The success in developing Coronavirus vaccines at “warp speed” can be matched by rapid administration. Disrupting the traditional model of vaccination can help facilitate a more rapid phased roll-out. Increasing the efficiency of vaccine administration usually aims to increase one-of-four distinct elements: the vaccine supply, number of venues, number of vaccinators or number of recipients. However, one simple solution, self-vaccination, can efficiently increase the venues, vaccinators and recipients simultaneously. It relies on trust and empowering the public to participate in the success of a vaccination campaign. Dr. Israel Weinstein, the orchestrator of one of the most successful mass vaccination campaigns in history, understood the value of relying on the public.
In 1947, under Dr. Weinstein’s leadership as health commissioner, New York City recruited volunteers and vaccinated over 5 million individuals for Smallpox in a period of 2 weeks. This was nearly 25 times the pace of the current vaccination effort, that vaccinated 300,000 New Yorkers in over 3 weeks. How was he able to achieve such success? Dr. Weinstein credited the “intelligent cooperation of the public” and “generous volunteers.” Over 73 years ago, he understood the public was intelligent, capable and needed to be central in a successful mass vaccination campaign. As of January 6th 2020, despite growing demand for a Coronavirus vaccine, nearly two-thirds of the vaccines delivered in the United States have not been administered. At this rate, it could take years to vaccinate the American public. To ensure the success of our current plan, we should learn from New York’s success in 1947, and rely on the public to play an increasing role.
Under the planned phased-vaccination roll-out of the US Government, the limited supply of vaccine is prioritized to at-risk populations. Tracking of vaccine allocation, ordering, uptake and management is web-based. As the volume of availability increases, vaccines will also become available at additional venues, some that may be efficient at vaccination like retail pharmacies that already give millions of flu shots every year. Should the planned venue expansion fail to relieve the current vaccination-rate bottleneck, mass outdoor vaccination sites such as stadiums may be used. Increasing the number of vaccinators by enlisting allied health professionals, might also speed administration. However, bureaucratic and regulatory hurdles are inherent in allowing these additional practitioners to administer a needle stick. Self-administration presents an alternative option, may overcome hurdles and can act synergistically with existing vaccination plans.
Research has shown self-vaccination from a prefilled syringe is safe, effective and that providing this option to individuals increases their intent to get a vaccine. Self-vaccination can take place independent of a traditional venue, freeing healthcare professionals to vaccinate others or care for sick patients. Alternatively, self-vaccination may incorporate the venue or participation of healthcare workers, if desired. In a designated healthcare location or a patient’s home via telemedicine participation, healthcare workers can provide further support, education, observation or documentation of self-vaccination. Similarly, vaccine tracking can be performed by self-vaccinators, participating healthcare providers or volunteers using existing IT web-based tracking systems using a computer or mobile phone.
Work is already underway to mass produce prefilled vaccine syringes, which among other advantages can save time, money and increase vaccine supply by up to 30%. Apiject, funded through Operation Warp Speed in May for this purpose, reports current capacity to prefill 45 million syringes per month and is working towards 250 million monthly capacity. Another company, currently preparing multidose-vials with Coronavirus vaccine, also has the ability to prepare prefilled syringes. Once fully FDA approved, large scale shipping of vaccines directly to individuals would be feasible. In the interim, manually prefilled syringes can be prepared from multi-dose vials. However, due to anticipated waste, these vials are intentionally overfilled, which is avoided when prefilling vaccine syringes. Self-administration of the injectable medication is not only a possibility, but a proven concept. Millions of Americans already have relevant experience with injectable medications and can contribute to a self-vaccination effort. Not only can these individuals—like the 10 million diabetics who inject insulin daily—self-vaccinate, they can assist others such as household members, relatives or friends. Additional participants in the self-vaccination effort can include medical professionals, pharmacists, phlebotomists, dentists, paramedics, veterinarians, and others with professional experience administering injections. By providing informal support to household members or others in their social network, they may bypass the licensure, professional or regulatory constraints that exist while working in their professional capacity. Many of these individuals might also be interested in contributing towards a more organized nationwide volunteer vaccination effort.