Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
Featured topic and speakers
In today’s COVID-19 update, the president and executive medical director of Washington Permanente Medical Group in Seattle details his health system's approach to vaccine distribution and administration.
Learn more at the AMA COVID-19 resource center.
Speakers
- Paul Minardi, MD, president and executive medical director, Washington Permanente Medical Group
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 update. Today we're talking to Dr. Paul Minardi, president and executive medical director of Washington Permanente Medical Group in Seattle about vaccine distribution and administration.
Dr. Minardi, since the rollout in December, Washington Permanente's played a key role in getting shots into arms. Can you tell us about the current state of your vaccine program?
Dr. Minardi: So thank you, Todd, and good morning. We began this endeavor about eight weeks ago, and we've delivered about 46,000, going on 47,000 vaccinations. We have a very, very simple approach to this, but spend a lot of time in planning. We were a key part of the original research during phase one, phase two and three, where we were very involved in the testing, if you will, of the vaccination during those phases. We also have one of our physicians as a key partner in terms of the western states evaluation for safety and efficacy.
So, we have spent a lot of time on planning and it's been a very robust planning approach and we've created something that's really simple and easy for most folks to understand, as well as to get through the process. Our door to needle time is about 5 to 10 minutes.
Unger: Wow, that's incredible. I think the word planning is one of the keywords you said there, because I get the sense that when you look across the United States and you see the unevenness of the rollout, that planning had to have been essential. What do you think others can do to learn from your experience thus far?
Dr. Minardi: For us, it was kind of a little bit more simplistic. We have a defined population, we understood exactly where each one of the phases were. We've identified all the people in that population, both at a state level, local level, and also inside of the organization level, and we're able to define then how many vaccines will we need, in what locations. Then what process will we need in people, process in systems to be able to bring that all together and harmonize and orchestrate the entire end-to-end process.
We did several sites with simulation to begin with before we even began to vaccinate, and we were able to really work out all the inefficiencies and create the efficiency, as well as the efficacy of the entire process. We couldn't be more proud of what we've done and we've continued to improve since we embarked on vaccinating the population.
Unger: I'm curious, when you went through that planning process and those trial runs there, what did you learn in terms of the obstacles that you were running into or the bottlenecks in the process that inform how you're approaching this right now?
Dr. Minardi: I think really key in all of this was the supply of vaccine is limited, so let's treat it like the most precious commodity on the planet for the moment. Let's begin to think about how many patients, how many doses and let's make them equivalent and to the absolute number. So, that was the first piece. The second piece as we went through the process of how do we want to have people enter into our buildings. Safety, efficiency, social distancing, all key and important.
The screening questions, to make sure that we had people really deeply understanding the risks associated with vaccine so that they were really apprised and understood. We had a massive communication strategy upfront in terms of our membership, as well as the community to make sure that people did understand if they qualified and where they were in line, so to speak, for the vaccine.
When you harmonize all of those individual pieces together, communication, understanding who's eligible, having a process to make sure that we're able to link a patient to appointment that is very simple and easy, as well as a process to door to needle in 5 to 10 minutes, it's amazing.
There's one other thing I want to say. Patients, people, members, the population at large, so excited to be vaccinated. So, this was an incredible experience as I've worked at a couple of the vaccination clinics to see people coming in, so excited to be vaccinated and so delighted with the process. As a matter of fact, many patients have written into the local papers, Seattle Times, talking about what kind of experience they had at Kaiser Permanente, that they remarked on that was so remarkably easy and simple and quick.
Unger: That's amazing. I'm one of those really excited people, can't wait to get my vaccine. The platform, having seen my mother go through this for instance, just difficult to find out about and sign up for. Did you have to build those systems yourself? What did you do?
Dr. Minardi: So in preparation for the launch, we had built what we call an eVisit, so that it checks for eligibility, are you in the right phase, and then also links that eligibility directly to an appointment. At the height of the opportunity for people to be vaccinated, as we went through Tier B1, there was a lot of traffic, both on the phone, as well as on the platform. We were running about 600 eVisits an hour, which was pretty tremendous, and about 25,000 calls in the call center.
So there was an initial surge, but we crafted and created each one of the components, both on phone and voice, as well as web and app, to make sure that we harmonized and we were able and capable to be able to manage all of that. One of the learnings from all of this is the surge is going to happen with every time there's an announcement. So every system in the country as we think about this together, we need to be prepared for those what I'd like to call and euphemistically call Black Friday events, so that we've got the ability to be able to manage that kind of volume in the moment to be able to get people what it is they need, both information, as well as that vital appointment to be vaccinated.
Unger: Yeah, listening to you, I mean, in my digital world, we call that end-to-end process experience. It sounds like you're accounting for the whole spectrum, from communication into the actual vaccination is so important in that. You mentioned before too, supply is obviously a huge limiting factor. The Biden administration announced 16% weekly increase of vaccine allocation to each of the states. What else can state and federal officials do to support health systems with their vaccine rollouts?
Dr. Minardi: We are limited in this sense. We already have maximum production happening, and so we have the maximum off the line production occurring right now. There's an opportunity though. Reading just recently that one of the vaccination suppliers, Moderna, has actually got something clever in mind, thinking of filling every vial with yet five more doses. That would increase by about 50% what's in a vial. That could massively be a game changer in terms of our ability to get more volume into those vials, and therefore with the same vials, we'll be able to get to more patients, more members, more of the population. So, that's a critical thing, that is right now I think in FDA approval status.
Johnson & Johnson, another fabulous opportunity for us. It'll be looked at for emergency use authorization the 26th of February, we look forward to that, that will give us yet more supply. And because it doesn't require the cold chain that does the Moderna and the Pfizer vaccine, it'll enable us to do this very ... much easier to manage, simple, one shot, one opportunity to vaccinate.
So that limits basically the two vaccines down to a single vaccine, which makes this a little bit simpler and be kept in the refrigerator, makes the handling much more simpler. So I think with that additional capability, that will be remarkable for us, because that too will bolster the opportunity for us to get to more lives and be able to get us to the next tier and to the next phase.
In addition, it's the recasting, if you will, and the redistribution where we're not using vaccine, let's get those vaccines where we can use them. So I know that there's more emphasis now on taking some of the vaccine, for instance in California, from some of the pharmacies and getting them into the population at large and to Kaiser Permanente in particular, that will be helpful.
I think by far and away the most important thing though is we need to keep a constant state of communication to the population at large. Here's what we're doing, here's where we're at, this is how we're aligning the states. We need to try and avoid what's happening now what I call the vaccine hunters. They are going from county to county, state to state to try and find vaccine. We need to eliminate that, because where our end point is, we want to create the opportunity for every community to get community immunity. We can do that best by keeping people in place and by making sure that we've got the proper inventory, the inventory control, supply chain to be able to get vaccine to everyone to the best possible way that we can.
So it's aligning, it's communication, it's having a real clear sense instead of the murkiness that I think we have sustained with what the supply and inventory looks like, because that will be critical for the governors then to announce to the population. So, it's really transparency and the ability for us to really understand deeply what is there, what is supply and to eliminate the vaccine hunters as well as maybe some of the misunderstanding about how the vaccine's been distributed.
Unger: Yeah, I read an article yesterday about vaccine envy, certainly a result of what you're kind of laying out there when there's so much uncertainty. When you talk about communications, I have a couple of questions to ask you. Have there been any lessons learned in terms of communicating to people? Multiple challenges there, but just the logistics part and then countering misinformation and vaccine hesitancy, what have you learned?
Dr. Minardi: So, there's so much to be said here. This is by far in a way I think the most important thing. As I mentioned, most people are very, very happy. About 70% of the patients can't wait, the population rather, can't wait to get vaccinated. So I'll call those the early adopters, we also have late adopters. We know that 30% that are a little hesitant at the moment. They're hesitant because of science.
We are collectively as a country a victim of the incredible science, the incredible decade-long journey that Messenger RNA vaccines have gone through. To where we had the genomic sequencing done, a vaccine created in basically a few days and then testing and into the population at large in about 10 months. That's amazing. That's created a lot of angst by many in that 30%. But out of that 30%, about 60% of those folks have said, "I'll take that vaccine in about a year." So, I'll call those late adopters.
So I think for the most part, it's the speed by which the vaccine came to market, created a lot of, I think, concern, because it's atypical from what we've seen in the past where it takes decades to get a vaccine using older methodologies. So, really I think the science is brilliant, the people that worked on this are brilliant, the opportunity for us as a country to really get this to market in 10 months is remarkable, but that's part of the issue.
Now beyond that, it's communication. It's really deeply understanding the confusion that exists around all of these tiers. So communicating and creating both public service announcements through the state, through the Department of Health, through the Public Health Department, as well as the organizations, I think could not be more critical, and really creating that bi-directionality of communication.
Not only pushing information to people, and we've done it in a variety of different ways, email, regular letters and all the information on our platform, to be able to really help people to understand supply and demand, the issues that we have in terms of the eligibility, the tiering, when folks' turns come up and really to help to continuously inform them.
We've also done something really remarkable and novel here, which is going directly to employer groups and making it incredibly clear through webinars what all this means to them and their employees. So, that's another channel that we found really, really impactful. So the companies and the organizations that have got both membership, as well as non-membership, if you will, in Kaiser Permanente speak, the opportunity to really inform their populations of employees as to what's happening and where we're going as a state. So, all of those things together really harmonized the communication strategy, I think, in a remarkable way.
Unger: I'm just going to follow up on one particular audience. There's been so much question about getting kids back to school. It was recently announced that the Washington Office of Superintendent of Public Instruction is partnering with Washington Permanente to get vaccine shots to teachers. Can you talk about that program?
Dr. Minardi: Delighted to. We have a series of town halls that we put on since the pandemic began every Tuesday night. Through that, town hall capability has brought information to all of our people consistently, so we got a single source of truth. We invite guests to the town hall. One of the guests that we had in summer was the superintendent of schools. And why? Because we have so many people that have been concerned about their kids and learning and what's happening, and the interruptions that this has created in their lives, that they really wanted to know more directly from the superintendent. So, we invited the superintendent. Chris is a fabulous person, and so there was a great relationship that was created with Kaiser Permanente, the Washington Permanente Medical Group with him in the moment.
The schools represent a large part of the population that we serve. There's about 155,000 school teachers, both in public and private sector and a great opportunity directly with them to set up 14 to 20 sites, in addition to Kaiser Permanente sites, but sites on their school campuses and gymnasiums and so on, for us to come in when the time is right, when the Tier B12 occurs, for us to then begin the vaccination process and to get teachers vaccinated.
We think that could not be more important to give them the safety and security that they feel that they need, and that we feel that they need in order for us to go back to school. It acts as an incredible backstop for them. So then in addition to all of the other things that we need to be doing, hand-washing, social distancing for kids and the opportunity to have air exchange in the classrooms properly, and to have all of the hand hygiene that we need, this will serve as yet another priority and backstop for them to get everyone back to school, to get in-person learning back in. We think it's critical on a number of different fronts, and a remarkable opportunity for us to create this partnership to get kids back to school.
Unger: Dr. Minardi, I've heard three key ingredients to your success. One is in the planning, one is in the communication and the third is that high-level operational approach that you've taken that allowed you really to be successful in this. Are there any other pieces of advice or secrets that you can tell and offer other health systems and practices on how to achieve a more effective rollout?
Dr. Minardi: I think by far and away is actually the notion of simulation. Putting all of those pieces together, getting a focus group, getting people to say, "This is what this looks like. How does this feel? Does this meet your need?" We have an advisory consumer group here that we actively participate in to make sure that everything we're doing resonates with people, resonates with consumers, makes it easy to understand. Then simulation outside of communication with here's the process. Let's put our people through that, let's stress test this, let's make absolutely sure we've got this right.
I think those are the key ingredients by practically ensuring that what we've done makes great sense and is safe and is efficient and is incredibly a wonderful experience for folks. Because at the end of the day, they become the best ambassadors for others to become vaccinated. They become the best people with telling their truths, if you will, to other family and friends. What we need as a community is to create that synchronous herd immunity that'll avoid all the variants, that'll avoid the fourth wave, if you will, and really in the pandemic in a robust way by all of us working together, but very differently.
Unger: Well, thank you so much. Seeing it work definitely makes me feel more hopeful and even more excited, so thank you for the work that you're doing and to the Washington Permanente Group. That's it for today's COVID-19 update, we'll be back with another segment shortly. For details on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us, please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
