Mass vaccination: COVID-19 protection for the many, not the few

By on 18/11/2021 | Updated on 22/11/2021
To cope with constrained supply, many countries drew up strategies to prioritise vaccine allocation to the most vulnerable. Photo by Captain Mark Getman, courtesy Division of Military and Naval Affairs, New York Guard via Flickr

Global rollout of COVID-19 vaccinations has raised questions over supply, inequality and logistics. Catherine Early heard panellists at a Global Government Forum webinar discuss how they have overcome the many challenges in the race against the disease and what more needs to be done

It is almost a year since the first COVID-19 vaccine rollouts began. Since then, six and a half billion doses have been administered worldwide, with some countries now starting booster programmes for their most vulnerable populations.

Such a rapid mass vaccination programme has been a challenge for governments. From securing supplies, establishing distribution networks – particularly for remote communities – and overcoming hesitancy and misinformation over vaccines, civil servants have had their work cut out.

The first issue many in charge of vaccine programmes faced was obtaining a sufficient number of vaccines. To make the most of supplies, prioritisation strategies were introduced to ensure the most vulnerable citizens got their jabs first.

In the Philippines, like many other countries, scarce supply was administered according to strict criteria. Workers in frontline health services, senior citizens, and people with certain underlying health conditions were given the first supplies, with the rest of the population following later.

If the incoming supply was less than the number of people in the population group selected for vaccination, the group was further split according to the burden of disease created by geographic location and the local government’s readiness to deploy the vaccines.

This strategy proved successful, according to Maria Rosario Vergeire, undersecretary of health and spokesperson for the Filipino Department of Health. “There are now over 24.4 million Filipinos, or 22% of the population, who are fully vaccinated from our priority sectors – the health care workers, senior citizens, individuals with morbidities, and frontline personnel in essential sectors,” she said.

“Of the 8,147 vaccination sites around the country, no vaccination sites are reporting reduced capacity in areas with high number of COVID-19 cases,” Vergeire said.

In Canada, though immunisation systems were robust, they had not been designed for vaccines that needed to remain frozen. This limited capacity, according to Heather Deehan, executive director of vaccine logistics and operations in the vaccine rollout task force at the Public Health Agency of Canada.

To cope with the constrained supply, a strategy was drawn up to prioritise vaccine allocation to the most vulnerable populations. Many of those deemed to be at highest risk were those living in remote or isolated communities, for whom an outbreak of COVID-19 could be devastating due to the difficulty in accessing healthcare, Deehan explained.

“What was included in some of the planning was the use of boats, planes, as well as the possibility of dog sleds and snow clearing machines to reach remote communities. We had a lot of innovation in a lot of the strategies that were being built early on,” she said.

Technology timesaving

In addition, technology was used for strategic planning. Deehan explained that Health Canada and Statistics Canada worked together to create a vaccination forecasting dashboard, which covered where supply and demand was coming from, and the anticipated level of human resources that would be required in order to be able to administer the vaccine within a week of that supply being available.

Many other countries have used technology to varying degrees to aid mass vaccination. Healthcare authorities in the US, for example, used a Robotic Process Automation (RPA) system developed by the webinar’s knowledge partner, UiPath.

The technology can emulate anything a human can do on a computer such as opening and extracting information from emails and transferring that information to an excel spreadsheet; making calculations; and scraping data from the web, explained UiPath’s senior manager of healthcare industry practice Lisa Weber.

“Processes that really lend themselves to this type of software are those that are highly repetitive and manual in nature,” Weber explained. In particular, she said, RPA is good at exchanging information between systems that are not integrated and cannot “talk” to each other.

When it came to COVID-19, RPA was used to carry out vaccine scheduling, mass vaccine administration, supply chain management and regulatory reporting on vaccination progress.

“Our technology really helped reduce the clinical and staff burnout to allow them to deal more with the patients, and not so much with the administrative stuff. And the data is better quality, because there are no human errors, and it’s more timely because we created interoperability between systems,” Weber said.   

For example, when RPA was used to transfer and upload COVID-19 testing results at one US healthcare authority, labour time was reduced from 40 days to 7.4 hours. It also reduced the amount of time taken to register patients at mass vaccination sites from seven minutes to two, according to Weber.

Disparity on show

Despite successful vaccine rollout in many countries, inequality between developed and developing countries has been stark. UK think tank Chatham House has been tracking access to vaccines across the world. Of the six and a half billion vaccine doses administered globally, the majority have been in high- and upper middle-income countries, with around 62% of people in those countries having received one dose, according to Jessica Hamer, research fellow at the center for universal health at Chatham House.

In low-income countries that figure falls to just 2.7%. Fewer than 1% have been fully vaccinated in low-income countries, with sub-Saharan Africa having the least access. The global vaccination target set by the World Health Organization to have 40% of the population in lower income countries vaccinated by the end of the year is likely to be missed in 67 countries, Hamer said. Indeed, more than 50 countries missed the “very unambitious” target of fully vaccinating 10% of their populations by the end of September.

Though more than 370m vaccine doses have been distributed via the “Covax” multilateral vaccine supply mechanism, that represents just 5% of the doses administered worldwide. “The statistics really speak for themselves here,” Hamer said.

“This situation is not only driving massive death and suffering, it’s self-defeating and makes absolutely no sense in terms of ending the pandemic for everyone. The mantra ‘no one is safe until everyone is safe’ has been often repeated throughout the pandemic, but it remains absolutely true,” she said.

In order to achieve mass vaccination in poorer parts of the world, Hamer stressed the need to speed up the sharing of vaccines – more than 1.2bn doses have been pledged by mid-2022 by G7 and EU countries, but just 12% have been delivered. Investment needs to be increased to fill the predicted shortfall of US$15.8bn for 2021, and US$20-25bn for 2022, she said.

These, Hamer noted, were very small, short-term, investments compared to the US$5.3 trillion of global economic losses the International Monetary Fund believed would be caused by COVID-19 by 2026 without further intervention. Technology transfer would be needed to further expand global production and intellectual property barriers would need to be addressed, Hamer added.

Even in countries that successfully rolled out mass vaccine programmes early, the challenge is not over. Immunity has waned, necessitating booster programmes to avoid further outbreaks. In Singapore, the vaccination programme began in December 2020. However, the Delta variant resulted in a large number of cases in the country, with reported cases averaging around 3,000 a day, and 300-400 of those needing hospitalisation.

“We have experienced quite a sizeable number of cases with vaccine breakthrough,” said professor Leo Yee-Sin, executive director of the National Centre for Infectious Diseases in Singapore. “This recent surge of Delta cases in Singapore is largely because of the very early introduction of the vaccinations, particularly to the older individuals,” she said. The Delta variant was so infectious that the immunity provided by the vaccine fell “significantly”.

Singapore is now introducing a booster programme for older citizens, which will then be extended to cover all frontline workers including those in healthcare, followed by all adults over 30. “We do not know the effect of the booster at this point, so we will look at data from Israel to decide on the booster campaign in Singapore,” she said.

Future lessons

Panellists agreed that COVID-19 had built up many countries’ capacity to respond to pandemics. The Philippines now has almost 300 laboratories that can deal with PCR tests, compared with one at the beginning of the pandemic, according to Vergeire. It also has 100,000 quarantine beds compared with just one quarantine facility designed for repatriating overseas workers, and is in the midst of establishing a virology institute for vaccine manufacture.

The value of having learned from experience can be seen in the case of Singapore, which has experienced previous disease outbreaks such as SARS in 2003, after which it beefed up its preparations for tackling infectious disease.

Nevertheless, however prepared a country is, governments must be flexible when it comes to tackling future pandemics, said professor Yee-Sin. For example, following SARS, Singapore built a purpose-built isolation facility containing all necessary medical facilities and laboratories, but its 330-500 bed capacity was not adequate for COVID-19. Instead, the entire healthcare system was mobilised, with all hospitals required to take in COVID-19 cases.

As for the international collaboration needed to expand access to the vaccine, Chatham House’s Hamer quoted UN secretary general António Guterres, who said: “We’ve excelled on the science, but we get an F for ethics on the global vaccine rollout.”  

However, she saw grounds for optimism in terms of work to change the status quo on issues such as intellectual property rights for medical technologies and the development of vaccine manufacturing capacity across regions so that it is no longer concentrated in small pockets of the world.

Lessons were also being learned in terms of governance and inclusion. “Part of the problem with this pandemic has been that some of the global governance structures, such as for Covax, have been skewed towards a historic way of thinking really, in that discussions have been dominated by traditional donors and terms set by companies.

“I would hope that in the future we’re building a much stronger representation of lower middle-income countries into those structures,” Hamer said.

When the COVID-19 outbreak began, governments had to move fast to protect their citizens from the disease, mobilising the healthcare sector to administer vaccines at an unprecedented rate. Many lessons have been learned but that doesn’t mean that governments should rest on their laurels – a future pandemic may require a different approach. What is clear though, is that while there have been many successful examples of multilateral collaboration in the last two years, the richest countries will be called upon to do more to help protect the world’s poorest.

You can now watch on demand the 75-minute Global Government Forum webinar Mass vaccinations: protecting the world held on 19 October 2021, with the support of knowledge partner UiPath.

About Catherine Early

Catherine is a journalist and editor specialising in government policy and regulation. She writes predominantly about environmental issues and has held permanent roles at the Environmentalist (now known as Transform), the ENDS Report, Planning magazine and Windpower Monthly, and has also written for the Guardian, the Ecologist and China Dialogue. She was a finalist in the Guardian’s International Development Journalism competition 2009, and was part of the team that won PPA Business Magazine of the Year 2011 for Windpower Monthly. She also won an outstanding content award at Haymarket Media Group’s employee awards for data-led stories in Planning magazine. She holds a 2:1 honours degree in English language and literature from Birmingham University.

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