COVID-19 Vaccine Logistics: How Have Digital Hotspots Supported The Rollout?
By: Dr Liz Breen, Director of the Digital Health Enterprise Zone (DHEZ), Reader in Health Service Operations, University of Bradford and Dr Sarah Schiffling, Senior Lecturer in Supply Chain Management, Liverpool John Moores University
1. Inventory management systems are critical to designing operations that deliver contracted quantities of vaccines on a sustainable basis and the global immunisation programme relies on their availability. People need assurance that, given the immense investment in the creation of vaccines, they can access them. Governments will seek assurance of manufacturing production capacity, securing access to stock in an agreed timeframe. Dedicated reporting mechanisms will be in place with established communications systems for information exchange and flagging production issues to prompt responsive actions in the supply chain and avoid/reduce public concern.
2. The transportation of the vaccines is critical to the success of downstream administration to patients. Concerns over cold chain fragility were heightened by the idiosyncrasies of the Pfizer/BioNtech vaccine. Information sharing mechanisms regarding the product and transportation solutions are vital. Scheduling software and supporting solutions are beneficial in designing the logistics. Tracking and tracing can alleviate concerns regarding stock tampering and contamination during transportation. Security operations to protect vaccine deliveries require a multi-agency approach that necessitates intensive information sharing.
3. NHS trusts have faced extensive operational challenges. Within the UK, the initial thrust of vaccination activity focused on NHS hospitals because of their capability to manage the storage and administration of the Pfizer/BioNtech vaccine with its challenging temperature requirements. Information sourcing and exchange is essential to facilitate the real-time scheduling of the vaccine delivery as well as business as usual and treatment of COVID-19 patients. The layout of hospital premises was reconfigured during the pandemic to facilitate priority treatment of COVID-19 patients and again to enable efficient vaccine administration. With hospital space being in high demand, effective discharge IT systems facilitate the transfer of patients no longer needing complex medical care into other settings or to other hospitals. Additional support must be provided for continuous onsite training for staff especially prior to vaccine administration, with digital platforms ideally suited to the task.
4. Strategically located vaccination hubs are pivotal in promoting vaccine uptake and optimal location sourcing. Within the UK, the movement of the vaccination programme from hospitals into vaccination hubs was a welcome progression for the public, due to local proximity (10-mile patient radius as per UK requirements), but also to remove pressure from NHS hospitals. Modelling and simulations have long been used to aid location decisions. Once these are made, information coordination is essential to supply each site with equipment, personnel, and amenities, but also to ensure the safe management of patients, staff, and volunteers onsite.
5. Primary care providers are pivotal in the vaccination programme, particularly in delivering the vaccine to early priority groups such as care home residents and staff. GP IT systems facilitate the identification of patients. The delivery of the vaccine closer to the patients through trusted and known professionals is undertaken by GPs, community pharmacies, dentists, paramedics, and other healthcare professionals. With more professional groups positioned to administer the vaccine, the coordination of ‘live’ data through connected digital solutions is imperative.
6. With vaccines being so scarce, avoiding vaccine wastage is key. Staff training and supporting e-learning programmes are important to minimise administrator errors. Guidance for best practice on issues like using the correct syringes needs to be available in an accessible format for staff to access and use with confidence. Furthermore, stock availability has to be coordinated with clinic processing capacity. To ensure all stock is used up before it deteriorates, contingency measures like overbooking appointments to make up for no-shows are essential.
7. Volunteers have shaped many parts of the pandemic response. The creation and coordination of a volunteer scheme to offer support in the mass vaccination hubs is facilitated using an online portal. This was directed at healthcare staff and willing helpers for non-clinical activities such as stewards to direct patient flows. A similar system supports volunteering in local communities for example with medicine deliveries to patients.
8. Patients are contacted to inform them when they can be vaccinated. Existing databases/systems are used by GPs to contact patients. Postal methods support this system, but have resulted in delays to appointment notifications. To facilitate greater uptake and a more timely public response in the UK and other countries, online booking systems are also in place.
9. Sharing public health information has been incredibly important throughout the pandemic to counter misinformation and, more recently, anti-vaccination propaganda that could reduce vaccine uptake. Public health messages on everything from social distancing to staying vigilant even after vaccination needed to be shared widely and the use of the internet greatly facilitated this. Social platforms and common digital solutions such as text messages and e-mails are important because of their accessibility. New solutions were created to deliver public health support such as the NHS app for coronavirus symptom checking and the NHS COVID-19 test and trace app. Press and media also support information exchange, endorsing the use of the vaccine through coverage of the Queen having her vaccination and the Pope condoning its use. The full extent of the efficacy of these measures in reducing vaccine hesitancy is not yet clear. Conflicting and changing information has led to confusion. For example, the time delay between doses was initially communicated as 2-3 or 4 weeks depending on the vaccine, but then extended to 12 weeks to achieve greater population coverage. Later suggestions indicate a reduced delay of 6 weeks.
10. Moving forward, the vaccination scheme has to be formalised. The World Health Organization have stated that the COVID-19 virus may be something that we continue to live with and thus we may need to instigate a regular vaccination programme to maintain immunity against this virus. Doing so will require the development of a system to manage vaccination levels, connecting with existing patient healthcare records but also connecting with vaccine production, production location holding, transportation scheduling, local storage information etc, akin to an ERP system (Enterprise Resource Planning). The required frequency of booster vaccinations is not known yet. This will determine the scale of this system and the digital solutions needed to enable it.
Digital solutions to address effects of the pandemic are omnipresent from online shopping to remote learning. Using the COVID-19 vaccine supply chain as a case study, we can see the profound impact they have had and will continue to have as the vaccination programme continues. These solutions are the best human and technological intelligence combined to deliver optimal use and successful outcomes. In many ways, the COVID-19 pandemic has accelerated the trajectory towards Society 5.0, "a human-centred society that balances economic advancement with the resolution of social problems by a system that highly integrates cyberspace and physical space".
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