Vaccines and Testing in Non-Acute Settings
With the 2020-2021 respiratory season on the horizon the burden on healthcare supply chain will grow greater. Health systems will soon be hit by a season like no other with the convergence of usual respiratory illnesses – flu, pneumonia, bronchitis, RSV – with COVID-19 cases.
On top of the ongoing personal protective equipment (PPE) supply challenges, supply chain leaders are being called upon to assist their pharmaceutical and laboratory counterparts in the procurement of a significantly greater volume of flu vaccines and diagnostic tests for COVID-19 and other respiratory illnesses.
This was the focus of conversation during the Supply Chain Leadership Forum that McKesson hosted at the 2020 IDN Summit Virtual Experience, where health system supply chain leaders voiced their concerns, challenges and questions on supporting the pharmaceutical and laboratory needs of non-acute facilities in the months ahead.
Pharmaceuticals and prevention
While there is no COVID-19 vaccine currently available, health systems and U.S. pharmacy chains are anticipating an increased demand for flu vaccines in the coming months as Americans attempt to protect themselves from this potentially preventable virus.1 They have a good reason to increase immunization rates. Studies have shown that vaccines for common preventable illnesses (e.g. flu, pneumonia, pertussis, etc.) can reduce hospital stays by four to 12 days.2
Hackensack Meridian Health Network (HMHN) is the largest integrated delivery network (IDN) in the state of New Jersey. Richard Killeen, HMHN’s VP, corporate purchasing, corporate administration, who attended the forum, said that while the pharmacies in their network are “ramping up and buying a larger than normal supply” of vaccines, there is no way to truly forecast what will be needed.
“We may get a groundswell of people who are now getting vaccines for preventable illnesses who didn’t before, but there’s no way to tell what the demand will be because there’s no reliable usage history – it has been wiped out by the pandemic,” he said. He also noted that over the past six months, telehealth usage has increased, and in-person visits are down. The clinicians have been working to develop a strategy to have patients come in for their vaccines.
Trevor Keeler, director, pharmaceutical sales, McKesson, shared insights on flu vaccine supplies this season noting that while there are currently no availability issues for these products, health system supply chain leaders should work together with their counterparts in pharmacy on a “thoughtful plan” surrounding their vaccination process.
“Match vaccine usage with ancillary supplies (e.g. needles, syringes, gloves). Determine whether your manufacturer or distributor relationship has a dedicated customer service agent to answer questions and address concerns. And in this uncertain environment, it’s critical to understand the return policy for any unused portion of vaccines,” said Keeler. “Not only is it important to prepare for the flu season by creating a flu vaccine plan, it is also important to vaccinate against other preventable respiratory diseases like whooping cough and measles.”
“Many parents and adults may have put off getting vaccinations for their children or even themselves because of fear of exposing themselves to COVID-19,” Keeler added. “The vaccination rates are down.3 It is so important for clinicians to communicate to their patients the safety protocols they have in place so that people feel better about getting their vaccines. Supply chain also has an important part to play by ensuring the clinicians have the pediatric and adult vaccines they need.”
Testing and diagnosis
Since COVID-19 was first detected in the U.S. earlier this year, healthcare organizations have struggled with the availability and accuracy of testing, and testing administration across various care sites. From hospital emergency rooms (ER) to long-term care facilities, clinicians have been tasked with diagnosing patients in a safe and effective manner. What they have come to determine is that a testing modality that works for one setting does not necessarily work for another – there is no “one size fits all solution.”
This fall and winter will present even greater challenges as clinicians will be required to test for a range of respiratory illnesses in order to direct patients to a suitable course of care, and in the case of COVID-19, quarantine to help prevent spread of the virus.
John Harris, VP, strategic accounts, laboratory, McKesson, urged health systems to develop a testing strategy or “algorithm” based on test modality effectiveness, availability and cost, that also takes into account the needs of individual care sites and their patient populations. Because the availability of different lab tests could vary over time, he recommends diversifying test options throughout health system networks (see sidebar with POC testing options).
“Develop a plan and make sure you know what is happening in the market from a supply chain perspective,” said Harris. “Know what testing options are available to you and whether the manufacturers you purchase from are expecting any supply issues. I believe we will see more people wanting to be tested for COVID-19 and other respiratory illnesses this season so anticipate shortages and stay in front of them.”
Another forum attendee, the senior manager of nonacute supply chain operations for a large, multi-institutional healthcare delivery system, commented on his coordination with non-acute labs.
“While our lab strategy for physician offices is driven by our health system’s lab leadership, I do get involved from an operational standpoint when there is a supply chain component,” he said. “There are coordinated efforts among the different departments across our organization. Things have gone well but I’m concerned that could potentially change because there are lots of unknowns around how things will go this fall and winter.”
An evolving environment
Because of the shifting dynamics of the COVID-19 pandemic alongside the uncertainties around the severity of the 2020-2021 respiratory season, supply chain leaders should continue to engage in an ongoing dialogue with peers in health system leadership throughout the coming months to connect on how challenges, perspectives and strategies evolve in preventing and diagnosing respiratory illnesses. One vice president of purchasing agreed and said COVID-19 has been challenging. His long-term care facilities are learning how to adjust to the new COVID-19 care guidelines, including adapting to ordering and wearing PPE.
“We’ve seen over the past six months an incredible resiliency within health system supply chains to adapt to this changing landscape. Supply chain is really an integral part of delivering care, be it through a tough respiratory season or adapting to new needs of patient facilities, like long-term care,” said Greg Colizzi, vice president of health systems marketing at McKesson Medical-Surgical. “Whenever we host these Executive Forums, we learn so much when we connect health systems together.”
“There is a lot of concentrated and coordinated activity occurring among division leaders like myself,” said Killeen. “Today’s session has been very educational, providing background information that I can use to ask questions and get ideas related to our vaccination strategy.”
The COVID-19 pandemic has highlighted the importance of supply chain to healthcare organizations and the need for greater collaboration and coordination among supply chain leaders and clinicians. This respiratory season it will be critical for supply chain to truly understand the needs of clinicians as they diagnose and treat COVID-19 alongside the illnesses they see every year, many of which exhibit the same symptoms.
Supply chain can lead their organizations in successfully navigating these unchartered waters by maintaining visibility into the availability of supplies for the lab and pharmacy and shifting resources to meet patient demand. While in the past healthcare organizations could look to supplies used during the same timeframe in previous years to help facilitate demand planning, this year is different. It will require stakeholders to stay engaged and remain alert to patient trends and supply usage on a continuous basis, communicate with each other and have the ability to quickly pivot the selection and flow of supplies based on changing consumption.
Active viral infection tests:
- Antigen: Nasal or nasopharyngeal swab at POC that delivers results in minutes.
- Molecular (RNA): Nasal or nasopharyngeal swab at POC that offers an accurate result for same day diagnosis.
- Serology: Blood test to determine if patient was previously infected or exposed.
1 Barna Bridgeman, Mary. Responding to Influenza Vaccine Misconceptions: Counseling Points for Pharmacists in 2020. Pharmacy Times, July 25, 2020. https://www.pharmacytimes.com/publications/supplements/2020/July2020/responding-to-influenza-vaccine-misconceptions-counseling-points-for-pharmacists-in-2020
2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802702 3 https://www.nfid.org/keep-up-the-rates/issue-brief-the-impact-of-co