Unusable and unused vaccine systems hinder Biden’s COVID-19 response

The federal government must build working IT systems to manage COVID-19 vaccines and share real-time data on supply and immunizations, say technology and health experts.

Under-resourced states and localities didn’t receive the tech they needed from the Trump administration to support vaccine rollout, according to current and former federal and state officials. States expected the federal government to provide at least one functional system for distribution, scheduling and reporting they could use. But, the officials say there’s still time to develop such a system given the uneven vaccine rollout nationwide.

Federal agencies also withheld “a lot” of data on the pandemic prior to the 2020 presidential election, said Ryan Panchadsaram, a board member for COVID Act Now, a nonprofit formed to make more pandemic data public. Most federal data products were developed for internal use by agencies as they sorted out their response to the pandemic, said Panchadsaram, who was a U.S. deputy chief technology officer under President Obama.

COVID Act Now and other organizations like it are helping to fill the data gap the government is still working to address. The nonprofit tracks cases, case count confidence, infection growth rate and vaccine data. Others, like The Atlantic’s COVID Tracking Project, focus on data like hospitalizations — which the Centers for Disease Control and Prevention didn’t begin releasing on its own until December.

States started receiving vaccines in December. But the Trump administration neglected to prepare a process for vaccine scheduling that relied on multiple systems, even though companies like ZocDoc had been offering their services since April. So, it’s up to the Biden administration to task agencies and industry with developing interoperable solutions for vaccine scheduling and reporting to ensure people who want to be immunized get the information they need.

“The real questions right now are: Where can I get vaccinated and when?” Panchadsaram told FedScoop. “Am I eligible?”

The Centers for Disease Control and Prevention awarded consulting firm Deloitte a no-bid contract back in May to build a $44 million system capable of providing the answers. But many states found its Vaccine Administration Management System (VAMS) — to which they were given free access to handle distribution, scheduling and reporting — unusable and have since purchased alternatives. VAMS is plagued by bugs that canceled appointments, informed people they were registered when they were not and locked staff out of the reporting section.

The numbers are simply too great for the data management systems to be fragmented. 

Assuming 75% of the U.S. population — about 250 million people — get vaccinated at two doses means half a billion injections. That requires cooperation among government at all levels, pharmacies and industry partners, but also a federally supplied “single source of truth” on vaccination numbers, among what groups, efficacy and health monitoring, Casey Coleman, former chief information officer of the General Services Administration, told FedScoop.

States ill-equipped

Scheduling alternatives to VAMS include the Maryland Partnership for Prevention’s commercial system PrepMod, adopted by other states, and even the events platform Eventbrite, which some Florida counties continue to use despite the state finally launching its own system. While far from perfect, states have generally had less trouble scheduling vaccines through these more established systems.

Alaska’s state government uses PrepMod, which has proven the easiest way to book vaccine appointments, according to officials. Despite that decision, the state has had a “bumpy” vaccine rollout because PrepMod updates have taken a backseat to work on other software for reporting data to the federal and state governments, Brendan Babb, chief innovation officer of Anchorage, said during a recent New America event.

The city’s innovation team had to write code to scrape the PrepMod site in order to show people what appointments are available because they lacked an application programming interface (API), Babb said.

Seniors applying for the vaccine using PrepMod have to fill out seven screens of information, and difficulties have forced officials to lean on phone sign-ups. Signing up 15 seniors by phone takes two hours, and they’re being asked pregnancy questions, Babb said.

“This is an issue that we saw coming as soon as we knew that the federal government was only handling the logistics portion and that the last-mile delivery would be handled by the states,” said Hana Schank, director of strategy for public interest technology at New America, during the same event. “We know from our work that the states are really not equipped to handle that kind of work; they’re not equipped from a staffing perspective, and they’re not equipped from a technology perspective.”

The application CDC ‘forgot’

To make matters worse, the CDC is sitting on unused software that states struggling with last-mile delivery could use as a fallback.

The application, CDC Assist, was developed as part of the pandemic response plan after the H1N1 flu to distribute vaccines, Andrew Needleman, CEO of DoseSpot, told FedScoop. The United Way involved Needleman in the CDC Assist program when it was still known as Flu on Call in 2013, and he’s spent the last two months trying to raise awareness on Capitol Hill and in the White House.

The web and phone app qualifies patients, directs them to pharmacies and other distribution centers that have the vaccine in stock, and notifies them where to get their shot when eligible — eliminating lines. Rides can even be arranged for people who can’t afford them.

CDC Assist last-mile delivery would complement scheduling systems, but the agency hasn’t told Needleman why it sits dormant. The CDC did not respond to multiple requests for comment.

“It’s one of those solutions where it’s as simple as basically just turning it on because we actually have been doing testing every year in order to make sure everything is ready to go,” Needleman said. “Sometimes people forget about things like this.”

Needleman has spoken to Biden administration officials and said they’re interested in using the program now and in the event of future outbreaks. But it’s unclear when they’ll give the green light and who’s responsible for doing so.

Launching CDC Assist would take about a week because, while the program is mostly automated, a call center consisting of a small staff needs to be stood up for people who aren’t tech-savvy, Needleman said.

The app qualifies people for the vaccine based on their state’s criteria and sends secure messages through pharmacies’ existing e-prescribing infrastructure. That’s important with some pharmacies currently writing and faxing fake prescriptions to themselves to get people showing up for vaccination in their systems.

CDC Assist can also connect to less traditional systems that distribution centers are using for vaccine scheduling like Eventbrite.

The program isn’t the only one sitting on the shelf either. CDC has another tool capable of checking vaccine supply at locations that works in tandem with CDC Assist. The agency intends to flip the switch but hasn’t said when, Needleman said.

Troubled transition

The Trump administration established systems like VAMS quickly, but the Biden administration is still assessing their usefulness.

Under President Trump, Operation Warp Speed saw the creation of Tiberius, a Palantir-developed software platform designed to analyze vaccine administration data the CDC receives from states and localities and then visualize national uptake.

While Tiberius is being used by the Biden administration, just how good a picture it’s painting of the U.S. vaccination effort remains unclear.

White House Press Secretary Jen Psaki couldn’t provide specifics on the vaccine stockpile during a Jan. 26 press briefing, saying only that the number is monitored daily through Tiberius and other systems.

“It sounds like a magical creature a little bit, to me. But it provides vaccine information — publicly available information on vaccine supply that’s gone to states and what’s been used,” Psaki said. “It doesn’t mean it’s perfect. Oftentimes it isn’t.”

The fact that the Palantir-developed system is named after “Star Trek” Capt. James T. Kirk’s middle name aside, neither state and local officials nor the public are informed of Tiberius’ insights.

Psaki further noted the Biden administration had only been in control six days. But it only took the Department of Health and Human Services nine days in April to create HHS Protect, the health insight platform informing the Trump administration on COVID-19‘s spread.

Asked about the government’s progress developing a clearinghouse for vaccine information on Feb. 8, Psaki had no updates.

“There is a great deal of confusion,” Psaki said. “And one of the focuses we have had is trying to alleviate that confusion.”

Operation Warp Speed was about funding the development and manufacturing of vaccines, but with the delivery phase must come a change in approach designed to eliminate bottlenecks, Coleman said.

Coleman now works for Salesforce, which recently launched a cloud service aimed at helping communities, including Lake County, Illinois, manage the scale and monitoring of vaccine delivery.

At the end of the day, such systems still need to connect back to a single, federal source of truth for vaccine reporting, experts say.

“This is the top priority of the Biden administration, so we’re seeing a lot of focus on connecting those dots — on the CDC playing a key role in terms of clear guidance,” Coleman said.

President Biden‘s COVID-19 strategy and executive order calling for a data-driven response offer promise that federal coordination on vaccine scheduling, data collection, information sharing and the required systems is coming. But a multidisciplinary team consisting of data, tech and health policy experts needs to quickly pick up where Operation Warp Speed left off to ensure equitable last-mile vaccine delivery and immunization tracking in real-time. While the Trump operation has not been officially declared over, its deadline for delivering vaccines was January.

“There are rumors that the U.S. Digital Service might take this on or that they might build a federal tech team together to work on this,” Schank said. “So there is hope.”

USDS hasn’t been directly tapped for vaccine data consolidation yet but is discussing how it can help with COVID-19 response, according to a spokesperson.

The team was responsible for the rollout of HealthCare.gov and served as the government’s fix-it team during the Obama administration. Tapping USDS to right the ship on vaccination data gathering could signal a return to its roots and resurgence under Biden, but that would require rapid hiring of the necessary talent. The team posted a hiring announcement to its Twitter page on Jan. 20.

In the meantime, Biden appointed Cyrus Shahpar COVID-19 data director, and under him, the Data Strategy and Execution Workgroup has ensured daily releases on healthdata.gov.

Taking more than ‘one swing’

States forgoing federal vaccine systems face their own struggles given the wide-ranging IT they buy or, in some cases, fail to buy.

CIOs supporting health departments have had to rely on two types of vaccine scheduling solutions, both originally designed for other purposes.

Enterprise, end-to-end scheduling applications can track vaccination eligibility, send reminders and integrate with state immunization systems. But they’re hard to adapt to states’ specific planning, technology, budgetary and population needs, said Raphael Lee, administrator of U.S. Digital Response’s Health Data Program, during the New America event.

Meanwhile, standalone scheduling solutions may not be health-related, like Eventbrite, or be repurposed after helping with COVID-19 testing, like Solv. The burden of selecting the best vendors, carrying out procurements and ensuring data is interoperable falls to states, Lee said.

While you can see “some foresight” in funding VAMS, Panchadsaram said, the Trump administration likely awarded the contract to the most convenient vendor: Deloitte. The same was true when HHS fast-tracked Palantir, which had been working on similar projects, to develop HHS Protect citing “unusual and compelling urgency.”

HHS did not respond to multiple requests for comment.

The CDC has attributed some of states’ issues with VAMS to user error. But that raises the question of whether Deloitte spent enough time with states refining the system’s scope and usability, Panchadsaram said.

“The CDC’s VAMS is one element in the complex vaccine ecosystem and has performed strongly, with consistent stability and availability since it launched in mid-December,” said a Deloitte spokesperson. “The overwhelming demand for vaccinations far exceeds the current vaccine supply and the availability of appointments. While we understand the frustrations many people are experiencing, they are unrelated to VAMS’ technology.”

At least nine states, one territory and one hospital system use VAMS.

Meanwhile, the CDC’s VTrckS vaccine tracking system is largely being used to report shots in arms. But interoperability with state systems has been a problem, leading to data transfer delays as state officials personally facilitate the exchange.

“A lot of these systems aren’t communicating well with each other,” Barr said. “So people are manually having to type in information.”

Investing in systems to improve their interoperability, automate data collection from electronic health records and other streams, and update legacy immunization registries won’t come cheap, but it will be harder to justify after the pandemic. And leaving it to counties to build or buy the right systems clearly isn’t working, Panchadsaram said.

Having one contractor attempt to build the perfect system for federal, state and local governments keeps failing, so it would be better to introduce competition, he said.

“What we need to do is find a way to really encourage groups within the government — like 18F and USDS on the federal level, contractors on the outside that can work in agile, iterative ways — to really try to build multiple solutions,” Panchadsaram said. “We tend to fail on technical projects a lot because we just take one swing at it.”