Outside the Box: This simple change would eliminate much of the COVID-19 vaccination chaos


If the distribution of COVID-19 vaccines seems chaotic to you, you’re not alone.

Despite the availability of three separate vaccines — those from Pfizer
and Johnson & Johnson

— many people who want the shot are struggling to get one, and the order of priority seems to have gone largely out the window, with a lot of individuals from lower-eligibility groups already vaccinated.

Moreover, there’s large disparity in terms of the share of a state’s population has already received one shot — from just 23% in Alabama and Georgia to 37.5% in New Mexico, according to regularly updated data published by The Wall Street Journal.

So what’s going on?

Ultimately, it’s a classic supply-chain problem. As a simpler example, a detergent-maker needs boxes and labels to package their product, then must get it on trucks and distributed to warehouses and retailers nationwide, all while paying careful attention to demand patterns. Simple-seeming problems like a shortage of labels or bad weather in a specific geographic region can throw everything off. I liken the supply-chain process to an orchestra; if one instrument is playing badly, the whole thing will sound off.

In the case of COVID-19 vaccines, multiple instruments are off-key, and it’s not any one group’s fault. Nor is the current, chaotic-seeming system without merit; for example, having less-eligible people who are ready and willing to be vaccinated get through the system ahead of more-eligible people who are slower on the draw actually makes for greater efficiency with vaccine distribution. A lot has already been written about reasons for the chaos in vaccine delivery—from wanting to vaccinate a large enough percentage of the population to drive herd immunity to healthcare workers’ vaccine hesitancy.

So I’ll focus here on a simple solution to the chaos, based on basic supply-chain principles.

Here’s the “big” idea: maintain a more truly centralized list of those who want a vaccine, and ask people who become eligible for appointments to confirm their appointment a day or two before they are supposed to show up.

That’s it.

A centralized registry, as you could imagine, would help to know the true demand—for both those distributing vaccines and those who want them. Without this, chaos ensues as people scramble to join as many lists as possible, and don’t update their status after they get the vaccine or opt out.

A weekly text asking ‘Do you want to remain on the list?’ should be a feature of every list.

Even if a “one-list-only” solution isn’t possible at the state level, centralizing the vaccine-availability information from a given provider—such as Walgreens
where it still takes multiple clicks to find out if stores near you have the vaccine (instead of quickly showing all vaccines available in a 20-mile radius)—could improve the situation.

To be fair, implementing an optimal list-based system may be easier said than done. For example, a centralized registry, like the system we have for organ transplants, would be more challenging for COVID-19 vaccines, given the volume of vaccines that must be delivered. States are doing their best to maintain such lists, but simply having them isn’t enough, as no-shows have been a consistent problem: when people miss appointments for a first or second dose, it results in a scramble to find “replacement arms,” and could result in waste.

That’s where the second part of the solution comes in: ask people who have vaccine appointments to confirm their appointments a day or two before, like many providers do for other procedures. This simple solution has proven to reduce no-show rates significantly. A call from a live human is ideal, but an automated reminder/confirmation system could definitely improve the current state of affairs.

A confirmation system would reduce no-shows, remove those no longer interested from the list, and give providers more time to find replacement arms for the shots. A weekly text asking “Do you want to remain on the list?” would be another simple way to improve vaccine-delivery efficiency and should be a feature of every list in play today.

In short, thinking of vaccine delivery as a supply-chain challenge and taking simple but strategic steps to improve on today’s system could get us a lot closer to the more “normal” times we’re waiting for.

Achal Basamboo is the Charles E. Morrison Professor of Decision Sciences and a professor of operations at The Kellogg School of Management at Northwestern University in Evanston, Ill.

Also read: Pfizer and BioNTech say COVID-19 vaccine was 100% effective in Phase 3 trial in adolescents

Plus: Don’t laminate your COVID vaccination card before doing these 5 things

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