Latest COVID 19 Vaccine Distribution Analysis from Philip Palin

This article written by Philip Palin summarizes a tremendous amount of valuable information about the supply chain and logistics challenges for global distribution of COVID 19 vaccines. Many thanks to Phil for compiling and sharing this information, and for giving me permission to post it! Please help us spread the word by sharing with your networks, and feel free to add additional information and links in the comments below.

On January 15 the President-Elect outlined priorities for accelerating vaccinations. In many ways, it was a supply chain speech. Mr. Biden focused on increasing supply, increasing access to supply, and more effectively motivating, serving, and targeting demand. Several of you were listening. Several of you especially noticed this part of the speech:

If we’re getting more people vaccinated, then we need more vaccination sites. That’s why we will harness the full resources of the federal government to establish thousands of community vaccination centers. On my first day in office, I will instruct the Federal Emergency Management Agency, FEMA, to begin setting up the first of these centers. By the end of our first month in office, we will have 100 federally-supported centers across the nation that will ultimately vaccinate millions of people. Think of places that are convenient and accessible. School gyms. Sports stadiums. Community centers.  

Site-selection for these federally supported community vaccination centers will give priority to serving populations most impacted by covid-19 and with the least access to other vaccination options.

In his speech the President-Elect also communicated his intention to "fully activate pharmacies across the country to get the vaccines into more arms as quickly as possible."

As the Supply Chain Resilience Technical Assistance cohort has discussed since October (see below), there is a particular need to motivate, serve, and target demand in so-called "vaccination deserts". Each of you are uniquely qualified to assist in this process. As previously emphasized, PolicyMap has developed an important set of research and targeting resources helpful to this mission.

Below is a November 30 email outlining three action steps relevant to this newly prioritized mission.The November note was focused on how you can help your Public Health colleagues. That collaboration remains crucial. The differences starting next week include the promise that this work will be a federal priority with related funding and other resources specifically calling on emergency management leadership.

Several of you are deeply engaged in very current efforts to accelerate vaccinations to those over age 65 and to key personnel in crucial supply chains. Mr. Biden noted that over-65 accounts for over 80 percent of deaths-to-date. The President-Elect said, "We must also continue vaccinating frontline essential workers like educators, first responders, and grocery store workers." We know that this extends to truckers, distribution center workers, food manufacturing personnel, and others who supply the frontline. Your continued work to vaccinate these workers remains as important as ever.

By statute, functions, and culture FEMA is organized to support state and local emergency management. Many of you are already engaged in doing the research, outreach, site selection, and scheduling necessary to stand-up federally supported community vaccination centers. Your work now has even greater priority and urgency. Please do not assume others are doing this.  Please do not underestimate your own strengths, especially in regard to local insight, local relationships, and your understanding of how demand and supply networks behave. 

Please let me know how I can help you.

[Philip J. Palin supports the FEMA-NIC Supply Chain Resilience Technical Assistance Program as a Subject-Matter-Expert. The background, points-of-view, and opinions expressed by Subject-Matter-Experts do not necessarily represent the positions or policies of the Department of Homeland Security or the Federal Emergency Management Agency.]    

SEVERAL PRIOR PARAGRAPHS REMOVED

So... here's my try at practical suggestions that reflect Supply Chain Resilience principles and the skills this TA program has attempted to develop:

First, demonstrate your demographic (demand) awareness. Try -- again -- to collaborate and coordinate with public health. In the midst of the current challenges they may be doing more than they have told you. It is also possible that they do not realize you have some relevant skills. You may need to make a small investment in demonstrating that you are worth their time. (This is similar to the technique we use for reaching out to private sector colleagues with early research outcomes).

On November 2 the CDC released a revised list of medical preconditions strongly associated with severe cases of covid-19. The CDC has also released a set of other factors that increase risks associated with covid-19. Some of these factors are coincident with demographic indicators that Supply Chain Resilience research can target. There have been several credible studies of demographic risks (gender, age, economic condition, marital status, etc.) that show increased risk for covid-19 and that could be helpful in targeting demand management strategies. For example, here is one study from the September edition of the American Journal of Emergency Medicine that found older men with preexisting difficulty breathing. Another study from the Journal of the American Medical Association found higher fatalities among covid patients with the following characteristics: older age, male sex, morbid obesity, coronary artery disease, cancer, acute organ dysfunction, and admission to a hospital with fewer intensive care unit beds. In a recent study the New England Journal of Medicine reports, "black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black." These are demographic factors that most TA participants know how to research, map, and target. Most of us are not competent to choose which demographic factors should drive demand management in your jurisdiction, but you can demonstrate your competence to develop data-informed demand management tools.

Second, find your concentrations of demand.  (Again, preferably in collaboration with public health.) Every TA jurisdiction has previously identified local so-called "food deserts". I betcha -- I hypothesize -- that you will discover that most food deserts are also "vaccination deserts" and the demographic profiles of these neighborhoods track with higher risk of hospitalizations, severe disease, and covid-19 mortalities. 

Dig in, find out, prove me wrong. But if this is confirmed, you will be developing demand-management maps for vaccine distribution that are not all that different from what you have done to support resilience of food or fuel networks.  Our good friends at PolicyMap have already jump-started this process.  Further, my November 16 note to the cohort provides information on how to use mobility and other data-informed models to more accurately identify "super-spreader" places, also-known-as potential concentrations-of-demand (or at least need).

Third, engage your preexisting (or make new) relationships connected to these concentrated populations. How, when, and where is demand (or reluctance) expressed? Who owns or operates these places? Do these places have the resources to serve as effective vaccination venues? 

How can you help them? Who has the most credible and influential preexisting relationships with your concentrations of demand? Work places? Faith communities? Schools? Bars and restaurants (these owners/operators should be vaccination motivated... how about promoting a free jab followed by a free beer?) The current federal distribution strategy (see prior emails and links below) depends on preexisting pharmacy networks -- including pharmacies in grocery stores. You can help your jurisdiction -- and even the pharmacies -- better understand which neighborhoods and networks may be especially valuable to proactively engage and how to engage.

Working through these issues with one TA participant, s/he wrote, "We should use the community organizations as the owner of demand (eg our Ukrainian orthodox leaders will know far better than we can what percentage will get vaccinated and who and how to target vaccines most effectively to develop herd immunity within a community that is religiously and culturally opposed to vaccines). Supply Chain Resilience typically depends on developing relationships with market-leading owners of preexisting demand. This is at the core of current HHS/CDC/OWS vaccine distribution strategy. But In the case of vaccines, we also need to be in relationship with market-leading "owners" of reluctant demand. 

How to engage each vaccination desert will reflect place-specific and population-specific issues of differentiated and variable demand and, almost certainly, lack of trust. Your hyper-local familiarity and connections will be fundamental to making meaningful progress. What works in one vaccination desert may be counterproductive in another. (Pre-pandemic research on trust issues related to vaccination.) In your vaccination deserts can you find preexisting oases of trust? If so, these are promising places to focus outreach and action.

But just to nudge your mind into demand management mode: how can coupons or other price rebates be used to reward vaccinations (especially second dose consumers)? What if every person vaccinated in the middle of a particularly drought-prone vaccination desert is automatically enrolled in a drawing for a fabulous post-pandemic vacation? What if every vaccination in a target neighborhood receives gift-points for restaurant meals? How about a lottery for free tickets to future music festivals? (Please notice emphasis on sectors hit hardest by Non-Pharmaceutical Interventions.) I am probably embarrassing myself with these cheesy marketing ideas. But there is plenty of evidence that demand motivation will be needed. (Anticipated advertising campaign). There is the opportunity to motivate through self-interest and other-concern, reinforcing that vaccination is the best way to protect others and restore many of our neighbors' livelihoods. To do this, community engagement will be needed. Involving the whole-community will be needed. Trust-building will be needed. Each of you have these skills. Deploying these skills to motivate vaccination demand will enhance your ability to encourage community resilience for a wide range of other risks.

At the core of Supply Chain Resilience are research, outreach, and action. Your preexisting skills in each domain can be very helpful to setting the foundation for effective Phase 2 and 3 vaccinations. Working this problem (opportunity) will enhance your ability to engage future Supply Chain Resilience problems.

[Philip J. Palin supports the FEMA-NIC Supply Chain Resilience Technical Assistance Program as a Subject-Matter-Expert. The background, points-of-view, and opinions expressed by Subject-Matter-Experts do not necessarily represent the positions or policies of the Department of Homeland Security or the Federal Emergency Management Agency.]