Now Is the Time to Develop Digital Global Goods for Equitable Vaccine Delivery

There is an unprecedented effort underway to develop safe and effective COVID-19 vaccines. Through COVAX, lower- and middle-income countries (LMICs) may receive enough vaccine doses for 20% of their population. Only if the vaccine is efficiently and equitably delivered will it stem the spread of the pandemic and speed economic recovery for hundreds of millions of people. LMICs will require robust and mature digital solutions to achieve this immense task.

On November 9th, Pfizer and BioNTech announced positive preliminary self-reported results regarding their mRNA-based vaccine candidate. This is exciting news for the world, and it is encouraging for mRNA platforms in general for COVID-19 and future viruses.  

Whether it’s this candidate or another, this will be the largest public health campaign ever attempted. We can rise to this historic challenge if we move quickly. It has now been demonstrated that digital health solutions can rapidly scale in LMICs. For example, more than 500,000 frontline workers were equipped with CommCare in 2019 alone, and more than 350 million people were registered using CommCare that year. The global health workforce is going to undertake heroic actions during this campaign and needs powerful and appropriate solutions in support.  

Digital COVID-19 Response in 2020

As the COVID-19 pandemic swept the world, Dimagi quickly moved to support response and mitigation efforts in the United States and LMICs. Our prior experience with Ebola response helped us rapidly design and deploy a set of digital COVID-19 apps for contact tracing, facility readiness assessment, port of entry screening, and health worker education. These apps were built on CommCare, our open source, no-code platform that is the most widely used and scaled platform for equipping frontline workers in LMICs.

Our dedicated COVID-19 response team enabled Dimagi to develop these apps, collaborate and coordinate with other digital development organizations, and stand up a dedicated COVID-19 response team that has provided hands-on support to many countries and large organizations to adapt and deploy CommCare applications for COVID-19 response.

CommCare has been used for COVID-19 response by more than 25,000 users across more than 30 countries since March 2020. A report by Johns Hopkins University determined that CommCare is one of the two most useful platforms for COVID-19 response. Within the United States, CommCare is the designated government COVID-19 contact tracing system for Navajo Nation, Philadelphia, New York, New Jersey, Alaska, and Colorado.

Our experience in this pandemic reinforced an important lesson: Digital solutions are much more effective if in place before an emergency starts. Worldwide, governments struggled at every level to deploy digital technology to support their pandemic response activities. Today, more mature technology is being deployed to replace COVID-19 response systems that were quickly cobbled together earlier this year.

We have a narrow window to put digital systems in place for COVID-19 vaccine delivery in LMICs. Relative to the early phases of the pandemic, we have several months of lead time before the emergency operations will begin. If we use this time wisely, we can develop robust, scalable, standardized, and interoperable solutions to both improve frontline workers’ efficiency in delivering the vaccine and improve transparency in the delivery process given limited supplies.

Digital Solution for Equitable COVID-19 Vaccine Delivery 

Dimagi is actively developing an open-source digital global good solution to track and support every client before, during, and after the vaccination process while providing analytics and visualizations to monitor the progression of vaccine delivery. It will provide direct digital support to health providers administering vaccines (via apps), people getting vaccinated (via messaging), vaccine managers and supervisors (via analytics and dashboards), and community advocates (via apps or messaging).  Dimagi’s solution will also integrate with biometrics, digital yellow cards, capture adverse events, and help manage the roll out of vaccines in stages based on occupation, age, and comorbidities. 

While some vendors are developing solutions primarily for high-income countries, Dimagi’s solution is tailored for LMICs. It will function in low-connectivity environments and will be designed to strengthen the health systems in LMICs that Dimagi has been supporting for nearly two decades.

It is critical that investments made now are built to be sustainable and highly leverageable in national digital health architectures going forward. The solution has been developed and will be deployed according to recommendations from the recently published WHO Digital Implementation Investment Guide (DIIG): Integrating Digital Interventions into Health Programmes, and follows protocols and guidance from COVAX, WHO, and the CDC. 

Client tracking: Health administrators will use CommCare-based mobile apps during each encounter with a client being vaccinated. The apps will guide the workers through screening to ensure eligibility protocols are followed. The app will enable integration with biometrics to verify dose completion, capture adverse events, and provide lists of clients who are at risk of defaulting on their regimen. It will run offline for low-connectivity environments. The solution will also provide digital support for Community Advocates to provide counseling to the population and to facilitate follow-up with clients at their homes to ensure course completion.

Messaging: A direct-to-client (D2C) component will guide clients through each step via SMS, WhatsApp, and other platforms. It will provide answers to frequently-asked questions and myth-busting information, while also addressing vaccine hesitancy. Building on Dimagi’s growing portfolio of D2C initiatives across five countries, this component will also help schedule appointments, provide updates to people on eligibility waitlists,l encourage completion of all doses, and monitor for adverse events. 

Analytics: Real-time analytics will help monitor vaccine delivery, track rates of missed appointments and lost-to-follow-up, and ensure critical segments are vaccinated first. Dimagi will apply anomaly detection algorithms developed with support from funders to help identify cases where eligibility protocols are not being enforced equitably (demo). 

Wrap-Around Solutions: Dimagi is also developing CommCare apps to help with facility readiness, health worker education, and to support community-based engagement and vaccination, where appropriate. The solution will also enable turnkey integration with existing digital components, such as health worker registries, routine immunization registries, and health management information systems.

To see this system in action, please view this demo video:

Rapid Collaboration

In the early COVID-19 response efforts, it was gratifying to see how quickly organizations were moving to respond to the pandemic and how much collaboration emerged within the digital development community. Many groups worked in public Google documents and shared their learnings in quickly-organized virtual meetings. Dimagi has been particularly encouraged by our close work with Medic Mobile on shared designs, apps, and dashboards for COVID-19 response apps.  

There is now another opportunity to collaborate as a community to enable equitable vaccine delivery.  Collaborations Dimagi is currently working on include: 

• We are building on our partnership with Medic Mobile for COVID-19 response to co-design modules to support community-level engagement to address vaccine hesitancy, to follow-up at the household level to ensure people complete the full course of the vaccine on time, and to monitor for adverse events. 
• Dimagi, Ona, and Medic Mobile are working together to create open source common data models that can enable rapid collaboration regardless of which platform is used for vaccination service delivery.  
• We have also created a public notes document on research our team has done while building out the solution.

Total Cost of Ownership Model

Since this post was originally published, Dimagi has drafted a Total Cost of Ownership (TCO) model to help organizations estimate the total cost of adopting Dimagi’s digital solution for vaccine delivery.

The Dimagi solution itself is intended to be covered by global funding, but this tool calculates the surrounding costs of implementation. Our hope is that this will be a helpful resource for governments or partners to estimate site administration, outreach costs, and other costs to support upcoming vaccine campaigns and deliveries. 

Please find a link to the TCO model here.

To use this tool:

1. Open the link
2. Make a new copy
3. Follow the directions in the ‘Instructions’ tab
4. Review the blue example tabs and the ‘Assumptions’ tab for further guidance.

If you have questions or feedback about the model, please reach out to our team here.

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For more information on Dimagi’s efforts to support efficient and equitable vaccine delivery, please contact: covid-vaccine@dimagi.com

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