To infinity and beyond: Digital health’s role in vaccine rollout
Vaccine distribution is logistical rocket science. The challenges are all too familiar by now: an estimated 70-80% of the population needs resistance for herd immunity. Global distribution must happen throughout hundreds of countries, each with a different healthcare system, rollout plan, and level of access to vaccine supply. Within the bounds of the U.S., coordination between federal, state, and county public health offices as well as pharmacies, hospitals, and employers is overwhelming. While high in efficacy, mRNA vaccines are difficult to transport due to cold chain requirements. With two doses required, scheduling, tracking, and getting the second dose on time adds further complexity, and vaccine distrust (even among healthcare workers) is a hurdle that smooth logistics alone will not solve.
Since the first vaccine in the U.S. was administered in December, several additional challenges have emerged. Inequitable distribution is preventing the communities hardest hit by the pandemic from having access to protection, with Black Americans receiving the vaccine at rates consistently lower than their portion of the population and healthcare workforce. Research from GoodRx uncovers “pharmacy deserts” as a key vaccine-access obstacle for many communities in both rural and urban areas. And while trustworthy information is one of our best weapons against the pandemic, critical coding errors and data lags have posed a threat to accurate assessment of vaccination progress in California—the nation’s most populous state.
Digital health offers a path forward
From alleviating burdensome administrative challenges to creating a secure and interoperable record of immunization status, digital health solutions are emerging to support this effort.
Information dissemination: How can the spread of information be scaled to help people find factual resources, while building public trust at the same time? Google is committing $150M to fund public health announcements, and supporting fact-checking research through the COVID-19 Vaccine Media Hub. Livi is deploying a text-based vaccine information campaign throughout the NHS via MJog, while Buoy is offering vaccine education modules and workforce interest surveys to employers.
Eligibility, scheduling, and registration: Providers and patients alike must have tools to confirm eligibility, facilitate e-consent, and schedule appointments for multiple doses. In the absence of secure infrastructure fit for this purpose, Florida counties turned to Eventbrite as a stand-in. Notable, ixLayer, and Zocdoc are all working to address this by deploying solutions designed for vaccine workflow.
Transportation: Assuming everything else goes according to plan, people then need to actually get to the vaccine. What are solutions that can help at-risk populations feel safe leaving their homes to get vaccinated? Lyft and Uber are in on this one, collectively committing 70 million free or discounted rides to and from vaccination sites, with Ride Health focusing on transportation for participants in ongoing clinical trials.
Vaccine delivery: The actual administration of the vaccine on such a mass scale is a Herculean effort. Juggernauts and national organizations have an opportunity to leverage their physical space, donate, or contribute other resources (like workers) to the cause. We’re also seeing new private-public partnerships assemble, such as Washington state working with Seattle-based companies like Costco, Microsoft, and Starbucks to achieve 45 thousand daily vaccinations. Notably, German-based Wingcopter has developed a drone-delivery-as-a-service solution to distribute vaccines to developing countries.
Post-vaccine monitoring: With new vaccines developed in record pace, closely tracking adverse events after vaccination is a necessary part of the process. Solutions which can predict, monitor, report, and act on adverse events will be valuable, as well as those that can support continued research of vaccine efficacy and safety. For example, the UK’s Medicines and Healthcare Regulatory Agency has contracted Genpact to use artificial intelligence to analyze adverse event reports.
Immunization records: How will people easily move through the world once again? This will require innovation around proof of vaccination and herd immunity tracking. A coalition of organizations including Mayo Clinic, Epic, and Salesforce have formed the Vaccination Credential Initiative to support interoperable, FHIR-standard access to digital vaccine records. IBM and Safe Health are both taking advantage of the opportunity to develop blockchain-based solutions for travel and crowd safety, and Denmark is racing to implement a national vaccination passport.
End-to-end support: Who is in a position to crack multiple challenges within vaccine distribution? A few companies are stepping in with more comprehensive solutions, such as Luma Health, with a platform for patient education, eligibility, scheduling, virtual waiting room, contactless check in, and adverse event reporting. Dimagi is focused on lower- and middle-income countries, looking to tackle screening all the way through certification of vaccination. Just a few days ago, Google Cloud introduced its Intelligent Vaccine Impact solution to help governments with vaccine scheduling, analytics, and even COVID-19 case forecasting.
What are the gaps?
We see a few untapped opportunities. While there are solutions bringing people to the vaccine, what about bringing the vaccine to people (a la Dispatch Health or MedArrive)? There is also an opportunity for existing COVID-19 monitoring solutions to pivot into post-vaccine monitoring, and for wearables and remote patient monitoring infrastructure solutions to follow suit.
API developers could get involved in integrating tech around proof-of-vaccine with tools people use (or used to use) everyday—travel, restaurant booking, dating apps, events, etc. They’ll need to pay close attention to privacy regulations as they build tools facilitating the transfer of personal health information into new and challenging territory.
With every solution, cyber security must be a persistent focus. Breaches of vaccine scheduling systems have already threatened the fairness of eligibility-ordered vaccine rollout, and there is a severe risk of vaccine distribution through an unregulated black market. To get vaccines to where they’re most needed first, new innovations will need air-tight data environments.
Another step change in innovation
We recently predicted that 2021 could be the year digital health gets its data together, with momentum building towards interoperability. This flurry of innovation around vaccine distribution could also lead to some long-awaited changes in how consumers interact with health data. With immunization records soon to live in an app on our home screens, will proof-of-vaccine tech also act as an accelerant for widespread patient access to medical records? There is already a regulatory force steering the U.S. sharply in this direction due to the 21st Century Cures Act. Will this finally be the push that gets medical records on our home screens?
So far, this vaccine effort has been a largely “just in time” production kicked into high gear to lift us out of a devastating global crisis. The lessons learned from this time of need could also inspire a new vision for vaccine discovery, development, and distribution. We hope to see a seamless end-to-end experience for patients from education to immunization records, with a supply chain that minimizes waste. Those innovating specifically for the COVID-19 vaccine rollout can become champions of this vision for the future if they commit to long term investment in improving routine vaccine delivery.
The emergence of vaccine wraparound tech will provide essential infrastructure to move toward herd immunity. Perhaps it could even be rocket fuel to reach a new horizon in digitally enabling healthcare.
Rock Health Consulting supports enterprise clients on digital health strategy. For more information, reach out to advisoryservices@rockhealth.com.