Vaccine Management with Eric Paternoster

Jeff Kavanaugh: Welcome to the Knowledge Institute Podcast, where we talk with experts on business trends, deconstruct main ideas, and share their insights. Today we're talking about the COVID-19 vaccination drive and why it's lagging behind expectations.

Jeff Kavanaugh: I'm Jeff Kavanaugh, Head of the Infosys Knowledge Institute. Today we're here with Eric Paternoster, President and CEO of Infosys Public Services. Eric, thank you for joining us.

Eric Paternoster: Thank you, Jeff.

Jeff Kavanaugh: How is the COVID vaccination program different from others, like the flu vaccine that states are familiar with?

Eric Paternoster: Well, the other vaccination programs that all of us have encountered as we were growing up and what the states and counties in the US have been involved with, they're used to much less time pressure. They only have to cover 30 to 45% of the population. Except for a few very specialized ones, like the new SHINGRIX vaccine; they only require one dose. It's just the whole coverage that we're looking for, the dosing regimen, it's like a whole order of magnitude different for COVID than it is for flu and other things that our whole system has been set up to work on.

Eric Paternoster: There's a series of administrative protocols that vary by which one of the vaccines that you're using. SO, there's a lot more complexity, and unfortunately, the systems that were in place that worked fine up until now, are not really set up to handle that level of complexity.

Jeff Kavanaugh: Eric, you graduated from West Point and served as captain of the US Army. Thank you very much for your service. I sincerely mean that. Leading infantry units in Korea and in the US, it does seem like it will take that kind of military precision to distribute this vaccine. Why do you think it's been so difficult for states to get their vaccines off the shelf and administered to people?

Eric Paternoster: Well Jeff, there's a few reasons. First of all, the military is set up under a totally different structure than our healthcare system in the US, which is very decentralized. There's a lot of different stakeholders and decisions are delegated to a much greater extent than they might be able to be in the military where you could control things. There's a couple reasons.

Eric Paternoster: First, because of the way this hit us and because of the decentralized nature of the system, there wasn't a federal mandate at the top that laid out all the rules for who got the vaccine, when did they get it, how the allocations would happen? So this led the states and counties even in some cases come up with their own rules for it.

Eric Paternoster: Second, by the guidelines for the distribution of the vaccine, they want to make sure because it's in scarcity right now that only certain providers are giving the vaccine that we know will not waste it and will give it to the right people in the right way. There's a registration, qualification and authorization process that has to happen for a provider to be allowed to give the vaccine.

Eric Paternoster: Third, not everybody can get to the place that is going to be giving the vaccines. If you have pop-ups set up for a certain tier of people eligible for the vaccine, the people have to have a means of getting there. This is a problem with elderly, infirm people. It can be a problem in rural areas where you don't have this healthcare system infrastructure necessarily out there. That's another issue that's there.

Eric Paternoster: I'd say finally, there are a lot of logistical hurdles that exists with this vaccine. You have the multiple shots required. You have the different cold storage requirements, and you have a certain amount of time between shots that cannot be exceeded, and that's another issue.

Eric Paternoster: I think that those are some of the main reasons why this has turned into such a level of complexity and why there's some of the frustration that exists.

Jeff Kavanaugh: It reminds me, apart from the human element, as well as the economic impact; this is a classic centralization/decentralization issue. The decentralized aspects; you're close to the edge, you're close to the people who need it, and you're flexible. Yet at the same time, there's an extreme level of efficiency needed as well.

Jeff Kavanaugh: Here in the US, the Biden administration has said it will “move heaven and earth” to vaccine a hundred million people in a hundred days. First, do you think it's possible? And second, what do you think the new administration should do to speed up vaccine distribution?

Eric Paternoster: It is possible. I think that we have proven just in fact by beating the estimates for how long it would take to develop a vaccine, of getting two to three vaccines online, available within four to five months of starting the R&D process, when most people in the beginning, even some of the experts in public health were saying, "It would take a couple years to get through the development of vaccine based on prior experience," the vaccines were brought out fast. I think we can distribute them faster than what we've seen today. Some of the confusion that I just mentioned is going away. The tiers are getting more understood by people. The supply chain is expanding to handle the demand. I think now we're dealing with specifics on how to reduce waste.

Eric Paternoster: I think that we're already doing, according to the New York Times, about a million doses a day across the country. I think that we have the distribution capacity and the supply really to at least double that. As long as the Pfizer, Moderna manufacturers continue to meet their supply agreements, which there's no sign that they will not be able to do that, I think that we can more than double what we're doing right now in terms of how many doses are being administered today.

Eric Paternoster: If we look back to the 1918 Spanish Flu pandemic, that really lasted for three or four years, everybody thinks of it as 1918, but it took a long time to die out because that was the age before vaccines. There was a debate that went on for a long time about whether it was a bacteria or a virus even causing it.

Eric Paternoster: This is going to be around for a while and as it continues to mutate, it could get worse. Although the general trend is that the mutations will weaken the virus over time, there's also some serious mutations that can occur. That's why some of these guidelines and follow-through on these things are important even after the immediate crisis is over and we get down to tier four, tier five in terms of the number of people who've been vaccinated.

Eric Paternoster: So we do need to build off of the strategy and make the execution better. That's really what really has to happen at this point. And then we need to learn from this, unlike maybe not applying the lessons well enough from SARS and the other ones that we've managed to put to rest fairly quickly, we need to realize that pandemics are something we're going to be living with, inevitably.

Eric Paternoster: With globalization and with how connected everyone is now, it's not going to be a local phenomenon; they will quickly spread worldwide. And we need to put this infrastructure in place and be ready to scale it up permanently, not just be caught like we were this time where our public health infrastructure had really not evolved very much from some of the mass public health victories that we had, like eradication of polio and other things that we did in this country that were great. I think that we need to have more of a public health infrastructure maintained to be ready for the next one of these that happens.

Jeff Kavanaugh: Yeah. Two points to come from that. One, the innovation process is messy, and I think it is on full display now. Obviously the messiness is captured and shared a lot, even though a lot of good things are happening. Second, hope for this also shows the government and business can be effective and a force for good, and like you said, create a template so that we can respond even more quickly and with more resilience in the future.

Jeff Kavanaugh: States are already using systems to manage the COVID vaccination program or the vaccine program. What are some system limitations they're seeing and how can governments build or enhance their capabilities?

Eric Paternoster: When you set up a tier it's targeted for essential workers, but then if the state can only get a hold of a fraction of what the essential worker population would require, and then you'd want to move on to the next tier while you're catching up on the first tier, that creates a whole level of complexity in terms of trying to never leave behind people that got missed for one reason or another when they were originally planned to receive it. Maybe because of capacity, it might be because of misinformation, but whatever the reason, you have to have a way to catch up. And the existing systems are pretty linear in how they're set up.

Eric Paternoster: I think that the foundational capabilities have to be improved also, not just the registration and scheduling, but I think in provider enrollment, we've talked about that a little bit earlier. One of the most important ones is in citizen outreach. There's a lot of misinformation that's out there about vaccines in general, but particularly around COVID there are a lot of rumors, a lot of people get their information from dubious sources now. I think the governments having a source of trusted information that's kept updated and distributed very timely will be key I think to being able to have a much better response in later phases of this, and also the next time that something like this happens.

Eric Paternoster: There's other aspects that are outside the core system, such as the inventory management, the analytics, the digital passports will be something that's added on fairly quickly, but eventually there'll be things like contactless check-in and mobile enablement. There's opportunities for some of the new technologies that we're very familiar with in other areas, like the Internet of Things, blockchain technologies could be applied for this cold chain inventory management and distribution that I think will be added in as we go also.

Eric Paternoster: I think that having something that's modular, that can address the most important issue that that particular jurisdiction is dealing with is also a very important aspect of the type of system that a state should be looking to implement if it doesn't have everything covered.

Jeff Kavanaugh: What's Infosys doing to help governments be ready for the COVID-19 program and deliver it rapidly, safely and securely?

Eric Paternoster: Well besides working with some of our existing healthcare and pharma clients in terms of working on their supply chain and working on their basic healthcare information systems that healthcare systems and insurance companies use in this country, we also have gone beyond that. Starting in August, Simplus, Infosys Public Services, and Salesforce Corporation have combined forces to develop an end-to-end vaccine management solution. That is intended for governments to be able to build, implement all the necessary capabilities quickly and be able to more effectively administer COVID-19 vaccination program.

Eric Paternoster: We had started working with the State of Rhode Island on contact tracing and got a lot of understanding, both in terms of how the Salesforce technology would work in a COVID setting, as well as how other governments were dealing with this problem. We looked at the scale of this and the different areas that you could tell were going to become bottlenecks. We basically took all these experiences and we used it to build a cloud-based digital vaccine management solution. We have pre-built modules for proactive advocacy campaigns, resident enrollment, prioritization, screening for eligibility, vaccine scheduling, and all the data reporting requirements that are going to continue to increase as the Biden administration rolls out more details around their strategy, and also all the state reporting requirements that already exist.

Eric Paternoster: Also very interesting, we have an integration hub that connects with existing immunization systems. Like I said, a lot of them were already out there that did various parts of this overall problem. There are things like VTrckS and the CDC has an immunization gateway that they've built. We have an integration hub to hook into that easily that's also in our solution.

Eric Paternoster: This solution is totally modular. Being cloud-based on a modern technology platform is how we were able to do this. You can deploy the entire platform, or you can pick certain issues that you want to solve by picking certain components of the platform, and then you can within a couple of weeks, put the foundation for those immediate issues. Scheduling is one that we've had a lot of discussions with jurisdictions about that continues to be a problem. And so our scheduling module could be dropped in in about two weeks to be able to help improve the scheduling problem for a whole state.

Jeff Kavanaugh: Two weeks; that's amazing. It's actually exciting to hear that the technology is not just to help inventory or not just to help something in a back office, but to help human beings in a very important area.

Jeff Kavanaugh: COVID-19 vaccination will not be a one-time program and the duration of immunity still somewhat unknown. What's your view on how this entire program will evolve and how should a solution like this or any that's helping evolve to support it?

Eric Paternoster: This is not going to be over with the full rollout of this vaccine for this variant of COVID-19. First of all, these vaccines are approved only for emergency use. There was quite honestly compressed clinical trials and testing. Very fortunately the results from the tier one healthcare workers and first responders, a bulk of which have been getting vaccinated for the last month, there haven't been very many serious adverse effects noted that are calling into question the efficacy of these emergency use vaccines. That's a very good thing. But there are unknowns because of the length of trials that were done in terms of how long will the immunity last? Will they affect pregnant women to any effect? Will there be any new adverse reactions that weren't noted during the clinical trial process?

Eric Paternoster: There'll be some inevitable confusion where different vaccines might be mixed and matched, especially if we figure out over time that the vaccine loses its potency and we have a new variant of COVID-19 next year that requires re-vaccination. Will we be having to put in a new vaccine or will we just have to re-administer the existing ones? So there'll be a lot of things around dosage levels, frequency that will go through fine tuning, and even with existing vaccines being suitable to be continued to be used for all the different variants that will come up until this pretty much goes away.

Eric Paternoster: The trials are still going on in parallel. They're working, for instance, to come up with versions that do not require cold storage, which would greatly simplify the supply chain. I mentioned the mutate varieties that are coming out, the so-called UK strain that was first detected there. I read over the weekend about a South African strain that's different from that. There's a fear that it has a higher degree of fatality associated with it. So we're going to have to be ready for these new strains and have pretty much continuous R&D regimen going on to keep checking these new strains against the existing vaccines that are out there.

Eric Paternoster: We have a problem that's going to be with us for a long time. It will run beyond this year of 2021, for sure. But we'll continue to improve. The vaccines will be updated. Processes, policies will be put into place and we will figure this out. We are hoping to continue to see improvements in how the entire process works end-to-end, and we're intending to keep our solution updated to be able to be relevant to however this unfolds over the next year or two.

Jeff Kavanaugh: Eric, what resources do you recommend for people that want to learn more?

Eric Paternoster: I mentioned about the Biden administration's national strategy is actually a very excellent comprehensive look at the entire COVID-19 problem in all of its aspects. On whitehouse.gov, there's a national strategy for COVID-19 response and pandemic preparedness that can be downloaded. I would recommend that for anybody trying to look at the breadth of the entire problem and all the different things that we'll have to work on in order to have a complete solution.

Eric Paternoster: We've published an eBook at Infosys called The Complete Guide to COVID-19 Vaccine Management. I think that that's actually a pretty good supplement to relate some of what's in the Biden strategy to what's being done on the ground right now today. The Knowledge Institute has a paper on vaccination on speed scale and security that I think is a very good too for planners at every jurisdictional level.

Jeff Kavanaugh: How can people find you?

Eric Paternoster: I'm on LinkedIn and also eric_paternoster@infosys.com.

Jeff Kavanaugh: Everyone, you can find details on our show notes and transcripts at infosys.com/IKI in our podcast section.

Jeff Kavanaugh: Eric Paternoster, thank you so much for your time in a highly interesting and very timely and important discussion.

Eric Paternoster: No, thank you, Jeff. I appreciate the opportunity.

Jeff Kavanaugh: Everyone, you've been listening to the Knowledge Institute, where we talk with experts on business trends, deconstruct main ideas and share their insights. Thanks to our producer, Catherine Burdette, Christine Calhoun, and the entire Knowledge Institute team. Until next time, keep learning and keep sharing.