Immunization Strategy Design
What is the best approach to delivering a vaccine for COVID-19?
Authors: Ana Baroja, Alana Jean, Douglas Nissen, and Jennifer Sowa
For our Design Thinking group project, we decided to put some critical thought into what a successful COVID-19 immunization program would look like for Canadians. For the purpose of this exercise, we will assume that at a set time in the near future there is a viable vaccine ready for a vast implementation program. Considering this assumption, we set out to examine what approach is needed to ensure that as many people as possible receive the vaccine in the most efficient manner. If the vaccine is effective, the speed at which we can deploy a mass immunization program will help save lives and finally bring this pandemic to closure.
Identify the Problem
To understand our problem we focused on talking to people with different perspectives around concerns of a viable COVID-19 vaccine and its distribution to the masses. As we are tasked with a feasibility study on how to best implement a Canada-wide vaccine, we used several Design Thinking tools to Identify the problems and propose a strategy to build and implement a successful vaccination program that meets the needs and wants of the highest percentage of the population.
We used the How Might We (HMW) tool to get feedback from potential users. This is a great way to discover the heart of the problem. When we initially started the study we were concerned about the amount of misinformation around a potential COVID-19 vaccine. We conducted a variety of questionnaires to target different demographics and determine what level of awareness each group had about the soon to be available COVID-19 vaccine. Below are the results of our findings.
We started out with collecting all of our HMW findings and narrowed our scope to approaches that, when better understood, will help us roll out the best vaccination program available. These allowed us to determine our priorities and set our goals.
How Might We
- Do a consensus and form a better understanding of how the public is viewing the COVID-19 health crisis and potential immunization program.
- Combat miss-information and educate fellow Canadians in order to set and achieve immunization goals for the public.
- Understand the logistics of the entire vaccination program in order to secure enough Personal Protective Equipment (PPE) and vaccine supplies when available.
- Inform enough of the population the benefits of getting vaccinated as early as possible.
- Set up a priority schedule for citizens who are potentially high risk.
- Use that schedule to select the at-risk population and get them immunized first.
- Adapt and create new innovative vaccination centers that work with the public.
- Understand how Canadians in rural areas can best access the immunization program.
- Get critical feedback about what Canadian citizens want in terms of a successful immunization project.
- Determine the best approach to roll out our findings.
Research shows that successful mass immunization programs have a number of necessary elements: ensuring appropriate facilities, equipment, and supplies are in place; preparing staff; identifying potential people to receive the vaccine; observing recipients following vaccination; and documenting the process (Grabenstein & Nevin, 2006).
Human-centered Design
Our group identified four different segments of the population who feel very differently about a COVID-19 vaccine. The four Empathy Maps below examine what they say, think, do, and feel. A successful widespread vaccination program that is based on human-centered design will need to address the needs and wants of these different groups of people and offer solutions that will suit a majority of the population.
To be agents of positive change, we as designers need to think more broadly about the direct and secondary consequences of our work. We need to be clear-eyed about what we are striving to do and minimize the chances of creating more problems than we are trying to solve (Girling & Palaveeva, 2017).
For example, in an effort to slow transmission of COVID-19, a number of developing countries postponed vaccinations of other diseases out of fear that mass vaccination clinics would cause the spread of COVID-19. Sadly, this resulted in mortality rates rising in some countries for diseases that are preventable with vaccines: cholera, diphtheria, poliovirus, and measles (Hoffman & Maclean, 2020). Canada must learn from this and ensure that existing vaccination programs are able to continue within their established time-frames.
Ideation
Once we were able to empathize with different types of users, we began to write down ideas on how we could potentially address the main concerns for each population segment. If we want our proposed vaccination strategy to be successful, we need to take into careful consideration what people with more reservations are saying and thinking without dismissing the importance of building a campaign that also caters to advocates of the vaccine. Through proper education programs, and by making communities feel assured that we recognize everyone’s needs and concerns, we can gain the support of some of the detractors and potentially turn them into promoters. The right strategy will focus on bringing the greater good while protecting the most vulnerable and empowering people with making the right choice for themselves and their families.
During the brainstorming process, we took into consideration three key groupings for our ideas. These are described in detail below.
Prioritizing. In determining the prioritization of ‘who’ and ‘when’ for vaccine distribution, we took into account some of the findings from a study conducted on lessons learned during the SARS and H1N1 pandemics in Taiwan. According to this study, when allocating scarce vaccine supplies to maximize pandemic control effectiveness, we need to prioritize vulnerable groups, healthcare workers, and school-aged children as a means to achieve herd immunity (Yen et al., 2014, para. 58). The theory behind the efficacy of ‘herd immunity’ is that by immunizing most of the population against an infectious disease we are able to indirectly protect those minorities that are reluctant or not able to get immunized (D’Souza & Dowdy, 2020, para. 3).
Our prioritization strategy also included coming up with daily time slots for when it would be safe for different population segments to acquire the vaccine as well as timelines for ‘waves’ in which prioritized groups would have exclusive access prior to making it available for everyone else. For example, one of our more favoured approaches includes a schedule for when high-risk individuals can safely get vaccinated without being in contact with others (i.e. between the hours of 06:00 am and 11:00 am), which is similar to how some shopping establishments currently address these concerns by implementing ‘senior shopping hours’.
Distributing. One of the most important factors we considered for the mass distribution of a vaccine was ensuring everyone can experience the same level of access. This is particularly important for people that live in remote rural communities as well as people with limited mobility or who are housebound. Among the ideas discussed that exhibited the most feasibility were setting up mobile vaccination clinics that follow a similar format as blood donation drives and offering special vaccination visits to those who are not able to leave their homes.
We also determined if community members are expected to stand in long lines in areas that could potentially become dangerously crowded, they would most likely decide not to take the vaccine. A good strategy to address this issue would need to include plans for organizing and reducing the number of people trying to get the vaccine at any given time. Prioritization guidelines would help with this, along with utilizing some type of cue such as last name initial or birth month, an approach currently utilized for vehicle registrations or, more recently, Canada Emergency Response Benefit (CERB) applications, to further control who should attend vaccination clinics on a specific day.
Educating. When it comes to the successful execution of an education campaign, controlling what is being generated by media outlets to ensure that only the facts are communicated to the public is the most challenging piece. Providing accurate information about why and how to get the vaccine will give supporters peace of mind that the program has their best interest at heart. It will also be critical when it comes to minimizing the number of arguments that could be used in anti-vaccination campaigns by protesters and extreme opponents.
Good public relations and marketing will also drive educational campaigns for the vaccine. Younger generations might be more enticed to get the vaccine if it is perceived as something ‘cool’ to do. Social media campaigns that promote immunization against COVID-19 through the use of catchy ‘hashtag’ phrases can be a powerful way to create global awareness (World Health Organization, n.d.), including endorsement by high profile people such as celebrities and social media influencers.
Prototyping
Education and time appropriate marketing will be disseminated throughout the vaccination campaign. We recognize that despite our best efforts with education, there will be a group of the population that will remain against vaccines, however we do hope that the education shared with everyone will help make this a successful program.
A schedule of how the vaccination program will roll out must be designed to align the different prioritizations and population groups. The first group to be vaccinated would be the “test group”. The test group will have representation from a range of demographics and it will be done across Canada. The demographics will include:
- Age groups with High versus Low risk susceptibility
- People with ease of access versus restricted access
- People who have had COVID-19 (symptomatic and asymptomatic)
- Control group (no detection of COVID-19)
As the vaccine has been worked on for months, suppliers will be prepared to distribute the vaccine once it is formally approved after testing.
The distribution schedule should be as follows:
- Hospitals and Long Term Care facilities will start to receive the vaccine two weeks prior to being able to administer. This allows for those identified as Priority 1 to be able to receive the vaccine as soon as available.
- Select clinics around the country will start to receive the vaccine one week prior to help accommodate front-line workers that are not in a hospital setting. The select clinics will only be open for two months to help boost vaccination numbers among Priority 1 individuals. Since this model is not sustainable long term, the resources supporting this effort would be reallocated to Mobile Clinics after the initial two-month period ends.
- Doctors’ offices and Pharmacies will receive the vaccine when Priority 1 group immunization process is underway. This will allow those in Priority 2 to be vaccinated without having to go to the hospital. With more options on where to get the vaccine, social distancing should be easier to follow.
- Mobile Clinics will take on the resources from the select clinics and will receive additional supplies. The purpose of mobile clinics is to reach those individuals who cannot get to a pharmacy or doctor’s office. They could be living in remote rural areas, or individuals that are not able to leave their home.
Conclusion
Through the use of empathy maps and visual brainstorming tools, we were able to examine the mindset of different members of the population in order to design a program that would sufficiently address important needs. The timeline was essential for optimizing efficiency in distributing the vaccine and considering the needs and special challenges of particular members of the population, such as front-line health-care workers and at-risk individuals.
The efficiency and success of the overall delivery according to our timeline will likely lead to positive reviews, word-of-mouth, and positive media coverage. All of these outcomes could encourage those who were not convinced about the vaccine to get it after all.
Although there is no guarantee that one hundred percent of the population will get vaccinated, we believe our efforts can at least reach enough people to lead to the overall success of this vaccination program and eventual immunity within the community. A successful vaccination program will also provide valuable “lessons learned” that will help address the next public health crisis or pandemic and ensure that society, in general, is better prepared.
References:
D’Souza, G., Dowdy, D. (2020). What Is Herd Immunity And How Can We Achieve It With COVID-19?. Johns Hopkins Bloomberg School of Public Health. Retrieved from: https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html
Grabenstein, J.D., Nevin, R.L. (2006). Mass Immunization Programs: Principles and Standards. Springer-Verlag Berlin Heidelberg. Retrieved from: https://link.springer.com/content/pdf/10.1007%2F3-540-36583-4_3.pdf
Girling, R. & Paleeva, E. (2017) Beyond the cult of human-centered design. Fast Company. Retrieved from
https://www.fastcompany.com/90149212/beyond-the-cult-of-human-centered-design
Hoffman, J., Maclean, R. (2020). Slowing the Coronavirus is Speeding the Spread of Other Diseases. The New York Times. Retrieved from: https://www.nytimes.com/2020/06/14/health/coronavirus-vaccines-measles.html
Kramer, S. (2020). A coronavirus vaccine may be available in record time, but experts predict pandemonium during the rollout. Business Insider. Retrieved from: https://www.businessinsider.com/experts-predict-chaos-during-coronavirus-vaccine-rollout-2020-5
World Health Organization. (n.d.). Raising awareness of immunization. Retrieved from https://www.who.int/westernpacific/activities/raising-awareness-of-immunization
Yen, M. Y., Chiu, A. W. H., Schwartz, J., King, C. C., Lin, Y.E., Chang, S. C., Armstrong, D., Hsueh, P.R. (2014). From SARS in 2003 to H1N1 in 2009: lessons learned from Taiwan in preparation for the next pandemic. Journal of Hospital Infection, 87(4), 185–193. https://www-sciencedirect-com.ezproxy.lib.ucalgary.ca/science/article/pii/ S019567011400156X
