Rebecca Weintraub

Rebecca Weintraub, MD, of the Division of Global Health Equity, has spent years thinking about how to distribute and deliver essential products in health care. Weintraub has led the research and development of over 40 publicly available teaching case studies, published through Harvard Business Publishing, which are taught at more than 500 medical, public health, and business schools. When new ministers of health have come to Harvard for an annual week-long intensive, they study how to run mass vaccination campaigns with Cases in Global Health Delivery materials that employ lessons from measles and polio epidemics.

During the winter of 2020, with plans to develop a case series based on the smallpox epidemic underway, Weintraub and her colleagues at Ariadne Labs, a joint center for health systems innovation at the Brigham and Harvard T.H. Chan School of Public Health, suddenly found themselves contemplating a different, but related question: What would a new health minister need to know about distributing a potential COVID-19 vaccine?

Ariadne Labs’ mission is to develop simple, scalable solutions that dramatically improve the delivery of health care at critical moments to save lives and reduce suffering. During the pandemic, the organization mobilized to quickly develop, test and spread tools and resources that are currently being used by leaders, clinicians, and the general public around the world. As part of this effort, Ariadne Labs launched the Vaccine Delivery initiative, which is made possible through the generous support of the McGovern Foundation.

This fall, Weintraub, who now leads the COVID-19 Vaccine Delivery initiative at Ariadne Labs, collaborated with the Surgo Foundation to produce a public, online vaccine allocation planner that provides policymakers with state- and county-level estimates of how many vaccine doses are required to immunize different subgroups of the population. The planner uses the National Academies of Science and Medicine (NASEM) Framework for Equitable Allocation of COVID-19 Vaccine​, which outlines 13 subgroups within the population that should be vaccinated in successive phases as vaccines become available.

With promising preliminary results emerging from Phase 3 vaccine trials, CRN spoke to Weintraub, director of Better Evidence at Ariadne Labs, to discuss the organization’s efforts to support policymakers across the U.S. as they craft evidence-based, equitable plans for vaccine allocation.

How did you become involved in vaccine allocation efforts?

RW: In early April, I co-authored an article with Seth Berkley, MD, CEO of Gavi, the Vaccine Alliance, that outlined tactics to distribute vaccines equitably and protect the global workforce. These hold true today, and we’re trying to operationalize them now.

Soon after the article was published, we unfortunately began seeing a growing number of countries taking a ‘my nation first’ approach to developing and distributing potential vaccines.

So I co-authored another article in May warning of the dangers of vaccine nationalism. In the midst of a pandemic, vaccines must be allocated on the basis of the best evidence of what will stop transmission and protect the most vulnerable groups — no matter in which nation they reside.

To counter the prevailing trend, we aimed to equip leaders with an evidence-based and science-based set of tools to manage the initial scarcity of COVID-19 vaccines. In the fall, we collaborated with the Center for Global Development to build an interactive web tool that allows users to generate predictions on the COVID-19 portfolio, in real-time, with up-to-date data. The tool is designed to help understand:

• Vaccine types most likely to succeed
• How long it will take to sufficiently supply vaccines for all health workers
• The average time of approval post-Phase III trials.

The site is live at https://covid19-predictions.org. This tool informed further work to understand the uncertainties ahead in vaccine allocation.

What allocation challenges did you hope to address with this tool?

RW: In speaking with state leaders across the country, it’s clear that they are overworked; public health workforces have been affected by COVID-19 themselves and face turmoil within their own ranks. We, like many, were following the National Academies’ meetings, and when it published its hundred-page Framework for Equitable Allocation of COVID-19 Vaccine, our thought was, ‘How do we help the state epidemiologist or health commissioner who’s going to be reading this report operationalize allocation plans within weeks?’

We built the tool to help stakeholders scenario-plan for the critical decisions they need to make. For example, we wanted to help state epidemiologists estimate the size of the populations that the plan will serve, understand the overlaps between the 13 priority populations outlined by the National Academies, compare allocation plans by population and social vulnerability indices, and manage what we know will be an initial scarcity of doses. My colleague, Kate Miller, PhD, MPH, at Ariadne Labs led our data-wrangling and modeling of public data sets like the Census and the Bureau of Labor Statistics’ Quarterly Census of Employment and Wages, and we launched the site in the third week of October.

Is the tool informing the work of local Boston policymakers?

RW: I was honored to present to the Baker-Polito administration’s COVID-19 Vaccine Advisory Group, which includes Brigham representatives like Wanda McClain, MPA, and is chaired by Paul Biddinger, MD, of Mass General Brigham. Marc Lipsitch, DPhil, of the Harvard T.H. Chan School of Public Health has advised and reviewed our methods and the National Governors Association recently highlighted our allocation planner.

What advantages does the tool provide for policymakers?

RW: As state leaders generate county level estimates for the Centers for Disease Control, the tool has been leveraged to scenario plan and validate local estimates of vulnerable populations.  We also have employers and unions reaching out to us and utilizing the tool to understand where they fit on the National Academies’ scale of 13 priority populations.

Many state leaders want to reinforce the idea that they are working to ensure equitable distribution, not only efficient distribution, so it’s been helpful for them to have a third-party tool that was built on public datasets and methods that are open to any member of their state to review. Our tool helps explain complex decisions and promote evidence-based decision-making for both stakeholders and the general public.

In what ways can the tool help ensure equity in allocation, and what challenges remain?

RW: We built a feature of the tool to equip decision makers as they manage the initial scarcity and promote equity as they scenario plan. The user can hold 10 percent of their vaccine stock in reserve for contingencies such as hotspot outbreaks, as recommended by NASEM. The tool then offers approaches — the user can allocate 10 percent of their vaccine stock preferentially to geographic areas whose residents are most vulnerable to COVID-19. This is in line with the NASEM guidelines, which stress the importance of considering the vulnerability of certain populations when deciding on vaccine allocation.

States are hard at work preparing for the first shipment of COVID-19 vaccines in December. The CDC’s 64 immunization grantees comprising 50 states, 8 territories, the District of Columbia and 5 large cities provide summaries of their plans. There are various alternative approaches floating around, and states are waiting to see precisely what vaccines they will receive and to hear from the CDC and the Advisory Committee on Immunization Practices (ACIP) for guidelines. What is clear is that state and local leaders need support and resources to equitably distribute COVID-19 vaccines.

What important messages do you hope the tool will help leaders convey to the public?

RW: I hope this tool equips leaders to build trust and confidence in the vaccine. We hope that the tool helps explain allocation and explain that it may be both essential and patriotic to pace expectations and wait for a vaccine. It may be that your neighbor receives the vaccine before you, and we hope that these visualizations help demonstrate why. There are so many reasons why this distribution process is complex, and we need transparency to build trust in the process ahead.

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