Managing 2nd doses (well)

Managing Second Doses (Well)

Verto Health has over 430,000 2nd doses currently booked across all clients. Of these more than 100,000 were “bulk rescheduled after the decisions to go to 16 weeks was made by the Science Table. This experience base leads us to some observations on the challenges of rebooking 2nd doses and also some opportunities. We do not have access to other systems data and so I will speak here only from our own data.

Comments on 112 (16 weeks). The reasoning behind 112 makes sense.  When we look ahead this what we see on our 18% of the province’s data:

Grey is completed, green is scheduled and blue is cancellations (102k through bulk rescheduling mainly).  Deferring the 2nd dose means that there is a bolus of operational capacity that needs to be available in June, July and August.  If enough first doses are done by the middle of June this may be fine. If not then new capacity will need to be online as we deliver both first and second doses. Alternatively, some smoothing of the capacity could be done through 2nd dose “pull forward” through automated early appointment offers for 2nd doses. There are some really practical logistical issues that intersect with the science and equity issues and should be discussed. Where systems do not support automated rescheduling, these options may not be being discussed currently. They totally should be.

Some example ideas of Policy Changes That Become Possible:

Easier switching of location for second doses. The current default is same center for all 2nd doses. Anecdotally, It requires a major effort of call center workaround to reschedule for some IT systems. This is problematic given 112 for several groups and reasons:

o  Students and other learners. Particularly in healthcare who are getting their second doses at home our at their PGY1 location

o  Cottagers. This would involve some reallocation among PHUs. I know this is not a particularly politically sympathetic group but if this is not addressed it will increase vaccine hesitancy

o  People who have moved. I have a personal friend who was vaccinated this week who has bought a house 400 km away in Ottawa and moves in June

o  The need to shuffle supply by type of vaccine among centers -- another potential logistical nightmare for the summer

Bulk moves on vulnerable groups made by the Science Table. Reading recent scientific articles it occurs to us that there may be a desire to move targeted groups by age or health status. Again, good software can enable better policy options. You could, for example:

o  Get an increased shipment of one vaccine type and choose to move all forward one month

o  Decide that an older age group should only wait two months and move from 112 to 56

o  Note an outbreak in a particular region and decide to deploy 2nd doses there quickly (particularly important if a variant could be a break out VOC)

o  Support booster regimes and new vaccines if a more severe VoC occurs

Bulk moves for vaccine targeting reasons. Geotargeting to date has been focused on 1st dose FSA targeting. This makes sense because the 1st dose impact on herd immunity is high.  But there may be a complementary strategy around 2nd doses. One could fairly simply offer bulk rescheduling at an earlier date to people in FSA or other categories that are high risk. This can be done using automation through email and SMS.  

THE HOW! Call Centres vs Automated bulk rescheduling of second doses. Using a call center to reschedule a second dose requires an average of 5+ minutes of call centre effort per rescheduling event. This causes both a bottleneck in call centre capacity and serious cost issue at about $3 per reschedule. Most of the better software systems have an automated rescheduling function. For example, Verto uses SMS and email to automate rescheduling with clients. This includes active confirmation from the recipient. More than 95% of 2nd doses can be rescheduled this way (probably 99%). This drops call centre costs by a full order of magnitude.

Verto developed this capability in part because we started automatic scheduling in December and so we had more than 100k 2nd doses that needed to be rescheduled when the Science Table made the 16 week 2nd dose decision. In fact, at least one client (London HSC) has said publicly that one reason they came onto our software was because of this feature; they report having taken 80% out of call centre costs.  This feature is critical to the smooth rescheduling of doses if and when this is needed. Without this it will be a customer service fiasco. This will increase vaccine hesitancy and undermine provincial goals. This issue needs an operational strategy ready to go if/when a change is made.

Bottom line: It is pretty likely that the Province is going to need to move medium to large groups of 2nd doses for logistical and/or policy reasons. We need to make sure that a solid capability exists to allow this to be done flexibly, nimbly and at a low cost.

Good Tech Creates Policy Options!