How the national Covid-19 vaccination campaign picked up speed
Using logistical expertise to make society a better place. That is one of the aspirations of Tilburg science. And while the Covid-19 pandemic was raging, Professor of Logistics Management Jan Fransoo realized this ambition: together with a group of volunteers he supplied the expertise that accelerated the pace of vaccinations.
In terms of logistical expertise, the Netherlands ranks among the best, but at the start of the year it didn’t quite look that way. The media carried lists ranking countries in order of vaccination speed, and ‘we’ visibly struggled. Minister Hugo de Jonge and his Ministry of Health, Welfare and Sport (VWS) faced harsh criticism. How on earth could so many countries outdistance us? The Dutch en bloc showed an expert-like interest in virus containment and vaccinations.
One Dutchman who certainly took a keen interest is Jan Fransoo, one crucial distinction being that he really knows what he is talking about when it comes to logistics. He has extensive knowledge of logistical processes and of how these can be designed for the purpose of, for example, mass-scale vaccinations. Fransoo has been with Tilburg University as Professor of Logistics Management since November 2020 (in addition to being a Visiting Professor at Eindhoven University of Technology), and he vividly recalls how very soon after he had assumed his professorship in Tilburg he became engaged in the vaccination strategy debate.
“At the end of last year, I received a call from a journalist of Nemo Kennislink who was writing an article on global vaccine transportation. I could give him some details on the transportation itself, for example, using dry ice. At the end of the interview, we came to talk about administering vaccines. That is a logistical operation in its own right, and I confessed to being astonished by the lack of clarity at the time about how that operation would be mounted. With the kick-off of the national vaccination campaign just one month away, such suitable sites as the Rotterdam Ahoy event venue and the Utrecht Jaarbeurs exhibition center had not yet been secured.” His astonishment finds its way into the Kennislink feature and goes viral. News shows like Nieuwsuur are quick to respond and invite Fransoo to spread the word.
Team of volunteers
Far from being content to call from the sidelines, Fransoo is eager to help VWS and sends the ministry an email offering his services. The email is lost in the massive correspondence addressed to the ministry, but the logistical challenge of swift and large-scale vaccination is simply too fascinating for Fransoo to ignore. “At the time the consensus appeared to be that the annual flu jab routine – one day of vaccinations by family doctors at their offices – could simply be copied and multiplied by ten, we’d be home free, and additional preparations would not be necessary. That was a fairly uninformed idea. It wasn’t at all clear whether family doctors would be able to manage. Also, there were a great many more uncertainties than the flu vaccination program presents, as that program comes with a clear and limited target demographic and a dependable supply chain.” Fransoo is not alone in having these reservations. The ministry is receptive to the criticism voiced and it decides to have the Regional and Municipal Health Services (GGDs) take charge of administering vaccines. “I then wrote a post on LinkedIn that essentially said: we’re headed in the right direction, but there’s still an awful lot of logistics to be done to get things going. Who wants to help move things forward?” That post does not fall on deaf ears: logistics professionals at ASML and Heineken volunteer to help. “Together with them and some students from Eindhoven University of Technology we created a team of volunteers that designed a logistics protocol for an effective national vaccination program and captured it in a set of six slides.”
Some members of the team that got to work at GGD West-Brabant.
- Ed Slegtenhorst (Districon)
- Saskia Kuijpers (DAF)
- Marle Muselaers (Pantein Zorggroep)
- Paul Enders (ASML)
Photo: Paul Enders
Eager though they are to help the vaccination campaign gain momentum, the team still need to ‘land’ their idea with the authorities. But how? Vice-Rector Magnificus Jantine Schuit of Tilburg University is happy to help and liaises between Fransoo and GGD West-Brabant. Fransoo and his team are invited to assess the GGD’s scaling-up plan and their analysis shows there is room for improvement. “The way the GGD wanted to handle things would require far too many human resources. If that approach had been adopted nationwide, an acceptable vaccination rate would not have been feasible.”
Using Lego bricks, a group of team members designs an improved logistical process and feeds it into a computer simulation model. The objective is to enable every vaccinator to administer four times as many vaccines per hour. No mean feat, but practicable by disconnecting the administrative processing of vaccinations from the actual injection of vaccines and to use efficiently laid out vaccination lanes.
Photo: Paul Enders
“Administrative processing takes more time than injecting vaccines and should therefore be organized in a way that doesn’t interfere with the pace of vaccinations.” They design a process that enables vaccinators to administer not 18 – the GGD’s original estimate – but 60 to 100 vaccines per hour. “That requires far fewer vaccinators and that was essential, because recruiting staff is a bottleneck.”
It’s better to have ten vaccinators twiddling their thumbs than have a single vaccine go unused
This approach is promising, and it is deemed prudent to use it as the blueprint for a nationwide roll-out. With Vice-Rector Schuit once again acting as liaison, Fransoo’s team is invited to give a presentation at the logistical coordination center of the RIVM (the Dutch National Institute for Public Health and the Environment) in late January. Half an hour after their presentation they receive a call: the RIVM would like to accept your offer of assistance in its entirety. Fransoo: “We immediately set students to work to make logistical planning tools, and we also made a new acceleration plan. We believed it was possible to increase the number of vaccinations from the originally estimated 700,000 a week in June to 2 million. That allowed the ‘vaccinate all in October’ ambition to be reset to ‘first vaccination for most in June’.” Shortly afterwards, Fransoo also meets Erik Gerritsen, the highest-ranking official at VWS. “He gave us carte blanche to ‘sell’ our plans to every agency and authority involved throughout the country, and he said: if you get stuck anywhere, call me straightaway.”
The ‘just in case’ scenario
Fransoo believes that the acceleration plan required the RIVM and the Regional Medical Assistance Organization (GHOR) to turn around their thinking. “Given the initial uncertainty about vaccine deliveries, they wanted to stockpile vaccines. Stock allows for precise planning and for limiting the number of vaccinators needed. This is classic efficiency-driven thinking, so characteristic of the healthcare sector. But in this case keeping vaccines in stock was inappropriate as a policy, because it would prolong health hazards for vulnerable people. So the buffer had to be moved to somewhere else in the chain. We needed to hire more vaccinators than would be strictly needed. I argued: it’s better to have ten vaccinators twiddling their thumbs than have a single vaccine go unused.” By the end of February it is apparent to Fransoo that his team and VWS are on the same page. “Gerritsen sent me a text message: we need to get to 2.5 million vaccinations a week in June. Yet at the time it was improbable we would have sufficient vaccines to make that happen. The ministry had decided to run with what it called the ‘just in case’ scenario, the reasoning being: it may not happen, but just in case it does, let’s be ready for it.”
No way? Way!
A GGD West-Brabant pilot shows that the approach proposed by Fransoo’s team works. Once the vaccination lane has been rerouted, it takes only 45 minutes to vaccinate the number of people it previously took all morning to vaccinate. This successful outcome heralds the all-clear for a nationwide roll-out of the process originally developed for the West-Brabant region. The team are given permission by GHOR to present their proposed and now tested approach to the regional GGDs. Most major vaccination sites subsequently adopt it.
Even so, more hurdles need to be cleared. The team are repeatedly told ‘no way’, ‘not allowed’, ‘can’t be done’. “We often had to insist that things be done in accordance with our plan. For example, we wanted people who showed up for their vaccination appointment to be given proof of vaccination before they were actually vaccinated, because doing away with an additional check saves time. But the law says that proof of treatment must only be provided after treatment has been given, so the authorities had to intervene and promulgate a formal, temporary exception.” Yet for the most part the team succeed in having their plan implemented as they designed it. By late April, vaccinations pick up speed, and things begin to run so smoothly that the team become redundant.
It was tremendously helpful that we are true outsiders
National team manager
One feature of the vaccination operation that will stay with Fransoo is the sincere willingness to contribute. “Everyone involved wanted to help for the sake of helping.” He checks off: “The professionals at ASML and Heineken who joined our team of volunteers. The logistics expert at DAF who helped analyse the vaccination lane process in Breda. And the head of user experience design at Bol.com, who built a website.” Doing the project as a self-initiated labor of love proved crucial to his team’s plan being accepted, Fransoo believes. Neither he nor anyone on his team had a single stake in the project. From the very start Fransoo is determined to remain independent, even to the extent of making it a condition with the RIVM that he may continue to express criticism of the vaccination campaign in the media as he sees fit. “It was tremendously helpful that we are true outsiders: we know a great deal about logistics, but we do not concern ourselves with the healthcare sector, either now or in the future.”
He was excited and relieved that VWS, the RIVM and the GGDs accepted his team’s help. That outcome was not a foregone conclusion. “They might well have regarded us as yet more onlookers shouting unsolicited advice from the sidelines.” And speaking of sidelines, Fransoo is glad that the successful vaccination campaign has shifted the public gaze from Covid to international sports events this summer. Fransoo: “Thankfully, we can once more be instant sports experts rather than join the ruckus as virology enthusiasts.”
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