COVID-19: The US needs to be a leader in implementing vaccines

Caveat and Bona Fides: 

Aside from being a healthcare consumer and a potential victim of the COVID-19 pandemic, I have no experience or expertise in public health or healthcare. I try to be well informed by paying attention to reporting from several high-quality, relatively non-partisan news sources, I am certainly not fully informed.

However, I am experienced in planning and implementing large, complex projects and in disaster preparation and recovery, in both the telecommunications industry and the federal government.  I was part of the core team that planned and managed the implementation of the Bell System Divestiture, which was, at the time, the largest corporate restructuring in history, one that involved about 1 million employees and thousands of locations across the Nation. I was also part of the team that restored service and re-built the network after the 9/11 terrorist attack on the World Trade Center, which resulted in perhaps the largest single outage in the history of the telecommunications industry. Experience taught me that it pays to be almost paranoid about what might go wrong. 

What is the concern? 

We know today that safe and effective vaccines will be approved soon, hopefully in a few weeks or months. We know today that we will want to vaccinate hundreds of millions of people as quickly as is safely possible. 

Upon approval, vaccination will take center stage, an undertaking critical to life and death, health, education, business, and national economic prosperity and security. For you and me. For your family, friends, and neighbors and for mine. 

It will be a huge and complex task. Success requires detailed, careful, coordinated planning and management across thousands of organizations. 

Yet, I see little to no evidence that a rigorous, detailed, constructively critical scrutiny, and coordination of plans is currently underway. Letters to my Senators and Congressperson have been unanswered.  I see scant coverage in the media.

Why be concerned? 

 A lot can go wrong. And, if it does go wrong, we will suffer the terrible human and economic cost of prolonging the pandemic longer than need be.

Decades of experience with large, complex projects warns me that when we start manufacturing, distributing, and administering vaccines we could have a repeat of problems similar to those we suffered through in the early days of the COVID-19 pandemic: the testing, ICU capacity, and PPE debacle

Unanswered policy and implementation questions could slow progress. For example, what is the estimated market demand; how many people are likely to want a vaccination or be required to get vaccinated? Will we require vaccinations to return to schools, return to workplaces, attend large events, etc.? Who pays for distributing and administering vaccines? How will they get paid? 

Resource shortfalls could delay or slow manufacturing. For example, what raw materials, equipment, and labor are required to manufacture vaccines? Will we have enough and with the required quality and within the desired timeframe?

Ditto distributing vaccines. For example, if the vaccines need to be refrigerated, is there enough refrigerated transport and storage capacity? 

Ditto administering vaccines. For example, will we have adequate vaccination sites, trained people, syringes, and alcohol wipes? 

Ditto managing the whole process. How will we measure and report progress to ensure transparency and equity? How will we rapidly detect and fix the inevitable problems that arise? Is there a defined process for prioritizing and escalating issues as they arise? Are the plans coordinated and synchronized across the whole end-to-end process of manufacturing, distributing, and administering vaccines? Do manufacturers, distributors, and first line healthcare providers understand and agree with their respective roles and how they inter-relate? Do federal, state, and local government agencies understand and agree with theirs?

What to do?

Start four things in parallel; they are all important.

First, raise public awareness of the potential issues and the need to assign them higher priority. We all can escalate our concerns to our Governors, Senators, and Congresswomen/men. Investigative journalists can lean in too, devoting more media exposure and high-quality analysis to potential problems and their consequences. A bad plan should be news; a bad implementation will be worse news

Second, appoint a single “National COVID-19 Vaccination Czar” accountable for 1.) building a consensus on our vaccination goals, in cooperation with federal, state, and local government leaders and experts, industry leaders and experts, and the public, 2.) developing, stress-testing, and coordinating the plans to meet those goals, and 3.) managing the implementation of the plans and, inevitably, adjusting the plans as we learn in the real world. In short, the Czar is accountable for our successes and failures in safely vaccinating as many people as possible as quickly as possible.

Third, we can solve virtually any problem if we have enough lead time to do so. We can and should predict potential problems, with both great care and urgency, and get about fixing them. We have weeks or months to do so if we start now. Time will be our enemy if we delay. Time can be our ally if we start now. 

Fourth, identify best practices from the vaccination plans from other countries, especially those that have a done better job so far in managing the COVID-19 pandemic, for example South Korea.

Charitably, given the novelty, scale, and rapid on-set of the COVID-19 pandemic, we might deserve a “hall-pass” for our early abysmal performance. But there will be no excuse for screwing up manufacturing, distributing, and administering COVID-19 vaccines by having poor quality, incomplete, and uncoordinated plans, plans that do not anticipate and fix likely implementation problems now.