Tracking who’s been immunized against COVID-19 and where people can find vaccines to take — tasks considered crucial to wiping out the virus — will be a massive and complex undertaking.
A jumble of interconnected state and federal databases will make it work. Their names range from the bland to the mysterious, and their vintage ranges from first-generation apps to ancient code written for mainframe computers.
They will be put to the test very soon. More than 2.9 million doses are being shipped this week to hundreds of sites around the United States, the result of breakneck drug development and a colossal logistics effort involving the military, several government agencies, academic and private partners, 64 individual jurisdictions and thousands of vaccination sites.
A failure to accurately track vaccine movements could delay shipments or lead patients to miss vital second doses of the vaccine.
Each step along the way, people who touch the vaccine are collecting and exchanging data — from the vaccine manufacturing facilities to state health departments to vaccination sites.
It all boils down to two main types of information: who has been injected with the vaccine (the demand), and where each vial of vaccine is located (the supply).
Every COVID-19 vaccine dose is allocated by the federal government’s Operation Warp Speed, ordered by states and tracked by shipping companies and then hospitals, clinics, long-term care facilities and other vaccination sites. Systems then track who gets the vaccine and report back to the federal government. There are also systems in place to log adverse reactions and patient follow-up, too.
“It’s a suite of integrated tools and resources, some old and some new,” said Jim Blumenstock, chief program officer for public health practice at the Association of State and Territorial Health Officials and former deputy commissioner of health for New Jersey. “A lot are being test-driven as we speak.”
Keeping tabs on all the data sources is a nerve center known as Tiberius (the middle name of Captain James T. Kirk from Star Trek, the show that inspired “Warp Speed”). Tiberius will monitor details of where the vaccine is moving and who’s received injections — although personal identifiers will be removed before federal contractors and authorities at the federal, state and local levels view the data.
The following is by no means an exhaustive list but rather some of the key components along the chain. Nor will these tracking tools answer every essential vaccine question people may have — such as, “When am I eligible?”. Experts recommend consulting your doctor or local health department website.
Colonel R.J. Mikesh, information technology lead for Operation Warp Speed, said on a Dec. 7 call with reporters that there could be more than 100 data systems involved in the effort, including software from health care company McKesson, the operation’s chief central distribution partner, as well as inventory management systems from package carriers FedEx and UPS. Walgreens and CVS, each with their own data management systems, will also be coordinating data from their vaccination sites.
“It’s taken, I’ll say, a Herculean effort across all these different spaces to come together and make sure these systems are connected, tested, data-verified,” said Mikesh.
The challenge is ensuring they’ll all work in concert once the vaccine becomes widely available, said Rebecca Coyle, executive director of the American Immunization Registry Association.
“It’s all hands on deck,” Coyle said. “We’re trying to get these systems to work as best they can, sort of in the eleventh hour.”
Here’s what each data system does:
When people go to get their COVID-19 shots, the clinic or drug store doing the work will send their names and other identifiers to an existing state database. Commonly known as immunization registries, immunization information systems are managed by states — and in some cases cities — and have been in existence for decades, said Coyle.
“Right now every state with the exception of New Hampshire and some larger municipalities like New York City and Philadelphia operate an immunization registry,” Coyle said. “Those systems originated as a way to keep track of a comprehensive immunization record for someone that a medical provider or authorized user like a school could access and see what a person had, regardless of where they received services.”
These information systems also handle supply data. They gather orders for vaccine that providers in the state have placed and, in turn, place vaccine orders with the Centers for Disea.
So how will the snowbird that got her first shot of the COVID-19 vaccine in New York make sure the pharmacy in Florida gives her the right second shot? That’s where the IZ Gateway, a centralized exchange for patient-level data comes in.
“I describe it as a post office,” said Coyle. “States will mail their letters, if you will, and it’s got to get to the right spot.
“The IZ Gateway is that technology tool that the Florida immunization registry uses to send a message to New York to say, ‘Hey what does this person get?’”
IZ is public-health shorthand for “immunization.” Hosted by the Association of Public Health Laboratories, the IZ Gateway passes patient information on to the CDC’s IZ Data Clearing House, which draws in patient information from additional sources like pharmacies and federal agencies such as the Bureau of Prisons.
If you’ve ever gotten a flu shot or taken your child for a routine immunization, you’ve benefited from the CDC’s Vaccine Tracking System, VTrckS, a vaccine ordering and management system that has contracted since 2006 with health care company McKesson to distribute over 150 million doses of vaccines like the MMR, chickenpox and flu vaccine annually.
The system fulfills orders that doctors and other providers have placed through state Immunization Information Systems.
“VTrckS is the system that’s used by CDC and by states to order vaccines,” said Coyle. “Once those orders are placed, CDC sends an order over to McKesson, McKesson ships it, and that information gets sent back to the state.”
Since VTrckS has been in place for more than a decade, it should be able to handle the strain of hundreds of millions of COVID-19 vaccine orders, said Coyle. “Which is good,” she said. “We need to keep things as steady and stable as they possibly can be because there are new systems that are going to be put into place for this response that are different and that could potentially create some issues.”
Atop the existing system of tracking vaccine supplies, the CDC is rolling out a new, web-based application called the Vaccine Administration Management System.
Designed to track vaccines from when they arrive at a vaccination site to when they go into a person’s arm, VAMS can help cities and counties identify vaccination sites and pool data. It can allow companies to track dose schedules for their employees. Vaccine providers can use it to schedule patients, check inventory and organize vaccines by manufacturer. Patients, meanwhile, can track appointments, get reminders for a second dose or receive a certificate showing proof of vaccination.
VAMS is ultimately optional, and adoption will likely vary across the country.
VaccineFinder is a public-facing website that will be a Google Maps for the COVID-19 vaccine. Originally built by Google for the H1N1 pandemic in 2009, the project has been led by a team of epidemiologists and software developers at Boston Children’s Hospital since 2012. Now it’s pivoting to focus on COVID-19, in partnership with the CDC and healthcare technology company Castlight Health, a major provider of data on COVID testing locations.
Not unlike bicycle share service maps or the icon showing your cellphone’s remaining battery, the VaccineFinder map will show users where they can get their shot and whether the supply at these locations is high, medium or low. The app is set to go live in early 2021, once the initial high-risk immunization phase for front-line health care workers and nursing home residents has passed.
Dr. John Brownstein, the chief innovation officer at Boston Children’s Hospital who leads VaccineFinder, said vaccine sites will send inventory levels to the app daily, and in turn the data will be sent to the CDC.
That could make the information essential not only for people seeking vaccines, but for government managers looking to spot shortages across the country.
Operated by the CDC, the COVID-19 Data Lake brings together all the major data systems covering the supply and demand for vaccine. Patient records enter the Data Lake from the IZ Data Clearing House after being scrubbed of personal identifiers. Orders for vaccine flow into the Data Lake from VTrckS. Daily supplies on-hand come from VaccineFinder.
Tiberius is the eyes and ears of the entire COVID-19 vaccination tracking operation, drawing directly from the COVID-19 Data Lake and in-transit data on shipments from FedEx and others.
Software tailored for Operation Warp Speed by government data contractor Palantir, Tiberius combines logistics information with census data to coordinate distribution of the vaccine. The tool is adapted from Palantir’s Foundry platform, used to manage supply chains across industries like aviation and auto manufacturing as well as the United Nations’ World Food Program.
Palantir has taken heat for its work with U.S. Immigration and Customs Enforcement, where its software is being used to track undocumented immigrants. But it’s also rapidly expanded its business with other parts of the government. In addition to ICE, Palantir has worked with the Department of Defense, the National Institutes of Health, the Department of Homeland Security and the FBI. Last week, the company was awarded a $44 million contract with the U.S. Food and Drug Administration for data management and analysis.
Tiberius is what Operation Warp Speed and the CDC will use to calculate their weekly allotments to states, territories and jurisdictions, taking into account inventory, storage capacity and target populations. The idea is to keep vaccine doses from piling up or getting wasted between the manufacturer and the vaccination site.
More than 600 representatives across 64 jurisdictions — which include states, territories and federal agencies — will have login credentials to Tiberius to check on their weekly allotments of vaccine. Health officials can also check the status of their vaccine orders through Tiberius.
Some of Tiberius’s additional features include incident management, planning, tracking, data visualization and modeling, said Blumenstock. These features help with decisions such as how and when to distribute doses to counties or hospitals based on the numbers of front-line health care workers or residents of long-term care facilities. A separate Tiberius feature currently being developed is a marketplace where states and jurisdictions can exchange vaccine doses.