A Better Federal System for COVID Vaccinations

SMITH BRAIN TRUST – Around 1.7 million COVID-19 vaccine shots are being given per day in the United States. This translates to roughly 12% of the population having received a first dose with just 4% being inoculated with both two shots. Public health experts have pegged three million shots per day as a goal that’s appropriate.

However, an obstacle is a governmental IT structure dragging the vaccination effort, says Maryland Smith’s Henry C. Lucas. Disjointed state and local efforts to administer vaccinations stem from a lack of Federal government IT support – “from mismanagement and poor design,” he says.

“Apparently few lessons were learned from Healthcare.gov – the previous, huge public-facing information systems failure,” says Lucas, Robert H. Smith Professor of Information Systems Emeritus. Early in the pandemic, the focus was singularly placed on vaccine development, leaving vaccine administration to the states. “Systems planning should have started as soon as the nation realized the pandemic in early 2020,” he says. “As a result, the country is confronted with a patchwork of systems – cobbled together at state and local levels – that require work-arounds to function.”

The results, Lucas says, have varied through these key components of this patchwork:

The CDC Vaccine Administration Management System (VAMS) – a $44 million no-bid system built by Deloitte – is known for bugs, including randomly canceled appointments, unreliable registration, and problems that keep the staff from accessing the system.

The HHS portal Tiberius – built by Palantir during summer 2020 for allocating and planning vaccine distribution and ordering vaccines – appears to be working well at the federal and state levels.

VTrckS – a 10-year-old CDC legacy system built by multiple vendors – provides for states to order and distribute shots. The system also is Tiberius-connected through users downloading files from one system and uploading them to another.

Local registration systems have been problematic. An example: A Tucson, Arizona-based system is a front end to a health system’s existing patient medical record. As a result, the vaccination appointment looks as if one is a patient of the health system, not someone who only wants to be vaccinated. Meanwhile, the State of Arizona administers its own registration system.

Ad hoc registration systems – being built by volunteers – are using tools from Google Docs to spreadsheets to provide information on vaccine availability by site, how to register and more.

Measure these systems and early returns, Lucas says, against key tasks that a federally administered, integrated system would be designed to accomplish:

• Federal government vaccine allocation to states, including shipping instructions to FedEx and UPS
• State allocation of vaccine to vaccination sites and distribution to each site
• Different prioritization approaches and algorithms for each state and territory
• State registration for citizens to make appointments for vaccination at different sites
• Records of the vaccine, the lot number and vaccination location for each person receiving a vaccination
• State reporting on number of inoculations by vaccine type and remaining inventory levels
• Federal tracking of patient reactions to vaccinations

A well-designed Federal system would require “a designated team to gather system requirements from all types of eventual users of systems, including the CDC, HHS, state and county governments, public health departments, and medical personnel and staff who operate vaccination sites, as well as people who will register and receive vaccinations.”

Such a comprehensive system would be complex given different kinds of vaccines with different requirements like refrigeration temperatures, “but no more complex than many systems available to the public now,” Lucas says. “Plus, FedEx and UPS have superb distribution systems to get the vaccines to the vaccination sites once the Federal Government determines the shipping quantities for the week.”

Lucas notes that several successful tech firms have volunteered to help with the COVID vaccination effort. “How much better might IT support for vaccination be if the development team included people from Google, Amazon and Microsoft? They have built impressive websites for various kinds of transactions and have expert knowledge of the Internet and cloud computing.”

“Successful development of information technology requires good management decisions and good design,” Lucas says. “The United States should be able to do better than its efforts to date to vaccinate the population against COVID-19.”