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By Karen Conway, Vice President, Healthcare Value, GHX
The approval and distribution of multiple COVID-19 vaccines has created hope, disappointment and confusion. The hope is real; with an increasing percentage of the population vaccinated, we are moving closer to a level of herd immunity that will bring back some sense of normalcy in daily activities. The disappointment with the pace of the roll-out is understandable, as the federal government has repeatedly had to adjust supply delivery projections, most recently due to extreme winter weather conditions. The confusion, on the other hand, could have been minimized with the application of some fairly standard supply chain practices and tools.
V is for Variation Reduction
For the healthcare supply chain, as well as healthcare delivery in general, reducing variation is a common mantra. Anyone who has studied and practiced continuous quality improvement understands that uncontrolled (and unwarranted) variation is the enemy of quality. In the case of the COVID-19 vaccine, there was a conscious decision made by the then Trump Administration to have each state decide how to distribute the vaccines and to whom. This is not necessarily an unwarranted decision, especially for advocates of states’ rights, but it does come at the cost of confusion. States made different decisions about how to prioritize vaccine eligibility (e.g., by age, health risk, level of exposure, etc.). More recently, the new director of the Center for Disease Control and Prevention has called for greater harmonization around how people are prioritized.
States have also chosen different mechanisms for the delivery of the vaccine, and too often, those distribution channels have failed to fully utilize the expertise of supply chain professionals. Some states have delegated the responsibility to local health departments, which have significant public health expertise, but very little supply chain experience. Others have chosen to rely on independent and/or chain pharmacies, the latter of which certainly has some supply chain expertise, at least at the corporate level. Whether that translates to improved response remains to be seen. Based on early data, states that deployed the national guard, which has both clinical and logistics expertise, have been among the most successful. What remains a surprise is why the supply chain professionals in hospitals across the country have not been called upon more often and more routinely. We have all witnessed how they have overcome seemingly insurmountable odds to get personal protective equipment (PPE) into the hands of healthcare workers over the past year – they can do the same with vaccines.
V is for Visibility
The mandate for Operation Warp Speed, the national program to accelerate the development, manufacturing and distribution of COVID-19 vaccines, was to deliver vaccines to the states. Had that metric been extended to the point of inoculation, Major General (retired) Vinny Boles, is certain it would have happened. General Boles, who has significant military logistics experience, says visibility in the supply chain was greatly diminished once the vaccines reached the states.
We have the tools to help improve visibility, some of which have been around for decades. One is the barcode, which is nearly ubiquitous in the grocery and consumer packaged goods industry, and which is more prevalent in healthcare thanks to regulations such as the pharmaceutical barcode rule and more recently the unique device identification (UDI) rule for medical devices.
Scanning the barcodes on vaccine packages would make it easier to track products (including quantities of each) as they move though the supply chain, from manufacturers to distributors, on to the states and the entities charged with vaccinating the public. The international standards body, GS1, which manages data structures behind barcodes, has developed a way to integrate sensors in a data matrix barcode that can help monitor both the cold chain and potential counterfeit activity. Both are particularly important given the need to keep some of the vaccines at very cold temperatures and the rise in attempts to sell and distribute fake vaccines. Scanning could also more accurately document: which patients received which vaccines, any adverse reactions, when to deliver second doses, and efforts to reach the most at-risk populations (e.g., persons of color).
However, barcodes are only required on the secondary packaging level – not at the primary or individual does level. That means that if partial contents of the case are removed to inoculate smaller populations, we will have lost the ability to scan those barcodes. Information could still be captured manually, but that significantly increases the chance for error.
For these reasons, we must make a greater industry-wide investment in barcode scanners. There are several benefits to doing so. For example, barcodes can help address the inventory challenges hospitals have faced during the pandemic. Many hospitals could not accurately account for existing PPE inventory levels nor see how much inventory was in the pipeline and available to order. In the wake of COVID-19, many hospitals and their suppliers are having meaningful discussions about how to share data on inventory levels, forecasted demand and upstream manufacturing capacity, and more accurately track the location and status of products and raw materials. In industries where these capabilities are more mature, barcode scanning has been a key enabler.
V is for the Village
While tools that can help enable better visibility is certainly a part of solving the puzzle, any real advancements in supply chain capabilities, whether for vaccine distribution or day-to-day logistics, requires greater collaboration.
Too often, the reason given for not investing in these capabilities – from labelling products to scanners – comes down to a lack of time and money. Manufacturers have argued that it would be too costly and time consuming to apply barcodes at the primary packaging level and many hospitals have not fully adopted scanning technology as a standard protocol. Building the business case for these investments requires a firm understanding of the multiple benefits that would be achieved across the healthcare system, from patient safety to inventory optimization. In highly regulated industries like healthcare, the tendency is to only do what is mandated. But COVID-19 has shown us the pitfalls that come with a lack of inventory visibility and automation.
Therefore, we need all stakeholders within the healthcare supply chain – suppliers, providers, distributors and their technology and business partners – to rally around a common set of objectives and work together to fortify the healthcare supply chain. COVID-19 has also shown us that healthcare can move fast when needed, from the near miracle pace of vaccine development to how quickly hospitals were able to shift purchasing practices to secure critical supplies. Just think what we could do if the proverbial “healthcare village” came together to design and invest in a system for efficiency, efficacy, and the well-being of individuals, communities and the nation as a whole.
By adopting these three simple ‘V’s,’ healthcare has an amazing opportunity to create a clearer and brighter way forward.