By Jason S. Lee, PhD and Members of The Open Group Healthcare Forum
On February 19, 2021, The Open Group published its best practice Guide for stakeholders involved in planning and conducting COVID-19 mass vaccination campaigns. Although campaigns evolve with changing circumstances, the major themes discussed in the Guide serve as stable guideposts for architecting a global response to the pandemic.
The Guide is intended for national, regional, and local authorities who are responsible for managing the organization, operation, and monitoring of COVID-19 mass vaccination campaigns. It is also written for campaign partners whose work must be coordinated and collaborative to ensure success in controlling the pandemic.
Its intended use is to provide the reader with a reference model for how to plan, conduct, monitor, and manage a mass vaccination campaign. It can be used as a standalone guide or as additional guidance with existing plans.
In the final month of 2019 a new coronavirus, designated as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), was detected in Wuhan, China, a city of 11 million. On January 11, 2020, its genetic sequence was published. At the end of January, the World Health Organization (WHO) declared COVID-19 “a public health emergency of international concern”. Just five weeks later, on March 11, 2020, WHO declared the COVID-19 infectious disease outbreak a global pandemic.
Surging infection rates observed worldwide in early 2020 triggered urgent vaccine development efforts that involved 80 companies and institutes in 19 countries by April. Countries responded with lockdowns and widely varied adoption of behavioral efforts to contain the spread of the disease. Though important, these responses had limited success, leading to roller coaster episodes of surges, diminished surges, and resurgent record-breaking incidents of disease and death. Economies have been dealt crushing blows and people and livelihoods have suffered greatly. By the end of 2020, worldwide reported cases numbered 83.8 million and 1.8 million people had perished as a direct result of the virus. By the end of the first month of 2021, cases swelled to over 100 million and deaths to over 2 million.
The end of 2020 also brought hope. The first COVID-19 vaccine tested in a large clinical trial was developed and approved in record-breaking time for emergency use in the UK on December 2, 2020. Within two weeks, the US authorized two vaccines for emergency use. Soon thereafter, other countries approved vaccines for emergency use.
Soon after the first vaccines were approved, both pre-negotiated contracts between countries and manufacturers as well as manufacturers’ pre-production of vaccine supply and packaging made it possible to start worldwide distribution of COVID-19 vaccine before the end of 2020, largely to rich nations.
Yet, just weeks after vaccine distribution rollouts began, countries experienced difficulties and challenges. Many times, goals were not met. Expectations were diminished. Public attitudes and trust suffered. Indeed, at the rate of early vaccination efforts, projections of herd immunity extended to years, and grave concerns were raised about the continued devastation of human lives and countries’ economies.
In the early stages of rollout, problems getting COVID-19 vaccine into arms related less to vaccine supply than to underfunded, insufficiently coordinated, and logistically complex campaigns.
Successful COVID-19 mass vaccination campaigns require comprehensive strategic planning focused on the following key factors: identifying jurisdictions, which have the power to exercise authority; collaboration among public and private partners; definitions of critical populations and decisions about their vaccination priority; selection of vaccination sites, which must be safe, accessible, and capable of meeting demand; a phased approach determined by vaccine supply and population needs; vaccination communications, to instil vaccine trust and counter vaccination hesitancy; and vaccination monitoring and management.
Mass vaccination planning is not “once and done”. Jurisdictions must remain vigilant; continuously modifying, refining, and improving their campaigns. Agility is key. Local, regional, national, and global rollout experiences should inform jurisdictions’ continuous improvement programs. Success in gaining control over the COVID-19 pandemic depends on key factors discussed in the Guide, including engagement among leaders at all levels of jurisdiction, effective coordination among campaign partners, commitment to fully funding campaigns, strategy planning elements discussed above, and a host of capabilities.
The Guide focuses on key capabilities required to move from the world “as it is” – caught in the devastating jaws of a once-in-a-century public health crisis – to the world “as it will be” – freed from the ravages of surging COVID-19 infections and deaths.
In the development and deployment of capabilities, a key ingredient for success is the ability to expand functions, operations, processes, and activities based on the workforce and other infrastructure resources that already exist (or can rapidly be built) where people live.
Jurisdictions should work with partners to help ensure that allocation, ordering, and distribution capabilities operate as planned. When barriers arise, which is inevitable, predetermined solutions should be rapidly deployed to avoid unnecessary bottlenecks and slowdowns. Preventable delays in vaccination rollout should be avoided because they can have a deleterious effect on the public’s health, expectations, attitudes (especially vaccine hesitancy), and behavior.
The backbone of modern mass immunization campaigns is the technology infrastructure used to collect, organize, store, share, and analyze data for the common good. Absent these capabilities, mass vaccination campaigns would devolve into highly chaotic, inefficient, and largely ineffective efforts to control the worldwide scourge of the COVID-19 pandemic.
All countries need to build digital platforms for planning, implementing, monitoring, and evaluating their COVID-19 mass vaccination campaigns. These systems should allow end-to-end monitoring, registration of beneficiaries, facilities planning, scheduling vaccination appointments, and planning the vaccination process. Monitoring systems are used to track vaccine-related information (e.g., utilization, wastage, and coverage) on a real-time basis at national, regional, and local levels.
The three main types of information collected by campaigns are:
- Supply chain data, needed to track and monitor the vaccine as it moves from point A (manufacturer) to point B (peoples’ arms)
- Vaccination administrative data, such as vaccine type, vaccination date, scheduling information, age, gender, and other characteristics of vaccinated persons, and key demographic information about those not vaccinated
- Research data, including information needed for clinical, public health, epidemiology, program improvement, and policy studies
Jurisdictions may use an existing immunization information system, vaccine registry, or other IT architecture developed to enable monitoring for public health purposes. Perhaps somewhat ironically, these monitoring systems may be more developed in low-income countries than in high-income countries, because low-income countries have had more experience responding to infectious disease outbreaks.
Mass vaccination campaigns should build their monitoring systems on existing IT infrastructure to the extent possible. Capability gaps and unmet needs can be addressed using new, agile solutions.
Non-Pharmaceutical Protections During Campaigns
It is unrealistic to expect that mass vaccination campaigns will eradicate the SARS-CoV-2 virus. Only smallpox has been eradicated globally, as declared by the WHO in 1980. As with influenza and its mutating viruses, protecting ourselves from coronaviruses is likely to become part of our annual public health plans.
Precautions After Vaccination
After getting a COVID-19 vaccine, people will still need to take precautions. A 95% effectiveness rating means that 1 out of 20 people will remain unprotected from exposure to the virus after vaccination. Populations will need to continue to observe precautions – mask wearing, social distancing, and frequent handwashing – until herd immunity is reached and more is learned about how long natural and vaccine-produced immunity lasts.
Testing for COVID-19, followed by isolation of positive cases, contract tracing, and mandatory quarantine for exposed persons who test positive, are practices that should remain in effect. The need for low-cost, self-administered, rapid COVID-19 testing remains significant and will continue after countries have successfully controlled COVID-19 through their mass vaccination campaigns.
Obesity, diabetes, inactivity, insulin resistance, and other impairments associated with poor metabolic health are closely linked to severe cases of COVID-19. Public health experts talk about the dual pandemics of obesity and COVID-19 and the negative impact they have on each other. Thus, life-style practices (healthy nutrition and exercise) and medical treatments that decrease metabolic syndrome will increase individuals’ ability to fight against severe effects of COVID-19.
 Refer to: SARS-CoV-2: An Emerging Coronavirus that Causes a Global Threat (see Reference Documents); accessed January 13, 2021.
 Refer to: A Timeline of COVID-19 Developments in 2020 (see Reference Documents); accessed January 13, 2021.
 Refer to the Coronavirus Resource Center, John Hopkins University of Medicine (JHU) at https://coronavirus.jhu.edu; accessed February 5, 2021.
 Refer to: FDA Takes Additional Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for Second COVID Vaccine (see Reference Documents); accessed January 14, 2021.
 AstraZeneca’s COVID-19 vaccine was approved for emergency supply in the UK and the first doses were released on December 30, 2020. Refer to: AstraZeneca’s COVID-19 Vaccine Authorized for Emergency Supply in the UK (see Reference Documents); accessed January 28, 2021.
 Acquisition and distribution of vaccine for low and middle-income countries is orchestrated by the COVAX Facility, a joint international effort funded by dozens of countries (including high-income countries) and philanthropic organizations, intended to ensure the just and equitable distribution of vaccine throughout the world.
 Exceptions were observed in small countries with protected borders.
 This is not to say that vaccine supply is not and will not continue to be a major gating factor, however.
 Early in 2020, countries began developing COVID-19 mass vaccination campaigns based on knowledge and experience gained from decades of prior vaccination campaigns. It is widely recognized that controlling the COVID-19 pandemic will require a global response at a significantly larger scale than any previous response to outbreaks of infectious diseases, including MERS, SARS, Swine flu, and Ebola.
 For one example where this is happening, consider the collaboration between a large technology company (such as Microsoft®) and partners (Accenture, Avande, EY, and Mazik Global) to build and launch new platforms for COVID-19 vaccine management to assist public health agencies and healthcare providers. Refer to: Microsoft Deploys COVID-19 Vaccine Management Platform (see Referenced Documents); accessed January 6, 2021.
 Refer to: https://en.wikipedia.org/wiki/Smallpox; accessed January 22, 2021.