To maximize the benefits of COVID-19 vaccinations, delivery strategies must integrate evidence on vaccinating with speed, scale, and equity. As supply is currently low but demand high, prioritization strategies should consider mortality and infection impacts. Robust allocation, distribution, demand generation and verification are needed. Successful rollouts have used diverse providers and sites to reach populations. International cooperation on vaccine access is important for global protection.

1. Maximizing the Impact of COVID-19 Vaccinations:
With Speed, Scale and Equity
Rebecca Weintraub, MD

2. Key Takeaway
For current and future COVID-19 vaccine rollouts, robust
delivery strategies are essential to manage the initial scarce
supply and adapt to the dynamic demand for COVID-19
vaccines.
To maximize the public health benefit from vaccines, we must
integrate the evidence base on how to design delivery channels
that vaccinate with speed, scale and equity.

3. From Vaccine to Vaccination: What is the goal?
1. Direct protection: vaccinate those most likely to die or most likely to
die if infected
2. Herd immunity: vaccinate as many people as possible, especially high
transmitters, to slow transmission and protect even the unvaccinated

4. Vaccination requires robust vaccine delivery strategies
ALLOCATION DISTRIBUTION VERIFICATION
Generate demand and address hesitancy,
tailor engagement, communicate
Identify the right
populations for
equitable
distribution
Get the right vaccine
to the right people
at the right time in
the right place
Ensure proper
distribution and track
progress towards herd
immunity
DEMAND
Weintraub, R; Submaranian, L; Karlage, A; Ahmad, I; Rosenberg, J; COVID-19 vaccine to vaccination:
Why leaders must invest in delivery strategies now. Health Affairs. November 2020.

5. Strategies must address dynamic supply & demand
Currently facing low supply, high demand scenario
Phase 1 Phase 2 Phase 3
Low Supply,
High Demand
High Supply,
Low Demand
5

6. Given scarcity, must consider the impact of vaccine prioritization
strategies on mortality and infections
Bubar KM, Reinholt K, Kissler SM, Lipsitch M, Cobey S, Grad YH, Larremore DB. Model-informed
COVID-19 vaccine prioritization strategies by age and serostatus. Science. 2021 Jan 21.

7. Definition of
“essential workers”
https://www.nytimes.com/2020/12/05/health/covid-vaccine-first.html

8. US COVID-19 Rollout: New Federal algorithms determine
where vaccines are shipped
Information on
individual vaccine
recipients, such
as age, gender,
and race
IZ
Clearinghouse
VaccineFinder
Daily vaccine
inventory levels
Information on the
vaccination sites
Number of
vaccines
ordered and
distributed
VTrckS
IZ Data Lake
Ordering
and
shipping
data
Provider
data
Vaccine
administration
data
Local vaccine
inventory data
Vaccine
manufacture
rs and main
distributor
Tiberius
Vaccine
allocations
and orders
Vaccine
allocations,
orders, and
shipments
Physical
shipments
of vaccines
De-identified and
de-duplicated
information on
vaccine recipients
Daily
vaccine
inventory
levels
Vaccine
allocations
and orders
Data access
Vaccination
sites

9. Patchwork of COVID-19 vaccine data available from state websites
Number of
doses:
Vaccine
recipients by:
County or local level data
Administered
Allocated to state
By 1st or 2nd dose
Given to LTC residents
Some information: 37 states + DC
By manufacturer
No information:
13 states
Number of vaccination sites
Appointment availability
Age
Gender
Race/
ethnicity
Last updated: Jan 18, 2021

10. Example: Tennessee COVID-19 Vaccine Dashboard

11. We are at a critical moment …
Twelve months into a raging, global pandemic,
vaccine supply and time are our most scarce resources.

12. Threat of slow vaccination programs
https://www.washingtonpost.com/nation/interactive/2021/vaccination-pace-herd-immunity/

13. We are at a critical moment ...
Achieving impact from vaccination does not require the
exclusive use of vaccine with extremely high levels of efficacy.
Modeling studies of vaccine implementation suggest that even
vaccines with modest efficacy can still result in large
reductions in COVID infections and deaths if they are swiftly
delivered to a large percentage of a population.

14. Paltiel AD, Schwartz JL, Zheng A, Walensky RP. Clinical Outcomes Of A COVID-19 Vaccine:
Implementation Over Efficacy. Health Affairs. 2020 Nov 19:10-377.
Nine heat plots for 42-day delay to vaccine efficacy
“The effectiveness of a
COVID-19 vaccine will be
shaped by the success or
failure of efforts to deliver
a trusted vaccine quickly
to the public.”

15. Highest priority
groups
Health care
workers
LTC residents
Retail pharmacies
Mass vaccination
sites
Primary care practices
Onsite/mobile sites
Employers
FQHCs
Community-based
organizations
Onsite
Health systems
LTC facilities
Who ?
Where ?
Large priority groups
All 65 or older
Motivated general
public
Late adopters
Skeptics, hesitant
Isolated/homebound
Homeless
Rural
15
Improve readiness of
delivery channels for
high supply/low demand
Vaccination needs to succeed through the “last mile”

16. We need to bring the vaccine to the people and
meet them where they are
Identify providers who are influential
and trusted by certain populations:
● Hard to reach
● Hesitant
● Not trusting of Federal government
● Isolated/homebound
● Cultural/language minorities
● Rural

17. 31% Americans say, when an FDA approved vaccine for COVID-19 is
available to them for free, they would wait to see how it works for others

18. Eight in Ten say they will turn to health care providers
when deciding whether to get vaccinated

19. Different vaccine distribution channels attract different populations
Source: Ad Council’s Partner Strategy Summit

20. West Virginia
Using geocoding technology
to help identify where
people are and who needs
to be vaccinated
5 vaccine hubs within 2hr
driving radius
Community vaccination
clinics in 55 counties
Glimmers of hope for speed, scale and equity in the US:
Examples of High Performing States
Connecticut
“Just in time inventory”
system: unused doses of
vaccine are transferred to
other facilities at end of day
Expanded pool of
vaccinators to include EMTs,
dental workers,
veterinarians, podiatrists
Kentucky
Broadbent arena
administering 1,500
doses/day
Staffed by volunteers
(~4,000 sign ups) →
After 40 hours of
volunteering, eligible
for leftover vaccine

21. There is a lot of work to do: Who’s procuring vaccines?
Doses by country, income level
Duke Global Health Innovation Center;
Data as of Jan 18, 2021

22. We all benefit from the global population being equally
protected: cooperation matters
Chinazzi M, Davis JT, Dean NE, Mu K, Pastore, Piontti A, Xiong X. Estimating the effect of cooperative versus
uncooperative strategies of COVID-19 vaccine allocation: a modeling study. MOBS Lab. 2020 Sep 14.

23. “Remarkable progress has been made using vaccines.
The future holds great promise for vaccine-mediated
control of global pathogens, but providing affordable
access to effective vaccines for everyone who could
benefit from them remains an important challenge.”
- New England Journal of Medicine

24. We work to deliver the best possible care for
every patient, everywhere, every time