While much of the COVID-19 pandemic response is the navigation of new global coordination, much of the response has also been a result of poor expertise continuity. This is particularly true for countries with decades of funded emergency preparedness structure, and particularly true of the United States.
Many in leadership have not handed off continuity of expertise, nor accepted the hand off, well. Continued reinvention of the wheel has left resources depleted and depreciated. As mass vaccination begins, it is unclear what planning, consideration and reach has extended from our previous work in H1N1. It is unclear how much will be learned for the first time, and by how many, for lessons that could have been previously shared. It is also unclear what national, state and local efforts, funded for decades, are now at the table.
The energy dedicated to recreating the wheel continuously cannot be entirely avoided, particularly with lapses in continuity and quality to operation evaluations. However, lessons learned, as well as continued efforts in industry improvements, should drive some overarching wheel bolt work.
There is continued encouragement of state and local design of COVID response, and this culture will define mass vac as well. There will be similar tones in many countries for regional autonomy. However, vaccination operations and logistics should not be left without standardized public guidance for greater integrity to quality. A few standard wheel bolts, regardless of reinvention efforts, should include:
- organization to technology, data entry, minimum basics and consent/paperwork storage. Where is the legal and policy framework for e-consenting and HIPAA, and how can technology enhance any follow up visits? If there is problematic follow up, how can state and federal support measure, monitor and provide resource (phone, EHR, liaison, staffing, supply)?
- technical issue FAQs, such a second vaccination outside of timeframe, storage failures, administration error (wrong site, wrong needle length, etc). How can these FAQ responses be assured across the board, so consistency is clear?
- post-vaccination surveillance clarity. How do primary care and other alternative vaccination sites report VAERS, who is responsible, and how will regions assure guidance? Should public health offer liaison support, should instructions be clear and public, and is there a way to increase real-time transparency to the public, with clarity to rumors and unscientific claim?
- incorporation of routine vaccination operations. Inclusion of records, consideration of follow up, simultaneous delivery with other vaccines, and everything else should be addressed upfront. No primary care office should need to reach out for these basics.
- special needs and disability considerations. How will vaccination programs be assured human and logistical support for special needs and disabilities? How will local, regional and international efforts change with this mass vaccination, to finally incorporate an organized response that connects providers of rare disease patients, providers of immuno-compromised patients, home caregivers of special needs and those with special needs for prioritization?
- professionalism. Immunization and vaccination is healthcare delivery, and professionalism cannot be diminished. Integrity to PPE, safe injection practice, consent and privacy, and accompanied therapeutics for first aid response (including epinephrine) are necessary. Diminishing respect to this with excuse of 'emergency operations' is unacceptable. How are local, state, national and international operations assuring professionalism to mass vaccination, regardless of income tier?
Considerations to mass vaccination, lessons learned and overarching structure are important. Handing over a few wheel bolts in an era that refuses to reduce wheel recreation is supportive and wise.
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