Six Critical Elements of Federal Mass-Vaccination Planning

As the United States enters the second year of the COVID-19 pandemic, vaccine distribution is top of mind: What will it take to ensure vaccines are administered efficiently and safely to hundreds of millions of people in the span of months?

We interviewed LMI experts who have worked with the federal government to effectively distribute vaccines for the flu and Ebola. They now work across the departments of Defense and Health and Human Services (HHS), the Federal Emergency Management Agency (FEMA), and other agencies to manage vaccine distribution and administration for COVID-19.

Here are six best practices they have learned from responding to pandemics.

Don’t wait for a virus to emerge before creating a plan.

1. Ensure strong nationwide oversight is in place.

The federal government’s ability to acquire products and make use of nationwide networks and data makes it uniquely positioned to oversee the equitable distribution of COVID-19 vaccines to the states. Effective distribution includes helping coordinate a national supply chain for COVID-19 vaccines, researching and communicating public standard of care guidelines, and supporting states as they prepare for last-mile delivery.

This national approach is even more critical when shortages have the potential to result in states, municipalities, companies, and even individuals competing for scarce resources—and as the scale of vaccine supply, distribution, and administration ramps up significantly. The federal government can also leverage nationwide data to understand trends, model scenarios, and forecast supply to ensure no vaccines are delayed or wasted as production increases and administration capabilities scale quickly.

“When you look at how we have prioritized the initial administration of vaccines, stakeholders can probably manage through the first phase without significant difficulty,” LMI disaster management expert Dr. Brandon Greenberg said. “Those are small, targeted populations. But top-down planning is important the minute you begin to scale beyond those groups. When you’re working with large, dispersed populations, everyone needs to be on the same page. If the guidance for scaling wasn’t there in the first phase, it’s absolutely critical to spend the time putting it in place for phases two, three, and four.”

2. Build on distribution networks.

The U.S. has a significant distribution network for delivering the influenza vaccine each year. With additional support, this network can serve as a basis for the nationwide distribution of other critical vaccines. National pharmacy chains including CVS and Walgreens are distributing the COVID-19 vaccine thanks to partnerships with the federal government. Funding and reinforcement of these and other public-private partnerships will ensure that the U.S. is prepared in the event of future pandemics.

“Building up networks and processes enables you to move quickly in response to a possible threat,” explained Bruce Kaplan, a fellow in logistics strategy and integration at LMI. “People think that we need to have stockpiles of materials. But the real issue is resiliency: Do you have a plan in place with entities positioned to provide materials or support quickly, and are you maintaining those relationships? That’s the key.”

3. Leverage federal capabilities for vaccine distribution and administration at the state level.

The federal government can use the Office of the Assistant Secretary for Preparedness and Response at HHS, the CDC, FEMA, and other national agencies to help states plan for distribution of vaccinations. Effective use of these agencies can also make up for shortfalls at the state level. In response to COVID-19, for example, the federal government could deploy retired and volunteer medical personnel to states to alleviate stress on local healthcare systems. Strategies like this can be replicated during future pandemics and other public health crises.

Dr. Greenberg noted that the COVID-19 response is an opportunity to consider the best use of federal agencies for operations. “We have seen the federal government deploy people as force multipliers, which is positive,” he noted. “For example, should we have a core group of people who can be deployed solely to administer vaccines? That would require less training, and it might be worthwhile to think through that kind of personnel need.”

Last-mile vaccine delivery should be prioritized but flexible.

4. Avoid information silos with deliberate communication.

Communication across all levels of government is critical. Pandemic response and vaccine distribution are particularly prone to information siloing due to the sensitive nature of the information. Once information and operations become decentralized, it can be difficult to distribute vaccines efficiently. A coordinated response from the federal government to the states on areas ranging from vaccine supply and delivery to public outreach is key. Federal emergency response personnel are well positioned to develop public messaging about the vaccine, disseminating information about dosing, ingredients, and potential side effects. Making this information widely accessible can go a long way toward limiting vaccine hesitancy and prevent the spread of disinformation. Free-flowing communication between federal and state governments can also help with resource management so that doses don't go to waste.

5. Pilot new ways to distribute resources.

Using nationwide data, the federal government can identify pilot sites for the earliest stages of vaccine delivery. These sites can serve as proofs of concept with processes that can be readily copied as more vaccines become available and eligibility expands. The federal government should also work together with state-level stakeholders to launch secure appointment registrations, call centers, and customer service. The use of so-called “navigators” can be effective to help the elderly or other low-tech or low-information populations obtain the vaccine.

Joe Spruill, a senior consultant with LMI and an operations officer with the Department of Defense COVID-19 Task Force, explained that pilot sites proved to be an important solution early on in the military’s plan for vaccine distribution. “Given the issues around cold storage, we opted to choose several pilot sites to ensure proper delivery and distribution,” he said. “By doing that, we limited the potential for mistakes. We were able to expand much faster than by trying to do 200 locations at once with a completely new process.”

6. Support last-mile delivery.

Coordinating vaccine prioritization through the CDC in concert with state-level stakeholders ensures that the most vulnerable populations receive the first doses. Maintaining coordination is critical as the rest of the population becomes eligible and vaccine supply increases. With federal- and state-level officials working from the same set of priorities, states are empowered to build flexibility into vaccine delivery to ensure that the maximum number of doses are administered at all times. A lack of clarity around prioritization and supply can lead to increased rates of expired, unused doses and an erosion of public trust in the process.

As with any national plan, it is critical that the federal government supports coordination and issues guidance for vaccine distribution. Without that support, 50 individual state plans could emerge, leading to inefficiency, confusion, and competition for scarce resources. The federal government is uniquely positioned to act as an operations hub for distribution, empowering states to focus on effective last-mile delivery. The U.S. response to influenza serves as a basis that stakeholders can build on to distribute other vaccines and support pandemic preparedness. As it does with influenza, the federal government can work with private-sector partners on operations management, data visualization, and logistics.