Vaccine Demand Management

Several folks around the country are saying they perceive their public health colleagues have been pushed over the edge by the pandemic, that  state and local public health agencies are dealing with urgent life-saving demands that are unlikely to moderate anytime soon, and many public health professionals assume that the coronavirus vaccine distribution program will self-organize along the lines of seasonal flu distribution processes.  One of my colleagues has pointed out that vaccine distribution for the current flu season will top out at about 198 million single doses and about half the target population was vaccinated during the 2019-2020 season (there are some indications that seasonal flu vaccination rates are increasing this year, but remain below national targets). Meanwhile the coronavirus vaccine will likely require 300 to 600 million doses and many are aiming for at least seventy percent of the population being vaccinated.  There is a significant demand management delta here.

So… here’s my try at practical suggestions that reflect Supply Chain Resilience principles focused on demand management… and especially demand motivation. These will be much more effective if developed and executed in collaboration with public health agencies.

First, look for demographic or other data-driven indicators of vaccine demand: On November 2 the CDC released a revised list of medical preconditions strongly associated with severe cases of covid-19.  The CDC has also released a set of other factors that increase risks associated with covid-19.  Some of these factors are coincident with demographic indicators that Supply Chain Resilience research can target.  There have been several credible studies of demographic risks (gender, age, economic condition, marital status, etc.) that show increased risk for covid-19 and that could be helpful in targeting demand management strategies. For example, here is one study from the the September edition of the American Journal of Emergency Medicine that found older men with preexisting difficulty breathing.  Another study from the Journal of the American Medical Association found higher fatalities among covid patients with the following characteristics: older age, male sex, morbid obesity, coronary artery disease, cancer, acute organ dysfunction, and admission to a hospital with fewer intensive care unit beds.  In a recent study the New England Journal of Medicine reports, “black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black.”  These are demographic factors that most TA participants know how to research, map, and target.  

Second, find your concentrations of demand.  Many Supply Chain Resilience jockeys are familiar with so-called “food deserts”. I betcha — I hypothesize — that you will discover that most food deserts are also “vaccination deserts” and the demographic profiles of these neighborhoods track with higher risk of hospitalizations, severe disease, and covid-19 mortalities.  Dig in, find out, prove me wrong. But if this is confirmed, you will be developing demand-management maps for vaccine distribution that are not all that different from what you have done to support resilience of food or fuel networks.  Our good friends at PolicyMap have already jump-started this process Further, if you are really ambitious check out this mobility (and more)data model to  identify “super-spreader” places, also-known-as potential concentrations-of-demand (or at least need).

Third, engage your preexisting (or make new) relationships connected to these concentrated populations.  How, when, and where is demand (or reluctance) expressed?  Who owns or operates these places?  Do these places have the resources to serve as effective vaccination venues?  How can you help them?  Who has the most credible and influential preexisting relationships with your concentrations of demand?  Work places? Faith communities? Schools? Bars and restaurants (these owners/operators should be vaccination motivated… how about promoting a free jab followed by a free beer?)  The current federal distribution strategy (see prior emails and links below) depends on preexisting pharmacy networks — including pharmacies in grocery stores. Supply Chain Resilience typically depends on developing relationships with market-leading owners of preexisting demand.  This is at the core of current HHS/CDC/OWS vaccine distribution strategy.  But in the case of vaccines, we also need to be in relationship with market-leading “owners” of reluctant demand. 

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