If you live in West Virginia and sign up on a new platform to be on standby for the COVID-19 vaccine, you’ll have a chance to make an appointment when doses are available for your priority group. But the system, rolled out on January 25, goes a step further: If someone doesn’t show up for an appointment, or if pharmacists are able to squeeze extra doses from vials, the platform can instantly contact the next eligible people on the list.
“Our governor’s directive is not to waste a single dose,” says Andy Malinowski, who leads the communications team for the West Virginia Department of Commerce.
The new system, created by the tech company Everbridge, is also designed to deal with mounting frustration from people who have been trying unsuccessfully to sign up to get the vaccine through call centers. “People were getting busy signals when they were trying to get signed up,” says Brian Toolan, Everbridge’s senior director for public sector strategy. Anyone with internet access can now use the digital platform instead to be put on the list. When doses are ready, they’ll be asked if they can come to get the shot at a particular date and time; if they can, the system instantly schedules them. People who don’t have internet access can join the platform by calling a phone number that’s now less burdened because most people are going online.
Other states, counties, and healthcare providers are turning to similar online scheduling platforms, though not necessarily with the added step of accounting for every dose. “If they have 500 people scheduled for a location and only 400 people show up, we don’t want to waste another 100 doses,” Toolan says. “So they have the ability to go right into the system and send out a message in a two-mile radius of that vaccine site, and say, ‘hey, we have an available dose for you right now if you’re able to come to this location in the next two hours’.”
Once a vial comes out of refrigeration and is prepared for administration, it has to be used. If some people don’t come for their appointments, that’s a problem. The number of doses in each vial is also unpredictable—Moderna’s vials contain 10 or 11 doses, and Pfizer’s contain five or six doses. (Pfizer, controversially, told the U.S. government that it would deliver fewer vials of vaccine after it was discovered that extra doses could be extracted with the right syringe.) In Los Angeles, young people who aren’t yet eligible for the vaccine have been camping out at vaccination sites in hopes of getting extra doses that are left at the end of the day. The system in West Virginia can help the process run more smoothly and equitably.
It’s one tweak to help improve the chaotic rollout of COVID-19 vaccines. Across the country, states are struggling, although West Virginia is doing better than others at distributing the doses of vaccines it’s received so far. For every state, one of the challenges has been funding: By mid-December, when the COVID-19 vaccine was approved for emergency use, the Trump administration had thrown $12.4 billion at vaccine development and toward ordering doses. But although another $8.4 billion was needed for states to actually distribute the vaccines, the federal government initially gave only $400 million. California—one of the states now doing the worst in distributing vaccines—had “a reasonable plan,” says John Swartzberg, professor emeritus at the School of Public Health at the University of California, Berkeley. “But they couldn’t execute that plan, because there were no resources to do that.”
As vaccines were approved from Pfizer-BioNTech and then Moderna, public health departments that were already underfunded didn’t have the money to hire and train all of the people who would be needed for a smooth rollout, from the people giving the shots to people trained in how to safely move the vaccines between freezers and trucks. At a time when many states and counties were consumed with a surge in COVID -19 cases, they didn’t have the resources to set up fully functioning distribution systems or technology like the platform now in use in West Virginia. Arguably, all of that should have happened in each state months earlier, so vaccines could get into arms as quickly as they arrived from manufacturers.
In the second COVID-19 relief bill in late December, lawmakers included $8 billion for vaccine distribution. “We need to pour a ton of money into every state to give the states the resources to execute their plans,” says Swartzberg. “That’s going to work.” The federal government also needs to give states clear guidance with their plans, he says.
Technology is one part of the solution, says Olaf Groth, who teaches at Berkeley’s Haas School of Business and focuses on global supply chain issues. “I believe if the president and [California’s] governor are serious about this, and really treat this like a war, we can mobilize the tech community,” he says. Tech platforms could potentially help with complex challenges like redistributing vaccines from one part of a state to another to match demand. But Swartzberg says that companies like Amazon, which have offered to help as the vaccine rollout flounders, should have made their offers months earlier; it will be difficult, at this late stage, to incorporate their technology into the process.
Still, he says that the issues with vaccine distribution can be addressed, from notifying states about deliveries to using leftover doses. “The problem is certainly solvable,” Swartzberg says. “It’s a logistical problem. It’s solvable, but it needs adequate resources.”