Vaccination Equity: Interview with Signetic Chief Product Officer Lukas Svec

HOW DO YOU WORK TOWARD EQUITY WHEN THE NORMAL FORCES OF SUPPLY AND DEMAND ARE HAYWIRE?

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• The following interview has been edited and condensed for clarity.•

What are your experiences on how municipalities are handling equitable distribution?

Local governments know that they need to reach communities that have limited access With vaccine registration platforms like MVS. It’s easier than ever for organizations to get in front of those that are in-the-know. But little has changed for residents that are not online, don’t have a phone, have hesitancy to vaccines, and have a distrust of government initiatives.

With that in mind, there’s a lot of pressure to create a registration link and open it up to the public. So how do you reach those that don't have that access? Organizations are taking the time to reach out to nursing homes, set up call centers, establish connections within underrepresented communities, and overall slow down registration speed.

The City of Seattle is going after zip codes, race and ethnicity. Organizations like United Community Health Center
, out of Arizona, are setting up mobile sites in rural Pima County to be closer to their community.

The City of Seattle has set goals around getting vaccines out in a fair way. Do you know what those goals are?

Every phase has a main target of who they're trying to reach. And they've identified who in that pocket is difficult to reach. They send out specific task forces weekly to do outreach. Early on, when eligibility was restricted to the 65-plus elderly population, they sent firefighters out to elderly home facilities, one by one. These were boots on the ground, doing work manually. Recently they installed call centers to handle outreach and notification. While their registration page gets 300k without any effort, they’re putting in hundreds of man hours to reach thousands of people that would otherwise not register.

Every organization has their goals and targets.They're all trying to meet them. If they do go the extra mile, the results will show it. And maybe, when this is all behind us, the public will feel more confident in trusting governments to look out for them.

Signetic has been enabling that all the way through, is that correct?

Yes, we work on a development stack that allows us to get tools and software in place in days. This allowed us to focus on organizations that were in the most need. We got to look at how they worked every day and adapted our software to make the biggest challenges more bearable.

I remember when Arizona got their first batch of Johnson & Johnson vaccines. Our partner UCHC in rural Arizona suddenly received thousands of vaccines—they didn’t order—at their doorstep. They needed to go out that week. We weren’t ready and neither were they. In the end, we got there by being flexible, listening to the people on the ground in Arizona, and a few late nights working extra time to get things right for abrupt deadlines.

A lesson we’ll be taking forward is how far we can get when software is built in the trenches with our partners. We’ve never been more driven to make an impact.

What do you think has gone wrong so far with equitable distribution? What have you seen happen when it hasn't been done well?

Every single place has the same challenges. And because the US is now approaching this from a local-government organization approach, all the pressures are there to do right. But nobody was ready for what would come that week or the next. We as a country and us as software developers weren’t set up to handle it.

One week a shipment gets cut. Another week an extra 1000 vaccines are delivered without notice. Then Moderna factories don’t manufacture to their target, limiting supply again. Once that’s solved, the state announces children under 19 are allowed to be vaccinated. It’s death by feast and famine.

When nothing is certain and everyone’s tired, it’s amazing to even get a single shot in an arm. It’s easy to forget whose arm that is.

We’re happy to have worked with organizations that put equitability first. It hasn’t always stayed at the top, but it’s allowed us to keep our priorities in check and take a breath. Herd immunity isn’t about the individual; it’s about everyone. We all benefit.

What are some other features that we've been asked to build to help enable these clients? I'm thinking about UCHC down and Arizona or the City of Seattle—they both have unique ideas.

The number one concern people have is ‘When will I get my vaccine? Or am I being considered?’ For the most part, people don't need it today, as long as they know that someone is thinking about them

We rolled out a waitlist that provides the people the ability to register early, to provide their eligibility criteria so they can at least rest easy knowing they won’t be left out.

So on this list, you have demographic information that then allows the vaccination organization to send out invites? What happens after you have the list?

Yes, demographic information is key. Once people are on the list, groups like UCHC and the City of Seattle can keep in touch and let them know that they’re still on top of mind. It also allows them to prioritize which patients to invite for registration when spots open up.

It’s a win-win. Patients don’t have to check for new openings every few minutes and organizations can prioritize based on those that need the vaccine the most.

Like people working in grocery stores or in medical fields, etcetera.

Yes. Lately emphasis has been on high-risk workers. Recently in Washington state, eligibility was expanded to teachers, for example. And so as you have all these questions that the city will want to use as triggers for evaluating eligibility, they can specify and have these features to select.

What are some other ways to go about doing this more efficiently?

When we first got out there in December, our clients just needed to get patient information into a digital form. We didn’t even know what the whole patient experience would look like, but we knew that manual work needed to be eliminated wherever possible. In the beginning we were eliminating work that took, on average, three minutes per patient.

Now, several months into it, the expectation for the client is quite well understood, and we’re looking at eliminating work that takes seconds. Sounds small, but when it’s multiplied by hundreds of thousands of patients, it really adds up.

The number one source of vaccinator burnout is working with electronic health records software. The more we look out for them, the longer they will stay in the game and continue to make an impact.

It almost feels like this has gone from vaccination to appointments, and then from appointments to almost a marketing and outreach tool. Are there features or plans for how to group and build campaigns? Is that something that you're you've considered?

That’s a good way to think about it. Our software is like a marketing campaign tool. We provide the tools to inform outreach strategies, create a patient pipeline, get the word out, create a customer list, make it easy to register, and deliver a great vaccination experience.

Touching back on equitability, there are groups that do need convincing, and then there are populations that need to be approached with consideration. They each need their own outreach campaign methods, and the hypothetical marketer needs to get signals back about how successful they were. That’s the only way to adapt and improve.

So solving a pandemic is a fairly rare occurrence. What do you feel we've learned from this that can help us in our future developments?

The way governments and tech companies worked together in the past is quite broken. The tools that states have to do outreach are limited and not built for it. We as a society are paying the price right now. If there's anything to be learned from the pandemic, it's how much we as software developers need to work more closely with our governments and provide them the tools to be flexible and adaptive.

This pandemic will resonate with us years to come. We'll need the state to be on top of this, ready for the next one—or even to manage the after effects for the variants from this year.

These tools need to grow, and the relationship the public has with their local government will need to evolve. And we need the government to be there, allow us to feel safe and guarded, to take our privacy seriously, and to keep us in mind.  

In terms of equitability, that means some with means will receive services slower, with the benefit that everyone has a more equal playing field.

Our ability as a tech company to reach mass amounts of people is great. Sometimes that needs to get tempered by external requirements, that we as tech companies don't have a direct connection to. Listening to local and state governments and providing feedback and tools that allow them to reach who they need to, that's where I think the future is going.

The relationship between the City of Seattle and Signetic has been quite unusual. With government work, usually there's an RFP process. Then specs are written up and provided to a list of vendors, and then the vendors then respond. Then a bid is selected, and then they move forward.

But it's very waterfall-esque. Working with the City of Seattle has been incredibly agile, to the point where it's almost on a one-day sprint that we've been going through. Do you think that will be a trend for the future, as to how we work with governments?

What you're describing is what digital transformation is all about. We as developers can no longer be happy with two-week sprints. We have to strive for two-day development cycles. And the effect of being on a platform like Power Platform with Microsoft, where we can do this quick digital transformation work, is one way where we’ve been able to do that.

We are, for our clients, this digital innovation hub that responds directly to their immediate needs. This isn't normal software development. This is one of the few ways I hope we don’t return to normal.

So in a way, you're using software to facilitate a conversation between these different entities that are all based on a shared experience.

Business applications that rely heavily on process are different than normal software. A consumer might have this regular email, or a normal mobile application. The process matters, the users matter, and the tools matter. They all relate to one another. If you build your software without the users in mind, or without a clear insight into the process, you're not building it for your customer. You're missing something.

How do you personally feel about equitable distribution?

Personally, equitability is one of those things to strive after as an ideal. But in this case, for vaccines, it has an added benefit for herd immunity. If we just went after those who are easiest to reach, we could get pockets of populations that are immune, quite quickly. But that could also leave large pockets that are not immune. We need to be reaching everyone equally to get the best effect. So by looking at equitability now, we're helping everyone in the future.

What can builders of vaccination management solutions like Signetic do specifically to help foster equitable distribution?

Being able to surface data to our clients is number one. Collecting it accurately, cleaning it, and providing reports. It’s our job to lower the barrier to entry and lower the barrier to take action. If we do it right, our clients will have time to take a breath, look around, and focus on their ideals.