Vaccination is an important topic of the moment. This article will be longer than usual, but I wanted to share what I have learned. I believe the entire world will get vaccinated against the deadly SARS-CoV-2 virus which has proved to be deadly and highly contagious causing COVID-19. Equally important is what has been learned about creating a synthetic vaccine based on a sequencing of the virus and using computers to model different scenarios of how the human immune system can be mobilized to prevent the disease. There are trillions of viruses out there and we need to be able to respond quickly without needing an Operation Warpspeed which infused $12 billion into the process.
Bringing millions of doses to the population within just 10 months after the virus was identified and sequenced in a Chinese lab was truly amazing. IEEE Spectrum reported that as of early December, the World Health Organization is tracking 50 other vaccine candidates which have clinical trials underway with human patient volunteers, with 13 of the trials in the final pre-approval stage. Tens of thousands of volunteers are being monitored for side effects and efficacy. As I have written before, I believe the mRNA synthetic vaccine is the future, although at this time, many vaccines will use the traditional approach.
What we are witnessing is spectacular scientific research to develop effective vaccines and at least equally spectacular engineering to develop processes to manufacture huge numbers of doses and distribute them while preserving the effectiveness. The missing ingredient is information technology (IT) to enable governments to analyze population segments based on front line exposure, age, and underlying conditions and then plan for storage and distribution within the states and countries, and to schedule appointments. IT is often an afterthought because our governmental leaders are frequently clueless about IT. As demonstrated in the CARES Act, many states had decades old unemployment compensation IT systems. Some collapsed and required paper-based backup systems. Our leaders love to debate high level policy issues but rarely ask about IT.
For decades, CEOs ignored IT and viewed it as a boring set of activities which belonged somewhere down the chain under the CFO. Many CFOs don’t like to get into the nitty gritty of IT either, so it all comes down to the CIO. I have witnessed more than a few cases where a CIO was selected from executives who were not going to rise to the top, were “good guys or gals”, but for whom the company didn’t know where to put them, leading to “make him or her the CIO”. There are many great CIOs, but not enough.
Let me dive a bit deeper on the complexities of getting needles into arms. The manufacturing process to create vaccines for the current world population of 7.8 billion people is daunting. With a number of the vaccines needing two doses, the manufacturing demand is huge. The recipe of ingredients is mind numbing. The Moderna COVID-19 Vaccine contains the following: messenger ribonucleic acid (mRNA), lipids (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC]), tromethamine, tromethamine hydrochloride, acetic acid, sodium acetate, and sucrose. To make this highly complex biotech product, the producers and their suppliers have had to construct new factories to mass-produce the vaccines along with the vials, syringes, and other materials needed.
Getting the right amount of each ingredient at precisely the right right time at the right temperature and viscosity and then blended enough to become a vaccine but not enough to break down the synthetic biological mRNA is incredible. Then comes the vials. Corning developed a strong aluminosilicate glass that can be prestressed during vial manufacture. They did this by replacing sodium atoms in the raw materials with potassium atoms, which enables the glass to resist breakage during freezing and transportation. As the doses of vaccine get closer to the arms of Americans, the sophistication becomes a bit reduced.
I am living in Florida this time of year. The state announced a plan to receive 367,000 doses of the Moderna vaccine before Christmas. The vaccine doses were distributed to 173 hospital locations which did not receive doses in the first allocation of the Pfizer COVID-19 vaccine. The hospital locations for the delivery span 43 of Florida’s 67 counties. The public health and emergency management teams take it from there. The variability among counties is quite different than what goes on in the manufacturing.
After Governor DeSantis changed the CDC recommended priority for the second wave to anyone over 65. The news reported how large numbers of Floridians camped out overnight to get in line for a vaccination. I live in Flagler County, which set up a text alert system to notify subscribers of when and how persons older than 65 could make an appointment.
On Monday, January 4, I received a text providing a link to a website to make an appointment. I immediately visited the link to find it was at Eventbrite, a system widely used to sell concert tickets. It turns out the supply of Moderna vaccine was roughly 1,000 to be dispensed on the following Tuesday, Wednesday, and Thursday mornings. Eventbrite was not well suited to the task of making an appointment with terminology and process oriented toward buying concert tickets. I acted quickly and was lucky to get a 10:30 appointment for Thursday. The roughly 300 15-minute appointment slots were sold out in less than 10 minutes. The Eventbrite app did not indicate how many slots there were and how many were left, and many people were understandably frustrated.
On Thursday morning at 9:45am I left home for Cattleman’s Hall at the Flagler County Fairgrounds in Bunnell, Florida. The process was incredibly well organized and staffed with public health workers and volunteers. Signage was clear and a half-dozen checkpoints were staffed with friendly people. They were organized to handle thousands, but unfortunately there was not enough vaccine supply for so many. At one checkpoint on the Fairgrounds, I was presented with a clipboard to fill out some basic information such as name, address, date of birth, and certain medications and conditions.
At the next checkpoint, a nurse asked a few questions, and then I moved on to tent #1 to which I had been assigned at the prior checkpoint. Remaining in my car, a very pleasant nurse asked a couple of questions, raised my shirt sleeve, and injected a half-milliliter dose of Moderna 012L20A vaccine in my deltoid muscle. I knew from experience to relax my arm to minimize pain. The injection was completed in seconds without getting out of the car, and I barely felt a thing. On to the next checkpoint where another person asked how I felt. Fine. The next few checkpoints were designed to last a total of 15 minutes to ensure no allergic reactions. A Post-it was placed on my windshield to show the last checkpoint person I could be cleared to leave at 10:32.
I was given a vaccination record card showing my second dose should be within a few days of February 3. An instruction sheet was provided to log in to vsafe.cdc.gov to register my vaccination. The site was very simple to use and requested basic name and address, date of vaccination, which vaccine, and mobile phone number. Later that afternoon I received a text message asking me to log in to the v-safe site with an assigned registration code. I was asked how I felt and about any symptoms. These health checks will continue until some time after the second dose.
Some people don’t like the Federal government having more data about them. I am happy to know the CDC is checking up on me and telling me how to report any side effects I may have. Overall, it was a very positive experience, except for the Eventbrite app. I received a text message from Flagler County saying, “We will not be using the Eventbrite system for new appointments. State has advised that we will have access to a new system next week.”
Can the world get vaccinated. I believe so. In developing countries it will be more complex, but there are organizations which care about getting the vaccine out there. In the U.S., we have about six million people vaccinated with a first dose. The first dose gives efficacy roughly equal to flu vaccine. The second dose will take it up to 95%. The holiday made a quick start difficult, but vaccinations have ramped up to 500,000 per day. The new administration is planning to double that. I suspect priorities will begin to shift to getting it out there to anybody rather trying to perfect a needs/risk based approach. We need to get to 75%-90% in order for the herd effect to take control.
In summary, from my perspective, the scientific research, development, and manufacturing have been miraculous. IT has lagged, but I believe it will catch up because the motivation is high. Work is underway at IBM and other organizations to leverage mobile devices. The Commons Project, based in Switzerland, The World Economic Forum and a broad coalition of public and private partners are collaborating to launch CommonPass, a trusted, globally-interoperable platform for people to document their COVID-19 health declarations, PCR tests, and vaccinations. The plan is to satisfy country entry requirements, while protecting health data privacy.The CommonPass app created by the group allows users to upload medical data such as a COVID-19 test result or a proof of vaccination. The app will create a QR code that authorities can scan. No sensitive personal information other than the health declarations is revealed. The app should be available as early as this month.
Epilogue: I use Apple Notes to keep track of immunizations for flu, shingles, pneumonia, Covid, and others. Not that I don’t trust the government or my healthcare provider, but if I have my data stored in iCloud and available on all my devices, I feel much better.