How can we distribute a COVID-19 vaccine fairly and effectively?

How can we distribute a COVID-19 vaccine fairly and effectively?

Expert in healthcare operations management, Professor Behzad Samii, outlines four distinct approaches for health policy makers to distribute a potential COVID-19 vaccine fairly and effectively.

With yesterday's promising news that a potential COVID-19 vaccine, developed by American pharmaceuticals company, Pfizer, and German Biotechnology company, BioNTech, could be on the horizon by the end of this year, attention now turns to how this can be distributed effectively, to bring us back to some sort of normality as soon as possible. 

Most experts had predicted that an effective vaccine could become available by mid-2021, but with yesterday's news it looks as though this will be a little sooner. However, as the vaccine is in relatively scarce supply, only 50 million will be made before the end of the year, not everyone will have immediate access to this.

The current global Personal Protective Equipment (PPE) supply shortage has highlighted how limited supply is for critical equipment in the fight against COVID-19, and the importance of health policy decision makers preparing for and managing supply as effectively as possible. This challenge is also something that we will likely see with a vaccine too, according to Behzad Samii, Professor of Operations and Supply Chain Management at Vlerick Business School, and expert in healthcare operations management.

Professor Samii says,

“The lockdown initiative has allowed overwhelmed healthcare systems to catch their breath and match hospitalization supply and demand. But once we start moving back out of heavy restrictions and lockdowns, and move further towards a potential vaccine, society expects governments, pharmaceutical companies, and international agencies to have strategies in place to quickly produce and distribute sufficient number of COVID-19 vaccines, and antiviral medicines. Vaccines, in particular, usually have complex manufacturing processes and long production lead times. We will have to rely on good targeting and rationing strategies for the quantity of vaccines available”.

The rationing of available COVID-19 vaccines has to be based on multiple competing objectives, where priority for a vaccination may be given to certain population segments. These segments are likely to be; personnel in healthcare institutions who are critical in tackling COVID-19; those who present the highest risk of transmitting the disease onwards i.e. the elderly in care homes; those who have pre-existing underlying conditions; those who work in industries directly involved in tackling the pandemic i.e. manufacturing vaccines.

On the other hand, some argue that an egalitarian healthcare approach should be taken, with the general population sufficient access to a vaccine, not just high priority population. At least some amount of the vaccine should be made available to the general population even if on a strictly First-Come-First-Served (FCFS) basis.

Professor Samii says,

“Public health planners clearly face the challenging problem of allocating scarce quantities of COVID-19 vaccines to a population consisting of both high and low priority segments. The key question they face is how do we decide the rationing levels or service levels for each of the priority segments?”

Professor Samii suggests there are four key approaches that could be taken by public health planners to distribute scarce COVID-19 vaccine supplies in a fair and effective way to the population. In any of these approaches, a part of the vaccine inventory is reserved for the exclusive use of the high priority segments while demand from the low priority segments can only be fulfilled from the unreserved portion of the vaccine inventory.

1. First-Come-First-Served (FCFS): This approach can be best used when sufficient doses of vaccines are available for all high and low priority segments – however this is yet an extreme case when vaccines are abundant.
2. Partitioned Allocation (PA): High priority segments can only consume the vaccines specifically reserved for them while the rest is for the exclusive use of the low priority segments. No borrowing from the unreserved vaccines is possible for the high priority segments.
3. Standard Nesting (SN): The high priority segments get vaccinated using the reserved and the low priority segments using the unreserved vaccines. Once (and if) the reserved quantity is exhausted and some unreserved vaccines are still unused by the low priority segments, the high and low priority segments compete for them on a FCFS basis.
4. Theft Nesting (TN): The sequence of allocation is reversed compare to SN as both priority segments start the vaccination campaign by competing for the unreserved vaccine inventory on a FCFS basis. Once (and if) the unreserved vaccine inventory is consumed, high priority segments continue to be vaccinated from the reserved inventory while low priority segments deterred.

Having completed the paramount task of procuring highly sought-after COVID-19 vaccines, health planners should then make impactful yet informed decisions about not only the suitable choice of the vaccine inventory allocation mechanism but also the desired reserved vaccine quantity.