-19 vaccine is available by the end of the year, equitable distribution globally or across the U.S. or even across a state will be a challenge. But if planning starts now, while promising research on the distribution infrastructure and methods continues, solutions can be in place early on.
Regardless of the roll-out strategy, a patient engagement platform will be needed to reach out to a patient population identified for vaccine administration—to prepare them, guide them through the process, and monitor them during after-care. At the same time, this type of platform also allows management of provider groups within a state’s jurisdiction, to track supply distribution equitably and efficiently.
The H1N1 experience
According to The History of Vaccines, “...most aspects of vaccine distribution were executed smoothly in the 2009 H1N1 pandemic.” Providers and nonproviders, such as retail pharmacies, corporations with occupational health clinics, and nonpediatric healthcare providers, received and administered vaccines.
In a pandemic, the use of private occupational health clinics to identify and reach people in high-priority groups to vaccinate is also supported by the same online historical resource. The History of Vaccines not only provides a living, changing chronicle of the compelling history of vaccination but also discusses some of the success and failures, controversies and challenges, difficulties, and tragic events that have occurred in the use of vaccines.
An example: In Tennessee, partnerships enabled the health department to carry out its vaccine program, according to the Centers for Infectious Disease and Research Policy (CIDRAP). The Department of Health partnered with private providers throughout the state to ensure that its H1N1 vaccine distribution plan was serving the immediate and long-term needs of the community.
The increased capacity to distribute the vaccine was also because the 2009 H1N1 influenza didn’t result in the extent of severe disease that would have led to healthcare provider offices being overwhelmed. By contrast, COVID-19 has both shocked the healthcare system, causing scarcity of medical resources and healthcare providers, and severely affected the global economy. As a result, a much-improved strategy is needed.
During a pandemic, the Centers for Disease Control and Prevention is expected to scale up existing vaccine distribution, tracking, and monitoring systems to support the response. From over 75 million doses of vaccines distributed to health departments and private health providers across the country, CDC’s vaccine distribution system needs to be expedited to manage and distribute almost 900 million doses of vaccine to support the needs of a pandemic.
Given the complex structure of vaccine distribution where data is crucial and communication plays a vital role in the goal of reaching both providers and patient groups, technology holds the solution to deliver faster to a larger population.
Innovative, HIPAA-compliant tech, such as a cloud-based, automated communication platform, can take care of population management. But the deeper value of this platform lies in the power of communication—how stakeholders are all engaged in one platform from which insights and data, both qualitative and quantitative, can be generated real-time to inform patients and allow providers and health professionals to make real-time, informed decisions.
The challenges identified
CIDRAP cited the experience of the Tennessee Department of Health and its H1N1 vaccine distribution plan that addressed some challenges through a “...decentralized approach. This involves distribution among health departments and private-sector providers, while giving preference to facilities that serve more people in target groups.”
Those challenges included the need to monitor vaccine demand and distribution among different groups, prioritizing target groups and reallocating vaccine supply based on changing needs as well as expanding vaccine eligibility to the general public. The health department hurdled these issues by also distributing small amounts of vaccine to as many ordering providers as possible, to maximize the number of points of access for target recipients throughout the state.
“These activities, and a constant flow of communication between the health department and providers, allowed the vaccine program to smoothly adjust to changing circumstances and enable providers to best serve their patients' needs,” CIDRAP noted.
What worked well for Tennessee's experience was the efficient communication system that tracked orders of providers and enabled the state to distribute the vaccine to a broad range of provider types. A preregistration system for private providers was in place and “...permitted providers to place specific orders for vaccines, rather than the public health department making its own assumptions about quantities.”
Engagement of partners was key in that vaccination program. Tennessee kept its provider partners updated through a weekly H1N1 Provider Update by email, notifying them to continue to prioritize target group members. According to CIDRAP, vaccine providers were prompted to do a situational assessment to determine whether to expand to additional populations in their facilities, either through a private office or a health department.
Based on the H1N1 vaccination experience, The History of Vaccines identified a few areas of improvement moving forward to the next pandemic. These were “...the need for accurate supply forecasts to inform vaccine ordering and subsequent distribution, as well as the need for clear communication about priority groups for vaccination.”
All of the examples referenced above illustrate the need for communication. But 2020 is a different time. The pandemic, social inequity, conflict, fear of contagion, various lockdown strategies, and news (good and bad) at the speed of Twitter—all these together feed nationwide angst. This angst can be either calmed or elevated when the vaccination becomes available. Doing nothing will increase the angst as voids in information and coordination are filled with misinformation and fear. Engagement, education, person-specific communication, choice, and empathy can all help to provide calm. Technology allows all of this to be done to scale.
An innovative engagement platform that enables and offers vaccination education, person-centered communication, and choice is the solution needed to achieve care coordination, resource management, and nationwide calm and preparedness.