Keep the Vaccine Moving to Save the Most Lives

The Centers for Disease Control and Prevention reports that Pfizer and Moderna have supplied more than 31 million doses of vaccine for COVID-19. As of the morning of January 13, only about 12 million people had received their first dose. That suggests that 19 million doses now wait in freezers around the country rather than in arms.

Although the federal government has released its entire supply, that simply means that the stockpiling is happening elsewhere, mostly at the state and local level.

Standard practice and theory in logistics tells us that stockpiles are a mistake in this case. In a global pandemic with an approved vaccine, a stockpile of 19 million doses is a logistics failure resulting in more infections and more lives lost. Eliminate the stockpiles by keeping the vaccines moving.

Policymakers at the national, state, and local levels have been stockpiling the shots for many reasons, such as to ensure enough for people's second doses, to plan transportation, and to align with workers' schedules. Managers also may fear a supply shock, such as from a production problem or natural disaster—but those risks should be prevented or solved without stockpiling.

These planning mistakes stem from confusion about the nature of the supply and the demand in modern logistics.

Stockpiles make sense when supply is assured but demand is highly variable. For example, the military must stockpile ammunition in case a war breaks out in the future. The current crisis is the opposite of that scenario: The demand is immediate and it vastly exceeds supply. At the same time, supply is growing quickly and more vaccines are becoming available. Just last week, the nationwide backlog of unadministered vaccines rose by 4 million doses.

First, these stockpiles far exceed what is currently needed for second doses. Second, rather than stockpiling for second doses that are three to four weeks off, managers could be planning to use new production for those booster shots. Ideally, vaccinations would be administered at the rate of production. If giving second doses in precisely three- or four-week intervals is vital, that could be accomplished with prioritized appointments.

Stockpiling vaccines also adds risk. The Wisconsin pharmacist who destroyed 500 doses highlights just one risk of storage. Freezers can break, storms can knock out power, and accidents can happen. But more to the point, every day that a dose waits in a freezer raises the risk of a person getting COVID-19.

Ensuring delivery of enough doses to each site while avoiding risk of waste requires both forecasting and scheduling at every stage from factory to syringe. Rather than stockpile vaccine for the next truck, have the truck waiting for the vaccine to arrive. Rather than stockpile vaccine for the next shift of workers, schedule workers to be waiting to deliver shots before the vaccine arrives.

Managers all along this chain of delivery could be brainstorming with staff how to speed up vaccination. In logistics, this is done by repeated problem solving around the question, “How can we speed up by 15 minutes moving the next shipment into arms?”

Eliminating stockpiles does not require changing who has priority for vaccination nor should it prevent on-time second dosing. Indeed, by slowing down the vaccination process overall, a stockpile will delay both first and second doses and extend the pandemic.

Long lines for vaccinations may look like bad management and raise safety concerns. But while people are queued, at least six feet apart, assistants can collect patient information and vitals. In a grocery store checkout, a busy cashier keeps the line moving. Similarly, the nurse with the needle could always have a patient ready for the injection. Until every dose on hand has been injected, the nurse giving the vaccine should never wait for a patient, a needle, or a Band-Aid.

Even in nursing homes, where patients cannot line up, the vaccine could keep moving. A small team might prepare each patient before the nurse delivers the vaccine room to room. This requires scheduling staff to do the paperwork, preparation, and injections whenever a vaccine shipment is slated to arrive.

Vaccine managers could also overbook slightly, like airlines do. Even if a few passengers are inconvenienced, this keeps all the seats on a plane filled. Likewise, no shots and no time would be wasted when we know some people will be no-shows and others may have COVID-19 symptoms and thus should not get the vaccine immediately.

The country is waiting to be vaccinated and millions of doses wait for arms. Modern logistics tells us how to address this. We understand that concerns about supply disruptions incentivize stockpiling. However, while supply ramps up and many people wait for a vaccine, policymakers could push to deliver vaccines to people instead of freezers. Keep the vaccines moving.

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Carter C. Price is codirector of the Center for Scalable Computing and Analysis and a senior mathematician at the nonprofit, nonpartisan RAND Corporation. Some of his major projects include modeling the impact of health care reform, assessments of terrorism risk models, and trends in economic inequality. He has also been providing analytic support for the Commonwealth of Virginia on COVID-19. John F. Raffensperger is a senior operations researcher at RAND. He holds an MBA and a Ph.D. in business from the University of Chicago. He has 39 years' experience in logistics, production, national security, and emergency preparedness.