The Great, Predictable Vaccine Logjam

Some parts of the U.S. healthcare industry performed admirably during the pandemic. Big pharmaceutical companies and their peers in other countries developed a vaccine in record time. In the United States, more than 27 million vaccine doses were produced and delivered by the middle of January.

On the other hand, the distribution has been a bust. Local health professionals have had to organize administering the doses they’ve received while caring for the soaring number of COVID-19 patients. This combined with the holidays caused the U.S. to miss its initial 2020 goal of administering 20 million vaccines by a lot — only 2.8 million doses were administered on Dec. 31, The New York Times reported. The pace has picked up, with 9.3 million administered by Jan. 12, according to the CDC.

Already, a medical center in Northern California has had to rush to administer hundreds of doses from a freezer that broke. Some Americans are traveling hundreds of miles to get their doses, running the risk of catching the virus on the way. Maryland’s governor threatened to withhold the vaccine from hospitals slow to distribute it.

As stories of haphazard administration emerge from the vaccine distribution campaign, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the government would relax some of its vaccine prioritization guidelines, which currently call for the elderly and health care workers to first receive the vaccine.

“We need to do better than we’ve done so far,” Fauci said Tuesday at a Schmidt Futures panel on preparedness. The initial categorization of who could and could not get the vaccine “were a bit too rigid,” he said during the panel. The U.S. is sticking to prioritization, but it’s changed since the rollout, he said.  

“(The guidelines) about getting health care providers, and getting people who are in nursing homes and the staff that takes care of them, then going on to the elderly … we were a bit too rigid in categorizing and classifying people.”

“When people are ready to get vaccinated, we’re going to move right on to the next level, so that there are no vaccine doses sitting in a freezer refrigerator, where they could be getting into people’s arms,” he said. A followup call to the CDC for more details was not immediately returned.

It’s possible to get 70 to 85% of the U.S. population vaccinated by the end of the summer “if we do this correctly and make this what it is — a medical emergency,” Fauci said. At this level, the country has a shot at return to  “some form of normality” by the fall, he said.

It should have been obvious that America needed an efficient distribution and communication system (see related story), and it had almost a year to prepare. But a state by state, town by town response wasn’t built to effectively handle the rollout, according to Mark Marino, senior program officer at VentureWell, a nonprofit organization that promotes and provides funding for technology entrepreneurs mainly in science, medicine and the environment.

He was VentureWell’s point person on a program developed by the National Institutes of Health to fund innovations that would make COVID-19 testing faster and more accessible. The Rapid Acceleration of Diagnostics (RADx) called upon hundreds of experts and innovators in its search for more efficient testing, said Marino. Yet, he said no similar major call to innovators of vaccine distribution was made. 

Federal officials have had months to nail a strong plan for rolling out the Covid-19 vaccine, but took little action, said Marino, on the questions of communicating the vaccine’s safety and actually getting shots into people’s arms fast, in an orderly fashion. It’s one of the most critical things officials could have been doing, he said.

“They (states and towns) are going to use their existing systems that they have, which are leaning heavily on the existing supply chain, heavily on the existing healthcare provider network and you’re just going to have a bit of a fragmented and ineffective response,” Marino said.

The Covid-19 pandemic, particularly the distribution problems, are shining a spotlight on America’s bifurcated health care system, which is both cutting-edge and underdeveloped.

Private sector innovative energy and funding in the United States tends to flow to companies with the highest-profit potential — which doesn’t include innovations in public health infrastructure, like home health care or rural health, that could be mobilized in a massive distribution campaign. Government research and development funding in the United States has fallen as a share of GDP since its mid-20th century highs.

Meanwhile, there are innovations in basic health care, but many are happening globally. 

Innovation Focused On Global Initiatives

Noah Perin has been thinking of more efficient ways to deliver health care products for years. He’s the Chief Executive Officer of Seattle-based VIA Global Health, a company that distributes medical supplies to low and middle-income countries. 

“Vaccine distribution is not a new problem,” Perin said. “I mean, it’s a new problem in the U.S. at the scale that we’re trying to do it, or in the developed world, but in fact, within the scope of global health, we’ve been trying to figure this out for a long time. I think that’s where these innovations have come in.”

Though, part of the expectation of speedy delivery could be due to the instant-gratification mindset of developed nations, Perin said. The supply chain for a global endeavour such as the COVID-vaccine distribution is not set up to happen with a snap of a finger.

“We’ve come to accept that Amazon can get everything to us in two days or less and Fedex can overnight anything, anywhere,” Perin said. “For the rest of the world, that’s not true.”

A Way To Keep Medicine Cold

Take, for instance, Insu Health Design.

One year after Hurricane Maria devastated Puerto Rico in 2017, Mason Lucich and Doris Candelaria realized a huge effect: the massive power outages on the island that took over 11 months to restore left many diabetics without a proper way to keep their insulin cold. 

Lucich was a graduate student at the University of Houston and Candelaria attended the University of Puerto Rico. The pair met during a collaboration program between the universities. Realizing the need, they came up with a solution: a portable device to keep medications between 36 and 46 degrees fahrenheit for days without a power source.  

Insu’s Lucich and Candelaria were part of VentureWell’s 2019 summer e-team grantee program, where they received funds and training to develop their startup. They plan to seek venture funding in the fall and have raked in about $185,000  in grants in the meantime. 

They’ve been watching what’s been happening with the Covid-19 vaccine distribution, or lack of it, with some surprise. 

“When it comes to pitching and, we’re trying to create the connections to raise money and whatnot, the kind of the feeling we’ve gotten is that they kind of wish that we were doing that (COVID-19 vaccine). But that’s not the goal of the company,” Lucich said. 

“Distribution is a massive issue,” Lucich said. 

America’s Blind Spot

The challenges faced in the vaccine rollout could have been avoidable if officials had turned to companies, entrepreneurs and organizations who have been tackling innovation for years, Marino said. 

Marino named a few other distribution innovators VentureWell has worked with that have models relevant the Covid-19 vaccine distribution: Insupply Health, a Kenya-based company that provides remote temperature monitoring of vaccines and data tracking; Nanoly Biosciences, a group out of University of Colorado, Boulder that is working to stabilize temperature-sensitive molecules; and Phixed Systems, a company out of University of California-Davis has created a sensor to monitor production parameters for biomanufacturing. 

Even with these existing delivery innovations, funders aren’t lining up to invest in efficient ways of distribution. Instead they gravitate toward the shiny inventions, which have a straight path of sufficient exit potential, Marino said. Distribution is not so glisty — its success is often nonlinear and unattractive to many investors. 

Though this may be changing, Perin said. “What has become apparent is that the innovation and the invention is only the first part,” he said. “There’s this dawning awareness that just because you built it doesn’t mean that they’ll come.”

Last month, the Bill and Melinda Gates Foundation committed $250 million for production and delivery of the vaccines. 

“This funding will support continued innovation to develop tests, treatments, and vaccines that are easier to scale and deliver, to ensure there are many options that are less expensive and can be used in different settings,” according to a Dec. 9 press release. “Today’s commitment will also support the delivery of new COVID-19 tests, treatments, and vaccines, particularly in low- and middle-income countries.”

The foundation reports it has donated a total of $1.75 billion to fighting COVID-19 as of the same date, much of which “has gone towards the production and procurement of crucial medical supplies,” its CEO Suzman writes in a Dec. 9 article.

But most of its health care work is focused outside the United States.

The question now is whether U.S. health care system and its innovators and funders step up to rebuild the less glisty but still essential parts of the system that the Covid-19 pandemic has revealed as broken. A large lesson of COVID has been how vital public health is, Marino said. Its innovation is essential. 

“There’s a lot at stake in trying to learn and adapt and doing things differently for the next year, next round, which I think there will be,” Marino said. “The changes we can be making in both investments and infrastructure systems and policies are going to be necessary because this issue is not just a one time thing.”