Risk-based analytics can breakdown COVID-19 vaccination bottlenecks
The Centers for Disease Control and Prevention (CDC) relaxed COVID-19 vaccine restrictions and the vaccine supply is growing, yet some areas are begging for more vaccines to meet demand.
The Biden administration is offering hope, but bottlenecks persist throughout the vaccine supply chain. Are they at the vaccine manufacturers, in the distribution system in getting vaccines to the states or the last mile of getting them into people’s arms?
The Transportation Security Administration’s (TSA) PreCheck program uses risk-based analytics to enable millions of people to receive expedited airport security screening in exchange for identity verification, including a background check. The same risk-based analytics justify realigning the immunization priority queue and distribution process, which will have lasting benefits both today and in the future.
Why is it critical to realign the immunization priority queue?
The ultimate objective is to get 100 percent of the population immunized. Initially setting tiered priorities was critically important given the early limited vaccine supply. Moving forward, simplifying the vaccine allocation process is imperative to allow it to function and serve its purpose on the national scale.
Every day that vaccines sit in a refrigerator is one extra day people remain vulnerable to infections and spreading the virus. Getting vaccines in the arms of at-risk populations over 65 years of age directly protects such people from poor outcomes, including hospitalizations and deaths. The benefit for such immunizations is clear, in both the short and the long-term.
Vaccinating people under 65 years of age prevents them from spreading the virus and moves our nation closer to the end game — herd immunity and population health. Designing the vaccine allocation process with this goal in mind is the surest and quickest way to get to the finish line.
The CDC fatality risk data suggests that anyone over 50 years of age should have access to vaccines, with age verification straightforward to accomplish. In addition, people under 50 who are at risk of contracting and spreading the virus, such as service workers who support essential services, TSA officers at airports, educators and hospitality services workers, should be targeted and vaccinated. Moreover, vaccination decisions should be at the county or community public health levels, since each area has unique characteristics that lend themselves to unique vaccine allocation decisions.
Are the vaccine manufacturers at fault for not creating the necessary supply?
Pfizer and Moderna have economic incentives to maintain their manufacturing supply chain. They are best suited to manage manufacturing risk and keep their production processes operating and at full-capacity. However, they can only send vaccines as directed by the federal government. In addition, Johnson & Johnson plans to submit their vaccine for Federal Drug Administration (FDA) approval shortly. If approved under Emergency Use Authorization (EUA), this will add a third vaccine to the public health arsenal. The Johnson & Johnson vaccine uses a well-established adenovirus-based process, making it more acceptable to those who remain skeptical of mRNA vaccines like the Pfizer and Moderna products. The Johnson & Johnson vaccine also requires just one dose, with no significant cold chain requirements, making distribution much simpler, especially for rural areas.
Is the vaccination infrastructure the problem?
Vaccines do not reduce COVID-19 risk unless they end up in people’s arms. With millions of doses of vaccines sitting in high performance refrigerators, the public health cost of keeping them there is far greater than the risk of not using them.
Distributing vaccines based on the capacity to vaccinate people — not based on population size — makes sense. Some states have run out of vaccines, while others have not. Realigning shipments based on areas that can effectively vaccinate people in their communities is a must.
An even greater issue of importance is that the immunization process may need to be used again in the future, if on-going COVID-19 immunization is required. Viewing the immunization process as a one-time event is flawed. As much as Operation Warp Speed was a Moon Shot program to get vaccines developed, a similar Moon Shot program for ongoing public health mass immunization should be on President Biden’s agenda. Until this possibility is fully digested, short-term efforts (like using the National Guard) will offer little permanent relief to an already challenging long-term public health deficiency.
Vaccine manufacturing risk is not the immunization bottleneck; the last mile of getting vaccines in people’s arms is. The need for skilled health care professionals to administer these vaccines has never been greater.
With herd immunity as the end goal, building and maintaining an efficient and effective vaccine supply chain infrastructure is supported by risk-based analytics, providing the pathway to breakdown vaccine supply chain bottlenecks.
Sheldon H. Jacobson, PhD, is a founder professor of Computer Science at the University of Illinois at Urbana-Champaign. His research on risk-based security provided the foundational concepts that led to TSA PreCheck. He served as a member of the National Academy of Medicine standing committee for the Strategic National Stockpile in 2015-2017.