From mass shipment to individual jab, it is a vital task to follow vaccine stock as immunization programmes roll out. It is crucial for public health as well as accounting to make sure no doses go to waste.
Never was this more challenging than during the COVID-19 vaccine rollout, which saw a rapid procurement process and an urgency to vaccinate populations at pace and scale. Ireland rose to the challenge, developing an innovative and tailored vaccine tracking system (TrackVax), which contributed to safe, effective and adaptable vaccine rollout in the country.
“One of the things we foresaw with COVID-19 was that if you’re manually typing in a batch number or an expiry date, you can easily make a mistake,” explains Dr Lucy Jessop, Director of Public Health in Ireland’s National Immunisation Office. “Whereas if you can scan a barcode and it goes straight into the system, you have the perfect data right away.” Dr Jessop led on various elements of the COVID-19 vaccine rollout, with particular oversight of vaccination safety, procurement and distribution.
Capturing complexity in detail
Vaccinating with multidose vials with a variable number of doses obtainable per vial in mass vaccination centres meant there was an acute need for full traceability of COVID-19 doses. This proved particularly important for the Pfizer-BioNTech COVID-19 mRNA vaccine, which had a strict time limit for use once thawed, which changed during the programme. TrackVax was developed in partnership with a global barcode standards organization whose know-how proved instrumental in the design and implementation of the system.
TrackVax ensured the printing of standardized barcodes for vaccine vials and drawn up syringes, which, when scanned by the pharmacist for distribution, managed to capture key data traceability elements. This included GTIN (Global Trade Item Number) product identifier, batch number, expiry date as well as discard time. The vial was clearly labelled with this information for easy selection by the vaccinator for the master vaccination record. When the vial was finished, it was returned to the pharmacy with a barcode scan and the yield was recorded, together with any discarded doses and reasons for those to provide a closed loop of information.
“Vaccines were expensive, and they were in short supply at the beginning,” says Dr Jessop. “So, we had to make sure we knew where every dose was, and account for each one.” Unlike a paper-based system, TrackVax made the immediate recording of data possible. To track wastage in detail, 7 different discard codes could be applied to give detail on why a dose was not used – to indicate if a vial was dropped or had expired, for example. Central reporting of this information allowed any changes to training or materials to be made and provided oversight of vaccine usage.
Technology designed to meet users’ needs
The role of the pharmacist was crucial in designing the system to ensure it was accessible and easy to manage. “A real strength was that some of the pharmacists from community vaccination centres (CVCs) helped to co-design the product themselves,” says Dr Jessop. “There’s no point in developing a system that no one will use because it’s too difficult or doesn’t give you the information you want.” Half of vaccines were administered at CVCs – which totalled 42 at the peak of the rollout – the rest by general practitioners and in local pharmacies.
To avoid wastage, it was vital to ensure the right number of vaccine vials were punctured for use throughout the day. Before TrackVax was introduced, pharmacists had to track vials through a paper-based system, which was a laborious task. “They were doing lots of accounting and trying to reconcile on bits of paper,” says Dr Jessop. “This was difficult near the end of a day of vaccinating, when you needed to know how many vials were out on the floor of the vaccination centre so that you didn’t puncture too many for the number of people expected to be vaccinated. This was a time-consuming exercise, before TrackVax automated it.”
Effective management system
Muriel Pate experienced the value of TrackVax first-hand. She is a medication safety pharmacist who worked with the quality improvement team and helped with medicines management during the pandemic in the COVID-19 CVCs. The system allowed national oversight of the quantity of stock of each vaccine in each of the centres.
One striking example of TrackVax’s value was when it picked up the failure of a new brand of syringe and needle. “A couple of centres changed to a different brand of syringe and needle last June,” explains Ms Pate. “We could see centrally through TrackVax that the average yields from each vial had dropped from 6.8 to below 5 in those centres.” This was a big problem given the finite availability of vaccines and the need to account for each dose. “Thanks to the system, we could react to this very quickly – the same supply of syringes and needles was about to be distributed to all of our centres, but we managed to recall it. After that, we turned to a different syringe-and-needle combination for all centres.” The early detection of lower vial yield greatly reduced avoidable wastage.
TrackVax has wowed people beyond medical and public health professions, winning several awards across the country. A mobile version is now being developed for community pharmacies and care home vaccinations.
“It’s as close to the people as possible and that makes it much safer,” explains Dr Jessop. “If we only had paper-based recording, I don’t know how we would have managed to collate all the information so quickly and reliably from each centre. It made all the difference.”