Co-Author: Dr. Brad Crammond, Lead – Research & Insight, RMIT-Cisco Health Transformation Lab
At the beginning of 2020, as the world was only just learning of the existence of COVID-19, there existed no vaccine for anything that looked anything like a coronavirus. However close humanity had come to such a vaccine during the SARS outbreak in 2001, efforts had been shelved when traditional infectious disease control measures were sufficient to stop the disease spreading. Barely 12 months later, there are 7 vaccines approved for use and an additional 6 with limited approval. Most remarkably, there are another 82 candidates in human trials. While amazing, development of vaccines is not enough. It will take collaboration in vaccine administration to ensure those achievements are not in vain.
The central role of the vaccine(s)
For a time, across the globe it seems, policymakers, individuals, families and firms hoped that the development and deployment of a vaccine held the promise of a ‘return to normal’. While these hopes may have been overly optimistic, the events of even just the last few weeks have shown how central the vaccine dimension is in the response to COVID-19.
The United Kingdom’s vaccine program seems to be successfully intervening on the link between COVID-19 cases and deaths. Symptomatic cases have dropped 60% and hospital admissions are down some 80%. The British PM is starting to tell a tale of optimism – of a potential opening of society and everyday life in ways hitherto unimaginable in that country – with a large chunk of the credit being given to the vaccine program and its robustness.
Meanwhile, in Australia – where the curve was famously ‘crushed’ by a series of wide-ranging interventions across economy and society – a vaccine program that has lurched from crisis to crisis has now run aground upon the latest set of concerns around blood clotting and adverse side effects in respect of the preferred AstraZeneca vaccine. And while government has sought to reassure the population that alternative vaccines are being sourced, and that program deficiencies can be remedied, what perhaps began as a policy-cum-logistical problem is fast becoming a political one focused around trust and governmental competence. Opinion is now rounding on the floundering vaccine program – with accusations starting to sound that its weaknesses are risking a slower opening of economy and society, the continued shutting of international borders, and the persistent spectre of locality-based outbreaks and lockdowns – and all the disruptions that accompany them.
The mare’s nest: complexity and vaccines
It can be tempting to cast vaccine deployment as an issue of simple administration – of generating a robust plan and executing it efficiently.
But lurking behind seemingly logistical matters is a profoundly tangled set of issues that complicate collaboration in vaccine administration – issues that touch on multiple parts, players and interests in society. At the base of the conundrum is a delicate dance of public trust and collective action, that can come unstuck in many – at times unexpected – ways.
One cluster of issues concern strategy and sourcing. Securing a supply of the ‘right’ vaccines has confounded nations: questions of contracts for supply of vaccines that at the time did not exist. Decisions between different vaccine technologies. Dilemmas concerning the optimal mix of different vaccines. Choices between local manufacture versus reliance on internationally sourced supply in a context of geo-political context of sharpened national interest. Each of these have proved themselves a complicated set of issues to be navigated by governments and states.
Compounding these have been issues of prioritisation and need. Within countries, questions have been confronted concerning the sequencing of prioritisation of different cohorts for vaccination – be they frontline workers, the immune-compromised, the particularly vulnerable. But of course, many of these issues are complicated, political, and controversial. Trade-offs are hard and different logics compete. Addressing (real or perceived) vulnerability may not always pull in the same direction as addressing epidemiological risk factors. Transparency can be hard to come by, and agreement can be thwarted by divergent perspectives and values.
The logistics of it all
And of course, logistics are central, too. In Australia, doses of the vaccine have been in government’s hands since February, while the rollout has so far been unhurried, with numbers quickly falling behind the government’s own schedule. Whatever the precise causes of the delay are, they highlight the pivotal role of logistics in transforming a vaccine into vaccinations. Public health experts have long discussed the logistics barriers to vaccine provision either in the context of physical inaccessibility or populations marked by generalised mistrust of government. In Australia, where 20 million flu vaccinations are given in 3 months each year, the leisurely schedule is surprising. Here, digital technology can help a lot: from patient access and outreach to field hospital and mobile clinic set up, from supply chain management to data security, privacy and compliance. Confronting a very new logistical challenge demands that we avail ourselves of the new tools that can help us to do so.
Part of the challenge with these seemingly strategic, logistical or policy decisions is that – as we have seen in recent weeks in Australia – missteps can cause significant erosion of trust in not only vaccine programs, but the desirability of vaccination at all. The worst fears of those who question the safety of vaccines are confirmed, and flaws in execution give succour to those whose trust in government ebbs. And while reasonable minds can differ on questions of whether and when to be vaccinated, in order to achieve herd immunity, two-thirds of the population needs to be vaccinated. In the United States, approximately 25% of the population reports that they will refuse to be vaccinated. In Australia the number is only slightly lower at 19.4%. With none of the vaccines being 100% effective, reaching herd immunity vaccination thresholds becomes complicated, and poor vaccine program administration needlessly risks increasing that complexity.
The conclusion: a call for collaboration in vaccine administration
Perhaps the central lesson to emerge from all of this is the need for a kind of collaboration between players – governments, technologists, industry players, clinicians and service organisations – if vaccines are to be converted into vaccinations, and if COVID-19 response to be truly successful.
An intriguing aspect of the COVID-19 vaccine space is that the most successful vaccines have been developed by private pharmaceutical companies, upending long-held complaints that most innovation happens within publicly funded universities with Big Pharma getting a free ride, trading patent rights for the capital required to get a novel drug through Phase 3 trials. But as we can see, pharma companies cannot – alone – solve the vaccine conundrum. Nor can governments. Nor doctors. Nor individuals.
Collaboration in vaccine administration is key: if we are to successfully execute the vaccination dimension of COVID-19 response, we will do so together – or not at all.
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