The vaccination campaigns are underway, marking a new chapter in a health crisis that has led to the deaths of more than 300,000 Americans and more than 1.6 million people across the globe as of mid-December. PwC’s Health Research Institute (HRI) reached out to PwC principal Ginger Pilgrim for insight into what healthcare providers should be considering as these vaccination efforts ramp up. HRI also spoke to PwC principals Omar Chane and Vitaly Glozman about the steps that vaccine manufacturers, distributors and the myriad other stakeholders in the process will likely need to take to help ensure that vaccines reach individuals who want and need to get them, as well as how they can learn and adapt along the way to help optimize the process. Our conversation:
HRI: How are providers preparing to ramp up distribution and administration of the COVID-19 vaccine?
Ginger Pilgrim, PwC principal
Healthcare providers vaccinate workers and patients all the time. But this is different. Demand could be immense while supply will be limited at first. The distribution channels are nontraditional: The federal government is distributing the vaccine to the states and then each state has its own unique way of distributing the vaccine.
Providers are trying to stay on top of how distribution works in their area, in the midst of chaos. They are facing a number of nontraditional challenges as the vaccine rolls out, including another surge of COVID-19 cases.
This is a fairly massive effort, compared to previous vaccine efforts. It is its own project requiring collaboration across the organization, from supply chain to clinicians to leadership. Providers are planning for receipt and distribution of the vaccine and communication about it. They are doing this in a very short time frame with resources that are stressed and strapped.
We went from clinical trial results to an EUA [emergency use authorization] to distribution in a matter of weeks, which is atypical. Providers are reacting in real time. All of this is happening with a clinical workforce that has faced challenges with work hours, nontraditional schedules and, in some cases, furloughs, benefit changes and even an erosion of trust to some extent.
HRI: How are providers communicating with their workforces about vaccination? What can employers learn from this?
Ginger Pilgrim: The first choice providers are facing is whether to mandate the vaccine. There have been historical challenges and even controversy in recent years around mandatory vaccines, including the flu vaccine. For the COVID-19 vaccine, most providers are going to highly encourage but not require it for now. They will strongly encourage it, educate their workforces about it and ask leadership to act as models, getting the vaccine themselves as an example to their staff.
The second choice is how to communicate with employees about it. Some are putting their clinical leaders out front to talk about the testing that has been done on the vaccine and its safety and efficacy. They are taking a clinical and scientific approach to educating their workforces. Some are recording interviews or podcasts with organizational leaders to get the message out. The right information at the right level is key.
Employers outside of healthcare delivery can learn from the provider experience with their workforces. They will have to think about their vaccination policies and how they will communicate about the vaccination to employees. They will need to understand who is going to get it and when—something that is largely out of their control. They will need to think through their approach once their broader workforces are eligible for the vaccine. Will they partner with a clinical system in the community to share safety information about the vaccine and alleviate concerns about it? Can they do this in a way that leaves the choice up to employees but helps them make an informed decision that is their own decision?
HRI: What role can providers play within their communities around the vaccine?
Ginger Pilgrim: There are opportunities for providers here. Early in the pandemic, many providers were caught somewhat flat-footed. Information was spotty and sometimes conflicting. This could be an opportunity for providers to reset their role in their communities as a trusted source of accurate and timely information.
Providers can get ahead of the messaging. They can proactively reach out to employers and offer to be their partner in communicating to employees. They can also work with employers to set up vaccine clinics for employees, when that is feasible.
Partnering with employers around the vaccine—communication about it or administration of it—could create strategic opportunities for providers beyond the pandemic. Direct contracting with providers and narrow provider networks are gaining traction among employers. Building relationships with employers now could enable these types of contracts and support other strategic opportunities in the future.
HRI: What should payers focus on as the vaccine starts to roll out?
Ginger Pilgrim: Payers are employers too, so they have employer considerations as well. Beyond that, payers should be thinking about reimbursement. Most of the vaccines are being paid for by the government or are required to be paid for under the CARES Act, at no cost to the member. This should be communicated to members. Following this crisis period, there likely will be future payer considerations around coverage and reimbursement.
HRI: Anything else they should be thinking about?
Ginger Pilgrim: The health industry is facing the current challenge of execution, delivery and communication about the vaccine. But it should not lose sight of the long term. Providers should not overlook strategic opportunities to differentiate themselves during the pandemic. That could be in the treatment of COVID-19 patients, around emerging therapeutics.
Or it could be around post-vaccine policies. The jury is still out on what will be considered acceptable post-vaccine behavior, and how long modified behavior will be required. There is workforce modeling and thought that need to go into the future of work for all employers.
Employers will need to think through their policies about masking, access to the office, social distancing, etc. They will need to think through what the vaccine changes and when that change takes place. Providers could lead the way here and help employers navigate it too.
HRI: As COVID-19 vaccine distribution begins in the US, what should vaccine manufacturers and distributors be doing to ensure the process is efficient?
Omar Chane, Principal
This is the largest public health effort undertaken since the rollout of the polio vaccine. We also have to keep in mind that the COVID-19 vaccine is being rolled out at the same time that healthcare systems are being pushed to the limit because of the spread of the disease and new therapies are being approved for administration to SARS-CoV-2-positive patients. It is almost like the perfect storm of all these things converging together and impacting our healthcare providers.
One of the key success factors of this campaign is very careful balance and coordination between supply and demand. The demand is being managed by the various state public health agencies, and the pace at which the demand is generated needs to be aligned to when the vaccine capacity is becoming available.
Vaccine manufacturers are working very closely with the CDC [Centers for Disease Control and Prevention] to ensure this close alignment and visibility into the supply capacity. Furthermore, given the fact that a core assumption around the success of this vaccination program is the public’s acceptance of the vaccine, the various players in the healthcare system, including manufacturers and distributors, have a role to play in ensuring a streamlined approach to communicating the profile of the vaccines. This also includes collaborating to ensure the appropriate level of patient activation and addressing any potential social and economic barriers to immunization.
Vitaly Glozman, Principal
Most important is the tight integration and coordination among the parties involved: manufacturers, distributors, providers, testing labs, and state and local governments.
Arguably, all the pieces of the process have been defined, from allocation and ordering through administration and follow-up. However, the integration of all these steps through data capture, clear accountabilities, and patient focus will be the greatest challenge to make the process work efficiently.
HRI: What can health organizations learn in the early days of distribution and vaccination, and how could that be applied in real time for the next wave or for the next batch of vaccines?
Vitaly Glozman: Obviously, the critical success factor of how effectively vaccines are working will be the severity of side effects or reactions, safety and efficacy. An additional sign whether the vaccination is going well will be the uptake for the second shot of the vaccine. If providers see a notable drop between the administration of the first and second doses, that signals that the process is not working well. The root causes could be scheduling difficulty, availability of supply, ease of administration, communication and change management, long queues, etc.
The industry has to realize (and be OK) with building this national distribution network while “flying.” Tactical missteps will happen, but the ability of key players to quickly address them and adjust their processes and/or flow with the understanding of upstream and downstream implications (from manufacturers to patients) will be critical for success.
Omar Chane: Another point that I would add is the importance of effective communication campaigns. Transparent and open communication with the public is critically important to alleviate any concerns that people may have, and to ensure that everyone who is eligible for a vaccine knows exactly when their “turn” is, and how and where to get a vaccine.
The target audience of the first wave of the vaccine is highly defined (healthcare workers and residents of long-term care facilities), so awareness of eligibility is well established. However, as the recommended population begins to increase, a crystal-clear communication plan at a state and local level will be required, especially given the fact that some variations may exist within a state or across bordering states based on specific local needs.
HRI: What about non-vaccine pharmaceutical and life sciences companies? What are they doing or what should they be doing?
Omar Chane: As mentioned above, we are going through a period of a perfect storm where the healthcare systems are dealing with many priorities across a number of fronts. Everyone has a role to play to make the provider life a little easier during the next six to nine months. Pharmaceutical and medical product manufacturers should coordinate with their value chain partners to ensure continuity of supplies.
We need to make sure that we don’t encounter any product shortages, especially products that may be impacted by the distribution and administration of the COVID-19 vaccines. In other words, I think it is incumbent on all pharmaceutical and device manufacturers to assess their supply and distribution networks and understand any potential disruptions that may occur and make sure that they put contingency plans in place.
With all the strains that providers are going to be facing over the next few months, we don’t want them to worry about other product shortages.
Vitaly Glozman: We have to remember that in addition to prevention of COVID-19 (vaccines), there will be a continuous need for treatment (small molecules, antivirals). Therefore, executing clinical trials, comparative studies and expedited regulatory reviews for products that help patients recover from SARS-CoV-2 infection is critical.
As we learn more and more every day about COVID-19, we are realizing that people with certain conditions are at an increased risk of severe illness from the virus.
Therefore, the industry must ensure availability of healthcare products for patients with cancer, kidney disease, immunocompromised systems, high body mass index (BMI), Type II diabetes, and other illnesses that make individuals more susceptible to the COVID-19 virus.