We the People — Must Vaccinate with Speed and Equity: Reflections from a Vaccinator

By Rebecca Weintraub, MD

Today, we mark a new chapter in how the United States Federal government will respond to COVID-19.

Over the past month, I have served as a vaccinator at Brigham and Women’s Hospital in Boston. This hospital holds great meaning: it’s where I work, trained, delivered my children, and have been a patient myself. But it’s in my most recent role here — as vaccinator — that I’ve come to understand the shared work of healing after prolonged stress and grief. We’ve rolled up our sleeves for the better part of a year, but this time, of course, is different. Each injection brings hope and relief.

As eligibility pools expand beyond health care settings, the picture is not so tidy. The shared work of healing has become alarmingly unwieldy, especially in the midst of the federal leadership vacuum and scarce vaccine supply. Six weeks after the first shots were given, only about 12.3 million doses have been administered out of more than 31 million distributed, or 39%. Our epidemiologists estimate that 245 million must be vaccinated to reach widespread or “herd” immunity.

States have done their best to get programs up and running. Encouragingly, this week CIC Health, in partnership with the Commonwealth of Massachusetts, Gillette Stadium, Mass General Brigham, Fallon Ambulance, DMSE Sports, and PWNHealth, opened the State’s first mass vaccination site. In California, a community-driven effort called VaccinateCA is helping Californians access accurate, up-to-date, verified information about the COVID-19 vaccine so that they can learn when they will be eligible and how to take their place in line. Across the country, stadiums are opening to get shots in arms. Yet state leaders continue to face unpredictable supply, and the public must navigate a decentralized and underfunded patchwork of organizations tasked with moving mountains.

Today, this federal government has shared its plans to transform the COVID-19 response including the vaccine rollout. Today the US starts the clock — with a common goal — 100 million doses in 100 days.

How can we skillfully manage the dynamics of vaccine supply and demand to support state efforts? Three key elements require immediate investment:

A trained workforce to carry out large-scale vaccinations.

First, we urgently need to expand the workforce to help administer COVID-19 vaccines as supply and demand ramp up. The new administration proposed spending $20 billion to establish community vaccination programs and requested funding from Congress to hire 100,000 health workers.

States are already constrained and local public health authorities are overstretched, using their limited resources not only to roll out vaccine campaigns but also to maintain routine health services.

Complicating the matter is that states currently require different qualifications for those seeking to become vaccinators. While doctors and nurses can provide vaccines in every state, other providers like medical assistants, physician assistants and midwives can only do so in some states. Here are the current requirements to become a vaccinator in every state in the nation.

Facing pressure, state governors are slowly modifying these requirements and mobilizing training programs to expand the vaccinator workforce.

As part of the administration’s new public health job corps, vaccinators can also be deployed nationally as need mounts. Efforts to recruit vaccinators is of equal importance to the administration’s promise to greatly expand vaccine access points, such as stadiums, school gyms, mobile clinics, and community centers.

An adaptive scheduling system that covers all channels of delivery.

Secondly, we urgently need an adaptive scheduling system for COVID-19 vaccination.

Right now, every state is on its own to figure out how best to schedule eligible residents for vaccination. Our patients are attempting to navigate online forms and notifications — it is a maze. We can leverage the best of machine learning to build adaptive scheduling software to achieve economies of scale and scope. Minimizing barriers to appointments will ensure that people can get their place in line efficiently and equitably, with minimal vaccine wastage. The airline industry uses an algorithm to ensure their flights are full; we can borrow this methodology to ensure that our immunization schedules are full and that both supply and people are moving as quickly and as clearly through the system as possible. Upgraded immunization scheduling will also have the ability to adapt as new distribution channels emerge and new vaccines are approved and delivered.

A centralized dashboard with real-time data to monitor equitable distribution.

Finally, we need a centralized dashboard of real-time data to monitor the distribution of COVID-19 vaccines and determine areas with the greatest need, from the CDC Data Lake or Palantir’s Tiberius system, a data analytics system to track COVID-19 vaccine distribution.

Currently, state-level data availability remains patchy, as shown below.

Anonymized, real-time data should be available so that local- and state-level leaders can monitor, and adapt vaccine allocation and fine-tune efforts to vaccinate the most vulnerable. Poor data quality is a bottleneck for all our efforts. We need the local, state, and national data to lower the fence and to deliver the vaccines with both speed and equity.

Today is cause for celebration as a new administration takes the reins on curbing this deadly disease with science-backed strategies. With enormous challenges ahead and rising expectations, we need to galvanize our sense of service to volunteer, line up, and share data to ensure that those who are ready and eligible for the vaccine can get it. The shared work of healing begins now.

Thank you to Ariadne Labs’ Laura Subramanian, Senior Specialist of Monitoring and Evaluation, and Kate Miller, Senior Scientist, for their research.

Rebecca Weintraub, MD is an Associate Physician and Vaccinator at Brigham and Women’s Hospital, Assistant Professor at Harvard Medical School, and Director of Better Evidence at Ariadne Labs.

Illustration by undrey / iStock