Thinking Through Rapid and Scalable Rollout of Healthcare Innovations for Public Health Challenges

The COVID-19 pandemic has led to an unprecedented pace and scale of innovation in vaccine development. Since COVID-19 was first recognised as a public health emergency of international concern by the World Health Organization on 30 January 2020, in a matter of only 15 months, as of early June 2021, 15 vaccines have been approved or authorised for use by regulatory bodies in various parts of the world. During this time, more than 2.1 billion vaccine doses have been administered globally, with approximately 900 million people receiving at least one dose.

However, rapid vaccine rollout has not happened uniformly across the world. Some countries have demonstrated early success with the pace of rollout, as a proportion of their total population (e.g. Israel, United Arab Emirates, United Kingdom, Chile, Bahrain, Serbia, United States [although with variability across states]). Others have shown slower gains but later accelerated their efforts (e.g. Mongolia, Canada and much of Western Europe, including Germany, France, and Italy) and some, as of 6 June 2021, are still lagging behind (e.g. Australia, New Zealand, India, Lebanon, Uganda).

What factors have contributed to such varied experiences? And what can we learn from these factors to assist with future rapid rollout efforts, including in the context of other public health emergencies and looking beyond vaccines alone?

Rapid rollout is a wide-scale systemic challenge and one for which we need better evidence to inform future actions. Based on RAND Europe research on healthcare innovation more widely, public health and related practical experience, this thought piece shares a roadmap for thinking through potentially important determinants of a country's ability to support the rapid rollout of life-saving innovations at pace and scale. We summarise factors to consider below. For each, we expand on the types of questions decision makers may want to ask themselves as part of efforts to ensure national preparedness.

Planning

Cooperation between diverse stakeholders is a critical aspect of effective emergency-response planning. Decision makers could reflect on: Have the main stakeholders been scoped and consulted? Is there an operational blueprint for how central government agencies and regional/local authorities will work together? Are there clear plans and protocols for managing relationships between government agencies and private sector suppliers? Are decisions around prioritising supply for specific population groups informed by the best available evidence?

Governance

Clear lines of decision-making authority and responsibility at both the national and local levels could be important to establish the required tools and resources for effective governance. Have milestones, key performance indicators and evaluation and monitoring arrangements for rollout been established and is there national and local/regional buy-in? Do plans for product supply and rollout comply with national product-related regulations? How will safe delivery to patients be secured (e.g. in terms of waste disposal, patient flow at delivery sites)? What does risk management entail?

Infrastructure

Rapid rollout may depend on ensuring supportive structures and facilities for delivery. What types of estates can serve as delivery sites to support maximum throughput, public and clinical safety? Have site specifications been developed? What third-party logistics requirements are needed for effective distribution (e.g. warehousing)? How will early assessment of globally scarce items and their acquisition be managed?

Data and information

A data and information infrastructure to support rollout may need be to be established in a way that can support coordinated data flows at local and national levels. Can the data and information infrastructure ensure that distribution is managed against real-time supply and demand? Is there an effective patient booking and management system? Can IT systems cope with the requirements of rapid rollout?

Access and supply chain

Access to products could be financed and secured with consideration of multiple supply options (e.g. bilateral, multilateral). How willing is government to take risks in terms of negotiating supply prior to product approvals and in the context of uncertain delivery timescales? How important is local production capacity to manage supply risks? How effective are public-sector relationships with private-sector suppliers and distributors, and can these relationships support risk management and plan adaptation if needed?

Workforce

Workforce requirements may need to be specified so that necessary staff can be secured, skilled up and managed in a timely manner. Are there enough staff or can staff be rapidly trained with the appropriate skills? Is there potential for volunteers or retired staff to be included and, if so, have they been identified? How will staff burn-out and fatigue be mitigated?

Societal context

Wider socio-political and cultural factors, as well as features of a nation's healthcare system, may need to be considered when determining the feasibility of a rollout plan. Is there a clear strategy for ensuring access to hard-to-reach groups? Is there clarity about how public health, health services, social care and community care sectors will interact to support rollout, given the organisational, governance and financing arrangements of these sectors?

Public engagement

Effective communication and messaging to support public engagement and innovation uptake is likely required. Is government messaging clear, consistent and tailored to different social and cultural contexts, including in the context of marginalised and vulnerable groups? Are innovative community engagement mechanisms in addition to a national communications strategy being used? Is there clarity on the ethical implications of individual choices regarding access and uptake?

Global efforts

National efforts could be coordinated with international and multilateral efforts to maximise efficiency and fair practices, including to avoid the pitfalls and risks of 'access nationalism.' Are national-level decision makers aware of the key criteria used by international initiatives in relation to decisions around access and supply? Do they have a strategy for dealing with potentially surplus stock? Are they contributing to international initiatives? How will intellectual property be managed?

Implementing a successful rollout strategy for healthcare innovations in the face of public health emergencies is complex. The factors that we present are interdependent and may interact with additional geographic, cultural, disease-related or innovation-specific factors not covered here. Future research may be needed to specify other factors that may be at play and to understand how to implement considerations raised above to support effective policy and practice.

COVID-19 was not the first, nor will it be the last, public health challenge that societies face. Being prepared to respond to new public health threats as they emerge could help to ensure that populations in need have timely access to live-saving innovations.

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Robert J. Romanelli and Michael Whitmore are research leaders in health and wellbeing at RAND Europe. Sonja Marjanovic is director of healthcare innovation and policy research at RAND Europe. For more information, please contact: healthcareinnovation@randeurope.org.

Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.