By Tarek Kassab, MD, MSc Biomed Eng, and James Waterson, RN, M.Med.Ed.
Becton Dickinson, Medical Affairs
Vaccination has been lauded as one of the greatest achievements of modern civilization. Childhood infectious diseases that were commonplace less than a generation ago are now increasingly rare, and one of the greatest examples of the world uniting to advance health was the campaign to eradicate smallpox via mass-vaccination. Smallpox is practically forgotten now, despite the fact that the disease blighted humankind for centuries and carried a 30% fatality rate.
The Covid-19 pandemic, and the race to repeat the achievements of the smallpox campaign with initially limited supplies of vaccines, requires that we protect, track, utilize absolutely ‘every drop’ of vaccine available to us. The speed at which these vaccines have come to market also places a responsibility on us to produce actionable Real-World Evidence (RWE), as we deal with virus mutations and variants, and heterogenous population responses.
Vaccine security
Medical device technology is central to the successful rollout, maintenance, and monitoring of high-quality vaccination programs. As soon as a vaccination clinic or health centre receives a supply of vaccine the issue of security and storage arises. There are already news reports of an emerging black market for Covid-19 vaccines and of ‘mafias’ looking to obtain these scarce resources. The core vaccines available also require judicious temperature control and an effective tracking of thawing, refrigeration, removal from refrigeration, time spent at room temperature, and documented de- livery to the patient.
Vaccine tracking
Technology can assist in ensuring safety and maximized usage of all supplies as medical-grade ‘intelligent’ refrigerated units integrated to Automated Dispensing Cabinets ensure accurate temperature control and create alerts for any deviation. They can also track a vaccine vial’s location through simple scanning processes and connected inventory systems. Distinct secure compartments within an integrated-intelligent fridge add the required security and access-privileges via codes or biometric recognition to enable tracking of the vial and alerting to any discrepancies in count.
The Institute for Safe Medication Practices (ISMP) suggests that vaccine centres and pharmacies carefully consider the timeframe for vaccine stability at room temperature and patient scheduling to minimize waste. A date and timestamp for removal of vials from the refrigerator is extremely valuable for both keeping this safe workflow going and for auditing. Verification of the doses needed per day from the vaccination centre to central cold-chain suppliers on a frequent basis – particularly in the case of those requiring ultra-cold temperatures – is also advocated by ISMP to prevent waste.
Medical grade, intelligent and inventory integrated, refrigeration units can also assist in this, as well in the allotment of doses based on footfall trends through the centre. As the currently available vaccines all require a second-dose, this is particularly important for Group Purchasing Organizations that service many vaccine distribution centres and need to know regional or national stock levels.
Real World Evidence
Vaccine usage data, when integrated into Electronic Medical Records (EMR), also has the potential to be a real asset for rapid review of appropriate and prudent usage. The societal value of reducing medication wastage has never been so well represented as it has been by the current crisis. Equally this data, as it can tie vaccine type, lot, vaccination date, and location to patient demographics from the EMR, assists in the gathering of Real World Evidence by specialized, effective tracking technology that has already shown an impact on the tracking of Antibiotic Microbial Resistance. This technology and knowhow are now being applied to help track and share Covid-19 insights with hospitals and public health agencies across the United States.
Given how potentially fragile an adequate global supply chain of vaccines is, utilization and protection are required in order to ensure these vital resources are shared as effectively and equably as possible. High rates of vaccine waste could potentially lead to extending extending the pandemic unnecessarily and make our societies vulnerable to continuing waves of infection.
