How a Patchwork of Federal IT Is Slowing Vaccinations

Although the White House announced last week the U.S. was vaccinating 1.7 million people daily for COVID-19, public health experts have pegged 3 million shots a day as a better target for effectively controlling the pandemic and tamping down the spread of newer and more virulent strains.

So what’s dragging down the nation’s vaccination program? One obstacle is a mishmash of IT structures that suffer from “mismanagement and poor design” at the federal level and contribute to disjointed state and local efforts, said Henry C. Lucas, the Robert H. Smith Professor of Information Systems Emeritus.

“Apparently few lessons were learned from Healthcare.gov—the previous, huge public-facing information systems failure” that in 2013 resulted in endless waits for people trying to access the online insurance marketplace, Lucas said.

Early in the coronavirus pandemic last year, the federal focus was entirely on vaccine development, leaving planning vaccine administration to the states—a mistake.

“Systems planning should have started as soon as the nation realized the pandemic in early 2020,” Lucas said. “As a result, the country is confronted with a patchwork of systems cobbled together at state and local levels that require work-arounds to function.”

The patchwork has a number of components, and they frequently don’t play well together, he said:

• The CDC Vaccine Administration Management System,  a $44 million no-bid system built by Deloitte, is known for bugs, including randomly canceled appointments, unreliable registration and problems that keep the staff from accessing the system.
• The HHS portal Tiberius, built by Palantir during summer 2020 for allocating and planning vaccine distribution and ordering vaccines, appears to be working well at the federal and state levels.
• VTrckS, a 10-year-old CDC legacy system pieced together by multiple vendors, provides a means for states to order and distribute shots. The system also is Tiberius-connected through users downloading files from one system and uploading them to another.
• Local registration systems are where things frequently break down. For example, a Tucson, Ariz.-based system is a front end to a health system’s existing patient medical record, causing registered for vaccination to appear to be a patient of that system. Meanwhile, the state of Arizona administers its own registration system.
• Ad hoc registration systems being built by volunteers are using tools from Google Docs to spreadsheets to provide information on vaccine availability by site, how to register and more.

The integrated federal system that’s sorely needed would work differently, tracking vaccine allocation to states, including shipping instructions to FedEx and UPS, all the way down to state allocations and distribution to each vaccination site, he said.  A comprehensive system would also keep track of the vaccine lot and the location for each inoculation as well as any reactions to the vaccine.

It would allow for different prioritization approaches and algorithms for prioritizing recipients for each state and territory, and put the states in charge of registration for citizens to make appointments for vaccination at different sites. The system would also maintain records of which vaccine was used, lot numbers, locations and any adverse reaction for each patient, and tally state totals for inoculations and remaining inventory.

Designing such a system would require “a designated team to gather system requirements from all types of eventual users of systems, including the CDC, HHS, state and county governments, public health departments, and medical personnel and staff who operate vaccination sites, as well as people who will register and receive vaccinations,” Lucas said.

Although creating the system would be a challenge, it would be no more complex than other tracking and coordination systems in use by manufacturers, shippers and distributors, he said.

Lucas notes that several successful tech firms have volunteered to help with the COVID vaccination effort.

“How much better might IT support for vaccination be if the development team included people from Google, Amazon and Microsoft?” he said. “They have built impressive websites for various kinds of transactions and have expert knowledge of the Internet and cloud computing.”

It would come down to good design and responsible decision-making, Lucas said.

 “The United States should be able to do better than its efforts to date to vaccinate the population against COVID-19,” he said.