Modeling Distribution on Tracing Ideals: A Novice’s View on COVID-19 Vaccine Management
I am neither a medical nor healthcare expert but I believe some of our approaches to managing the spread of Corona have lacked sensibility and I am hoping the manner in which forthcoming vaccines are distributed is more soundly aligned to science and logic. I am not talking about whether one should wear a mask or engage in high risk activities or not. Americans, at least, have made up their minds for better or worse.
I live in a community where measures to mitigate the risk of infection are more or less left to the institutions that remain running. I applaud the leaders of our local school district for their balanced approach. They have instituted a a mix of in-person and on-line education and have school nurses, who regularly consult with HHS, in touch with the organizations in which their students participate to institute policy to mitigate risk to at large. For example, a student playing hockey for an organization unaffiliated with the high school contracted Covid. The nurse was was notified. In addition to restricting all teammate of the infected individual to on-line classes for 14 days, requiring a negative test result prior to resuming on-campus activities, the nurse contacted leaders of schools of teammates not of our district, the hockey coaches and team parents to coordinate contact tracing. Rather impressive for the, “Live Free or Die,” state, but not without flaws. The exposed student athletes were quarantined because they were potential disease vectors, but what of the other members of their household? Their siblings were not, in turn restricted, leaving parents to decide whether to extend such measures to themselves and other children. Two parents, essential postal workers, sacrificed vacation time for safety’s sake, but siblings of other families hunkering down around the same breakfast tables went to school and in some cases, to sports.
This disease is spread by people who occupy space with other people, regardless of what those people believe or any classification system one chooses to use. Let us use that fact to drive vaccine distribution.
The way I see it, we have candidates that vary according to their storage requirements. Consider routing the, “hard stuff,” To hospitals, universities, prisons and healthcare facilities like nursing homes with mature supply chains, warehousing facilities, an operations. They should be capable of orchestrating the vaccination of their employees and the people they serve by adopting operations they are likely to already have in place. If we employ various local and government health agencies to adopt the, “on-site blood drive,” model in schools, shelters and places of business and worship that might not be capable of organizing receipt and administration of the vaccine on their own; routing the, “easy stuff,” to such agencies would be prudent for their success. Regardless of where one gets vaccinated, that person should be able to register members of their “household” for appointments to be vaccinated at the same site. Reverse contact tracing, if you like. Target the vaccines to the crowds and follow their members to their nests. Maskers and non-maskers go to grocery stores, dentists and the DMV.
What about the potentials for abuse such as hording, biased scheduling and the like? Supply and routing can be load driven and managed in a similar way as interest rates and bank reserves by examining the vaccination rate and opportunity by locale and balancing supply against providers serving those locales if only such statistics could be tracked and validated. I believe blockchain may be employed to do so.
Apologies in advance to blockchain practitioners for my gross generalizations. Blockchain in a method for creating and securing a log, or chain of records, in a manner that ensures records can be validated and used by multiple and/or distributed parties, and when implemented correctly can protect the privacy of those who participate in record. Think of it like this: There are two parties when someone is vaccinated (the event) and hence two owners of the record. The one being vaccinated will add the record (YOU received some treatment from some provider, THEM) to their medical history blockchain. You “own” that chain, and can decide with whom, when, and which records they choose to share it. Reciprocally, the entity administering the vaccine adds the very same record to their blockchain. This ensures that patients can prove treatment regardless of where it was received when they need to without going to the provider for evidence. It also provides a mechanism, where if compelled, an organization can provide statistics of how and how often they administered treatments without identifying the individuals, in compliance with HIPPA or similar privacy regulations. The registration of household members may be added to the record, too. Parties who are wait-listed for vaccination by the provider, rightly or wrong, may seek treatment at another venue. Parties who feel they may have been de-prioritized in a discriminatory manor can seek legal means to compel providers to allow a third party to examine the blockchain for patterns of behavior that support or disprove the claim… ideally after they have been vaccinated elsewhere. Other technologies may be brought to bear to help balance supply and demand, distribute supplier load, manage duplicate appointments and other logistical details using data securely derived from blockchains.
Common sense and technology can be extraordinarily powerful tools in mitigating the COVID-19 pandemic. Addressing Corona and other infectious diseases where they spread is a very practical approach but requires cooperation, organization and leadership at every level. The application of technologies like blockchain, represent practical and efficient opportunities to streamline healthcare but present challenging issues related to privacy, ownership and ethics in general, and should not be attempted without proper oversight and legal scrutiny. I am not claiming this is the only way or the best way to manage vaccines for COVID-19 but I am hoping this pandemic will teach our leaders at the local and global levels how to better balance logic and science and the tools available to them with the cares or the day and teach us as individuals that we have the responsibility to pay attention. Our actions, for good or bad, for right or wrong, are the underpinning of any real system of checks and balances.
