This is an excerpt from the March 9, 2021 edition of Medically Necessary, a health care supply chain newsletter. Subscribe here.
Good afternoon. Medically Necessary is a newsletter by Matt Blois about the health care supply chain — how we get drugs, devices and medical supplies to health care providers and patients.
Getting a vaccine at work funnels shots to people who need them most
The plan: The Centers for Disease Control and Prevention recently started encouraging companies to vaccinate their employees at work.
Offering the vaccine at work could streamline the supply chain, bringing shots directly to the people who need them most.
Phase one: Many people in the earliest phases of vaccinations, such as health care workers or correctional officers, received their vaccinations at work.
- The Federal Bureau of Prison has fully vaccinated more than 15,000 employees so far.
- Mayo Clinic has given more than 40,000 of its own employees at least one dose of a COVID-19 vaccine, according to a survey from Becker’s Hospital Review.
Phase two: As vaccine eligibility expands, employers in a wide variety of sectors, many in high-risk industries, hope to vaccinate their workers.
- Representatives from Tesla and Boeing reached out to public health officials months ago to ask about becoming vaccine distribution sites, according to public records obtained by Bloomberg.
- Trucking trade groups are asking the CDC to allow vaccinations at truck stops and travel plazas so truck drivers can get the vaccine, Alan Adler of FreightWaves reports.
Other companies have already started offering vaccines at work.
- Pharmaceutical company AbbVie, medical device maker Abbott Laboratories and heavy equipment makers John Deere and Caterpillar are among the companies offering vaccines at work, according to a Wall Street Journal report.
- Tyson Foods — which has seen dozens of coronavirus clusters at its facilities — expects to vaccinate more than 20,000 workers at meatpacking plants in Arkansas this week. The company has already vaccinated thousands in Iowa, North Carolina, Kentucky and Missouri, according to a press release.
- The city of Chicago started vaccinating up to 500 transit workers every day inside the O’Hare airport this week. The city is also giving American Airlines and United Airlines some vaccine doses for their employees at the airport.
How to do it: Employers must communicate with the health department in their state to register as a vaccine distributor and report their data back to the CDC, just like any other vaccine distribution site.
- A fact sheet from the CDC recommends working with local public health authorities, occupational health providers or pharmacies to carry out vaccinations.
- The CDC also recommends staggering vaccinations because some workers may experience side effects and will need to miss work.
Case study: Premise Health, a company that provides on-site or near-site health care for large workplaces, is helping administer workplace vaccines to employees at American Airlines, United Airlines and Delaware Poultry Co.
- The company has 600 wellness centers at worksites across the U.S.
Premise Health President Jami Doucette said one of the biggest challenges is navigating the complex web of eligibility rules. Each location is in a different phase of vaccine distribution, and definitions of eligibility terms, like essential worker or critical industries, differ from state to state.
- “We have quite a few team members focused exclusively on making sure we’re following all the rules and making sure we’re putting the right shots in the right arms,” Doucette told FreightWaves.
- Large employers have to follow the same eligibility requirements as regular vaccination sites. They can’t let employees skip ahead.
Workplace vaccinations generally come in two flavors, Doucette said. Mass vaccination events aim to inoculate lots of eligible workers at once. Ongoing vaccinations at worksite health clinics distribute shots over a longer period of time, as employees become eligible.
- “If an entire population has been deemed eligible, the event-based approach may be more time efficient,” Doucette said. “If there are only specific segments or demographics that have been deemed eligible, a more targeted wellness center approach may make the most sense.”
Doucette said Premise Health has helped several new clients administer vaccines to employees, and he’s hopeful they’ll become long term customers. Even when vaccines become widely available in the community, he said getting a shot at work is much easier.
- “Members are going to find it a whole lot more convenient to walk down the hall or engage a near-site provider than trying to navigate the traditional health care system,” Doucette said.
And if COVID-19 becomes a seasonal illness requiring yearly shots — a possibility that’s far from clear — that kind of convenience becomes even more critical to protect employees in the future.
More access is key: The pandemic has hit people in customer-facing service jobs or factory settings much harder than knowledge workers who are operating remotely. Offering vaccines at work ensures the supply chain funnels doses to the people who are at the highest risk of infection.
- A preliminary analysis (not peer-reviewed) of death certificates of working-age people in California found that, compared to a normal year, the pandemic dramatically increased the risk of death for food/agriculture workers (39%), transportation/logistics workers (28%), facilities (27%) and manufacturing workers (23%).
- The risk of death increased by about 11% for California’s nonessential workers, which included jobs in communications, information technology and finance.
The companies offering vaccines at work tend to be in industries devastated by the pandemic — food, travel and transportation. Bringing vaccines to the worksite protects their employees, but it’s also critical for the bottom line.
The vaccine supply chain is leaking doses, but few states are tracking waste
The problem: Thousands of COVID-19 vaccine doses are leaking out of the supply chain and going to waste.
However, data about waste is rare and decentralized, making it hard to get a full picture of the problem. Many states haven’t been tracking waste at all, according to a January report from ProPublica.
In many cases doses are wasted because they fail to meet stringent temperature requirements for handling and storage. Doses can also expire, or vials and syringes can break during handling.
The scope: The CDC requires vaccine administrators to report wasted doses, but you won’t usually find that number reported on state dashboards or CDC reports.
Often, it’s up to local news reporters to track down reports of waste.
- An ABC affiliate in Illinois reported the state had lost more than 500 doses by late February.
- A Fox affiliate in Minnesota reported 320 wasted doses there by early March.
- A Fox affiliate in Missouri reported at least 140 doses wasted in that state by early March.
- The Tennessee Department of Health sent staff to Memphis to monitor and improve handling procedures after thousands of doses went to waste. The state plans to check on the quality of handling procedures in every county over the next few weeks.
The ABC News affiliate in North Carolina reported that by late February about 2,400 doses had gone to waste in that state, about one wasted dose for every 1,000 delivered.
There’s no national database for tracking vaccine waste, which makes it hard to gauge the scope of the problem and implement solutions.
An outlier: Texas’ health department is one of the few states regularly reporting vaccine waste to the public. So far, about 6,800 doses, less than 1% of delivered doses, have gone to waste.
- Most of those doses were lost because of a natural disaster or power outage, likely related to the major winter storm that hit the state in February.
The state reaches out to providers who report waste to ensure they’re following proper handling procedures.
Solutions: With billions of doses needed across the globe, some doses of the vaccine will inevitably go waste. Here are a few ways to minimize the problem.
In January, the Public Health Foundation, a nonprofit focused on improving public health, created a list of commonsense countermeasures against waste.
- Use a backup generator to ensure freezers and refrigerators don’t lose power.
- Work with other clinics to find backup refrigeration or storage space in case primary storage locations lose power.
The Ohio Department of Health tells vaccine providers to use up excess doses by giving the vaccines to anyone in the vicinity, prioritizing people at higher risk.
- If more than 20 doses are at risk, vaccine providers are supposed to call a hotline to discuss their options, such as transferring the doses to another provider.
In Nashville, Tennessee, public health officials redistributed about 400 doses of the Pfizer vaccine that were about to expire to a homeless shelter for an impromptu vaccination event, according to Nashville Public Radio.
Bottom line: Stories of public health officials saving vaccines from spoiling are inspiring, but they hide the bigger problem: the country’s inability to measure vaccine waste.
Wishful thinking: One wish to improve COVID-19 vaccine rollout
Wishful thinking is a section of the newsletter where I give experts one wish to improve the health care supply chain. Send your wishes to email@example.com.
“My wish would be for all the different groups involved with vaccine distribution to share information about regional vaccine supply AND demand more openly. … Silos of this information within [public health authorities, insurers, providers and pharmacies] seem to create tremendous inefficiency.”
— Sandy Murti, VP of Global Partner Development at Impinj, a Seattle-based company that uses RFID technology to track supplies through the supply chain
Sharing information, or the lack thereof, has been slowing the vaccine rollout since the beginning.
- The IT systems used to manage the vaccine rollout are convoluted. Many states and counties are using different software systems, which makes it hard to share data.
The CDC’s vaccine management software, Vaccine Administration Management System developed by Deloitte, has run into major problems, according to MIT Technology Review.
- But competing systems, such as PrepMod developed by a Maryland nonprofit organization, have experienced major problems as well, according to a report from NPR.
New options: After watching the initial IT systems struggle, big tech companies are trying to make it easier to share data. It’s not clear if these systems are gaining traction yet.
- IBM announced a partnership with Moderna last week that promises to use blockchain and artificial intelligence to make it easier for stakeholders to share data.
- Google announced a suite of tools in February to help local governments distribute vaccines, schedule appointments and analyze their progress.
Too late? At this point, it’s not clear if adding new IT systems will actually make it easier or just muddy the waters.
- “Switching horses midrace is pretty disruptive to everybody,” Bill Brand, the director of public health informatics strategy at the Public Health Informatics Institute, told FreightWaves in a previous edition of Medically Necessary.
On the bright side, the acceleration of the vaccine rollout suggests vaccine administrators are getting better at sharing data with the current, mediocre systems.
Reading list: The best stories about the health care supply chain
- Watch: From Kalamazoo to Fenway Park: the logistics of Covid-19 vaccine shipments — STAT
- Pfizer CEO: “It will be terrible” if COVID-19 vaccine prices limit access — Axios
- Officials to explore COVID vaccine supply gaps, boosting production — CIDRAP News
- Teachers in all U.S. states are now eligible for vaccination, though there is confusion in some states — The New York Times
- In Alabama, South Carolina and Louisiana, CVS Vaccine Appointments Go Unfilled — Kaiser Health News