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Vaccination Site Operations Research Advice: Bigger and Faster

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The world was amazed at the speed at which science took on the challenge of creating an effective vaccine for Covid-19 and resolved it. But another science that is often overlooked, operations research engineering and management science, is just as important for getting vaccines into the arms of Americans.

As the coverage of the vaccine increases daily, SARS-CoV-2, the virus that causes Covid-19, develops, reducing the chances of further evolution into a formidable enemy. To win this competition with Covid-19 at maximum speed and efficiency requires a vaccination strategy that ensures that all available doses are used as soon as they are available for injection.

That may seem like an impossible goal, but it can be achieved if the vaccine distributor evaluates and acts. Three important insights From Operations Research on National Vaccination Campaigns:

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  • Optimize what is right: Maximum protection of the United States from Covid-19 requires a national immunization strategy that prioritizes both coverage and speed.
  • Use the appropriate metric. The goal of this national vaccination strategy is to maximize the number of people vaccinated as soon as possible from today’s date, rather than aiming to get a specific number of people vaccinated by a specific date. This is called maximizing the number of days vaccinated for the entire campaign. Failure to do so will increase the number of days for unvaccinated people, each giving the virus that caused Covid-19 to suffer and potentially mutate.
  • Scale up everywhere: The best way to maximize the number of vaccinated days in a system with limited supply and uncertain demand is to design the largest vaccination center that is realistically feasible, taking into account local conditions. Is to open. Sure, you may need local vaccine distribution points, such as churches and pharmacies, to hesitate to get a vaccine and reach a community that is historically underserved, but the same logic applies to them as well. This is true.

Individual optimization of vaccine delivery at pharmacies, churches, clinics, sports stadiums, and even state levels would not benefit the entire country without a strategy to link these efforts to the right national goals. .. As one of us (JAM) Teaching Operations research, a generations of supply chain managers, shows that “local optimization leads to global incongruity.”

The Governor cites the rate of government-assigned vaccines as a measure of success. Logistics companies advertise the efficiency and speed at which finished vaccines are delivered from manufacturing facilities to distribution and dispensing sites, but they are not always in the hands of people. While these achievements are commendable, they do not provide the best measure of national progress towards population protection.

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The national goal is 100 million doses in 100 daysThe important thing is whether these doses are given on day 1 or day 100.

1 Well-known editorialWas released when the vaccination campaign was launched in January, and the public needs to carry out this task, assuming that the optimal strategy is a uniform dispensing campaign 1 million times a day nationwide. Calculated the number of hygiene staff. Such an approach may seem reasonable from a planning perspective. This allows local government officials to develop dispensing plans that are well known in other public health activities, such as regular vaccination campaigns.

But fighting a novel and evolving pandemic is not a daily routine. The absolute priority is to vaccinate the largest number of individuals as soon as the vaccine is provided. So, only if this is the exact schedule of vaccine delivery, then the one million shots per day approach makes sense. Whole country. For everyone planning a Covid-19 shot tomorrow, the intended dose will actually be available today. For example, due to limited vaccination center opening hours and staff availability, unvaccinated people’s days will be added to the national ledger.

This is a greater unification to keep efforts to use local distribution sites, which may be essential to phased success in reaching difficult-to-vaccine communities, to remain unused and unprepared. That’s why it needs to be part of the strategy. This need can be met by linking a small local center to a tightly integrated network that can coordinate vaccine dispensing daily. Creating a more interactive and responsive vaccination scheduling system, not to mention accessible and straightforward, is essential for such networks to match daily supply and demand.

The importance of maximizing the number of days vaccinated at all dispensing locations across the country cannot be exaggerated. To understand why, consider the following example. Imagine that your local pharmacy gives you 100 Covid-19 vaccines each week, but due to staffing restrictions, you can only get 25 vaccines a day from Monday to Thursday. Under these conditions, 100 vaccinated people received 250 vaccinations that week (25 times from Monday, 25 shots added in 4 days, 25 times from Tuesday, 25 in 3 days). Add times).

In contrast, if the pharmacy is supported by additional staff and the time is extended to deliver all 100 shots on Monday, the result will be 400 vaccination days (100 times in 4 days). Population protection against infection is increased by 60%. Despite having the same total number of vaccinations per week. It may seem like a trivial matter to complete all vaccinations in one day instead of spreading them all in one week at the pharmacy. But multiplying this by 60,000 US pharmacies and countless community and church sites makes a big difference in our ability to end Covid-19.

Evaluating vaccination strategies at the local, regional, state, and federal levels using unvaccinated person day metrics provides greater transparency regarding vaccine use and vaccination practices to expedite the end of pandemics. An important opportunity to change is identified.

But how can you maximize the number of days for a vaccinated person? Insights from operations research using the same supply chain math that allows you to order one of the millions of items online and instantly find out if it can be delivered today, when it comes to vaccination centers, Even the smaller it seems to be smarter.

Important note Currently paid Improving access to vaccines in medically vulnerable populations that are historically underserved. Outreach activities here may require smaller, more targeted, and in some cases mobile vaccination drives. But indisputable math says that regardless of type or size, the path to efficiency at vaccine dispensing sites is the same. Increasing the number of shots per day per site minimizes the number of unused doses per day for unvaccinated person days and faster population protection from Covid-19 Speed ​​up the country.

To test this idea investigated Simulation of a 26-week vaccination campaign in 1.3 million states using a vaccine that is vaccinated 100 times in a box, such as the modelna vaccine. Immunizing everyone in the state on the first day will result in zero days for unvaccinated people in the 26-week campaign. With nine large vaccination sites (average 200 shots per day) and four high-volume vaccination sites (average 2,000 shots per day), 24 million man-days will be unvaccinated by the end of the campaign. I will. In contrast, using 181 simulated pharmacies and community centers (130 sites average 30 shots per day, 35 sites 100 shots per day, 16 sites 150 shots per day) vaccination The number of days for those who do not receive it is 144 million per day. More than 6 times difference in effectiveness of 26-week campaign and vaccination campaign.

Specific simulation results will vary in detail, but the general finding that large sites will reach their desired pandemic vaccination goals faster, especially when considering realistic logistics, is clear.

Federal, state, and local public health authorities at the forefront of the United States — and Their counterparts around the world — I didn’t choose this fight. But now that they are in it, they need all the benefits to win it. Operations research can provide a framework that can help guide efficient progress towards population protection and highlight potential inefficiencies in achieving that goal. It clearly and clearly teaches how to design an operational transparent system that can obtain the fastest herd immunity, including optimal strategies for vaccination of underserved vulnerable populations. I will.

Nathaniel Hupert is an associate professor and co-director of the Cornell Institute for Disease and Disaster Preparedness at Cornell University in New York City, and Oxford-based Covid-19 International Modeling Consortium John A. (“Jack”) Mcuckstadt He is an honorary professor of operations research and information engineering at Cornell University and was previously a member of the Scientific Counselor’s Committee at the Center for Disease Control and Prevention in the United States. Michael G. Klein is an assistant professor at San Jose State University’s Lucas College and Graduate School of Business in San Jose, California.

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