In this guest blog, Catherine Lawes offers a personal perspective on Covid 19, vaccines and vaccination considered as a system.
I took my mother to have her Covid vaccine on a bitterly cold evening in mid-January. While I waited in the car, I thought about the pandemic, the incredible scientific work to get to a vaccine, the ever clearer organisational brilliance and the fact that my mother (JCVI (1) Group 2) was now in the warm receiving her jab. There was the sudden sound of the passenger door being opened and there she was, beaming. “OK?” “Yes, fine, it was really well organised”. I felt somehow lighter, actually quite emotional, sheer relief I expect. It seems to be a common reaction.
The UK’s Covid vaccine rollout is an excellent example of full systems thinking. There is a wide and deep process leading ultimately to jabs in arms. Based on publicly available information we have a SARS pandemic where the elderly and those with underlying medical conditions are particularly susceptible to illness and death. The virus’s virulence and transmissibility risked overwhelming the NHS – we all remember the scenes from Italy. Our desired end point is a return to “normal” life, whether by natural or vaccinated herd immunity, a natural weakening of the virus or “learning to live with it”. The pro-active option is vaccination.
This vaccination option required a process to achieve mass vaccination. I’ve attempted to identify the main tasks, supported, of course, by a cascade of sub-tasks:
a. The science to identify and sequence the virus, and then to produce a vaccine(s).
b. The planning
i. Assessment and choice of vaccines
ii. How to get hold of them; ordering and manufacture
iii. How to get them in people’s arms, from manufactured vaccine to individual inoculations.
iv. Communication plan, both within the process itself and with outside stakeholders.
c. The execution
i. Assessment of potential vaccines for purchase: must be both efficacious and likely to meet approval requirements
ii. Manufacture in sufficient and significant quantities
iii. Storage, supply and distribution
iv. Identifying and recruiting the personnel to carry out the vaccinations and ancillary activities
vi. Ensuring those to be vaccinated, in order of preference per JCVI (itself another process) know when and where to go.
vii. Effective administration, data collection and paperwork to underpin the above
viii. Identifying improvements, i.e. using information feedback to drive improvement
Underpinning these you need the political will to seek, resource and then implement identified solutions (e.g. Vaccine Taskforce, JCVI). This is made harder by the need to make difficult decisions with imperfect information, while trying to explain those decisions, the overall strategy, to the British people.
How does this fit in with Cybernetics, feedback loops and John Beckford’s Intelligent Nation? Here are some reflections, summarised….
1. Complete focus on what we are trying to achieve – to vaccinate the entire adult population, in order of risk, to “…Protect the NHS, Save Lives”
2. Whole system thinking from the recognition of a threat and a potential solution through to development and interaction of each element – supply, distribution and vaccination. “Who, what, when, where, how”
3. Feedback and learning to improve the system. In this vaccination phase the government seems to be reflecting on feedback, adapting and responding. e.g. reducing bureaucracy for retired doctors who volunteered to vaccinate by eliminating documentation superfluous to the job in hand (c. 21 forms down to c. 15).
4. Cybernetics: feedback and reporting to maintain control of the rollout. Data collated to understand how well the process was going, adapting the process where necessary e.g. real world data on the efficacy of vaccines used to inform future policy; the recent review of vulnerabilities so that some 800,000 people moved up the vaccination priority list.
5. Cross-functional working, for example, co-operation between public (NHS), private and military (logistics) institutions for storage, distribution and application of vaccines. Or the vaccination locations, which were not limited to medical centres and obvious sites like conference centres but included innovative choices such as cathedrals and sporting or cultural venues. (2)
6. Delegation to lowest effective level (3). Led locally by GPs, with further vaccination by regional hospitals, vaccine mega-centres and pharmacies. In my area GPs are in co-operative groups, with several surgeries vaccinating from a common location.
7. Use of all available resources e.g. the vaccinators came from the NHS, retired NHS staff, vets, dentists, other healthcare professionals, airline crew, the military etc with suitable training as required.
8. All elements must be planned and executed, must actually work otherwise the whole would be, at best, less effective or at worst, in the words of the proverb, “for want of a nail the kingdom was lost”.
The UK’s Covid vaccination response is an excellent case study in complex systems and cybernetics but you know something; like millions of others, I’m just glad my Mum’s a bit safer.
(1) Joint Committee on Vaccination and Immunisation
(2)My favourite vision is being vaccinated in a cathedral by a vet, perhaps with Bach’s ‘Toccata and Fugue in D minor’ playing in the background.
(3) The Intelligent Organisation, 2nd Edition, John Beckford, Routledge, 2020