Vaccine as a Platform (VaaP): Why the future of disease eradication needs to be data driven.

Introduction

As COVID-19 sweeps the world in 2020, it is interesting to note that the recent decade is termed the Decade of Vaccines (DoV) Collaboration [1]. The Global Vaccine Action Plan (GVAP)—endorsed by 194 Member States of the World Health Assembly—is a framework to prevent millions of deaths through more equitable access to existing vaccines for diverse communities by 2020.

GVAP, an unprecedented effort is the product of the DoV Collaboration. Numerous agencies are committed to achieving the goals of GVAP to stimulate discovery, development, and delivery of lifesaving vaccines. The plan is founded on the previous success of transforming how vaccines move from formulation to factory, families, and individuals.

In 2019, the WHO identified Vaccine Hesitancy (VH) as one of the top ten global health threats [2]. This is paradoxical because it occurred while access to data-centered technology detecting cancer driver-gene events specific to tumors and tissues of origin is becoming available [3].

Mass vaccination vs Person-Centric vaccination

Though the GVAP of 2011–2020 was an ambitious effort, it was not a “data-centric” approach [1]. Therefore, GVAP could never be “person-centric” in its execution.

At this juncture, in order of us to understand the term person centric, there is an opportunity to tap in to the wisdom of Peter F. Drucker. Widely considered to be the world’s and foremost pioneer of management theory, in his book, The Five Most Important Questions – You Will Ever Ask About Your Organization [15], Drucker prompts organizations to pose five questions. Through these purposeful questions, organizations are primed to act:

What Is Our Mission?

Who Is Our Customer?

What Does the Customer Value?

What Are Our Results?

What Is Our Plan?

If we drill down into the details of these five questions, you will discover that there are not one or two individuals or groups but rather a network of inter-connected and distinct individuals. All with very distinct perspectives, objectives, values, beliefs, purpose, needs, strengths, limitations, vulnerabilities and everythng else, that makes them human. While there is an individual on both the supply side as well as the demand side of the vaccination process, the success of the vaccination process is dependent on all involved persons, without exceptions. From a marketing perspective, given that the demand side dictates the supply, in this context, we will focus on the specific perspective of the person, on the demand-side, the person receiving the vaccine, through the vaccination process. Whilst, acknowledging that the person(s) on the supply side are as important and critical, to the success of the vaccination goals but whose perspectives and objectives are different.

Specifically, in a “Mass Vaccination” process, numerous generalizations are made, pertaining to vaccine dispensation. Most of the generalizations are based on the target “herd” to be vaccinated. Some, generalizations could include age, ethnicity, and other demographic characteristics. However, certain precise information requirements are compromised. The focus on “the person” is compromised. Perhaps because of the perceived costs involved.

Thankfully, a “data-centric” approach on the other hand has the capabilities to narrow down a “herd” to a “person”, an individual. And this “person-centric” approach has the potential to create opportunities for precision. And this could potentially be a game changer for disease eradication. An example of such precision could include but not limited to the utilization of DNA data as a reference for necessary actions, more precisely addressing the very specific and precise needs of a specific individual. Simultaneously, on the supply side, other involved parties in the vaccination process also become important in the vaccine value chain. And, “who” needs “what” information, “when”, “where” and “how” are precisely understood, designed and orchestrated, so that every person in all the involved processes have the precise information needed to make the best possible decisions, in order to execute the best available action, for delivering the best possible outcome – a total eradication of a given disease.

In a very person-centric vaccination process, all involved parties benefit. In this panorama, the person receiving the vaccine benefits as well as persons who are accountable for delivering wider public health results. But, this can only be possible through the best use of all available data. Thus, in the digital age, to be data-centric is also to be person- centric. And this is true to any sector or industry.[4]

While there is little debate that vaccination is one of the greatest achievements of public health [5] and remains a widely accepted public health measure [6], a data-centric execution can reduce or eliminate VH. This point is made twofold, as the associated complexity in the vaccination process can only be addressed by a person-centric approach. Prior to the internet, there were no alternative options beyond a mass approach.

The Myopia: What business is vaccination in?

In 2012, the SAGE Working Group on Vaccine Hesitancy [7] was established. Its first task involved proposing a definition of Vaccine Hesitancy† and defining its scope to develop a model that categorized factors that influenced behavioral decisions in accepting vaccines.

†The group accomplished this through robust discussion of the use of the term that reviewed models of VH. This included: a commissioned systematic review of determinants of VH; field reports and personal observations from different organizations on hesitancy factors; and commissioned immunization managers’ survey of VH, and personal observations and experiences of Working Group members.

The working group presented their approach that focused on defining VH, its determinants, causes, expression, and impact. It also pursued the suggestion of indicator(s) of VH that could be used in monitoring progress within the DoV GVAP. Thus, organizational analysis and prioritizations based on identified strategies with their potential impact was performed. The role of WHO in addressing VH was outlined with specific roles of advisory committees [7].

While the approach focused on VH as the main issue, the Working Group was weakened by lacking a person-centric view of the problem. The focus was the vaccination process and execution rather than the vaccine consumer. At this juncture, one may compare the vaccine and the vaccination administration process through a lens of marketing scholarship that champions a product or service. Thus, new approaches to alleviate VH become clear.

One of the most influential ideas in marketing, introduced by Harvard Business School marketing professor Theodore Levitt, is marketing myopia—a nearsighted focus on selling products and services, rather than seeing the big picture of what consumers truly desire. An industry begins with the customer’s needs, not with a patent, raw material, or selling skill [8]. Levitt describes a lack of insight into what businesses do for their customers, effectively originating from the people who define the “why” of the product itself. Levitt cites an example of the train industry, arguing that railroad lines sharply declined because they saw themselves in the train business, rather than the transportation business. If leaders viewed themselves as helping customers travel, they could have expanded their business into other forms of transportation (buses or airplanes). Unfortunately, overlooking such potential allowed other companies to seize those opportunities and steal their lifeblood—passengers [9].

Medical sciences, broader healthcare, and public health industries are not immune from this same myopia. When troubled by the threat of VH, what are we threatened by? Its triumph in decreasing incidences of transmittable diseases, or by the loss of vaccines’ providing solutions for well-being? In Levitt’s words, “what business is the vaccine industry in?” One would hope they are in the business of “good health,” versus “vaccination.”

Lessons Learned–Data is key for success

The GVAP Review and Lessons Learned Reports confirm that VH presented major challenges during the past decade [10]. The report’s recommendation states the desire to “promote use of data to stimulate and guide action and to inform decision-making” [10]. This elaborates the next decades need for data collection; data-driven action; capacity to collect and use data; data transparency and sharing; flexibility to use data based on relative value; inclusion of qualitative data; integration with infectious disease surveillance data systems; preparing for transformative implementation of new technologies; collaborating with data scientists and informatics experts to ensure effective data use; and ensuring lessons are learned from Sustainable Development Goals and Universal Health Coverage/Primary Healthcare management strategies and data collection experiences [10].

When vaccines were first developed, data on vaccine failure was scarce, especially in vulnerable populations [11]. However, knowing the potential of applying data sciences, machine learning, or artificial intelligence, it’s plausible to better characterize vulnerable populations, which can be integrated to generate bioinformatic models for early identification of nonresponders. But, one non-biological risk persists–data non-use.

The disease of data non-use & the pursuit of wisdom

Data non-use poses even more risk than data misuse. It can be problematic with serious consequences [12]. The most effective initiatives to address specific contexts of data non-use include understanding the pertinent sources and reasons for data non-use to create appropriate incentives and repercussions; and awareness of multiple aspects underlaying this issue in other domains to keep benefits and limitations in perspective and move towards socially responsible reuse of data, thereby becoming the norm in saving lives and resources [12].

But what happens when people transform health and wellness experiences into data through tracking devices [13]? Our world is flooded with data from these devices—including those that log health data. Just as big data has the potential to rebuild America’s aging infrastructure [4], when sensor data is fully deployed to the frontlines, health data can meet the GVAP goals of the next decade. However, the health industry needs to embrace that health professionals cannot do this alone. Data comes from computers and from multiple sources . From a practitioner’s perspective, ALL the involved persons in the vaccination process, need to be able to answer ALL the specific questions posed, from all very specific individual perspectives – who, what, how, when, where and why. Only when these very specific personalized questions are answered in a very timely and accurate manner can we claim that our use of data has evolved.

In the case of the Immunization Information System (IIS)2 an expert system involved in administering vaccinations, it appears that it has not found its ‘why’ and this problem seems to manifest itself as the issue of vaccine hesitancy.

Vaccine as a Platform (VaaP)

The limited success in applying the IIS is partially due to capability limitations. Vaccinations as a social issue—including socio-techno-political-economic complexities—is best addressed from a “platform”3 viewpoint. Further scholarship is necessary to evaluate the IIS as a platform—Vaccine as a Platform (VaaP). This facilitates eliminating the myopia that Levitt identified. What’s certain: data must be understood as a capability and managed as such. Thus, a data strategy must be followed.

The data strategy for realizing VaaP

The data strategy blueprint [14] is a simple, strategy for decision makers to implement data use. It identifies data use as: data serves the purpose; data as a capability; and data as an asset. Fig. 1.

Fig. 1

Data Strategy Blueprint.

Conclusion: OMICs data & “Precision Vaccines”

Person-centric data is a key capability in VaaP, and critical factor for success for the GVAP. A potent idea that forms the basis for future development is predicting vaccine’s preventable disease with a great deal of precision [11] For this ambition to be fulfilled, we have OMICs data and its most recent success.

Combining OMICs data on vaccine immunity in groups with special vaccination needs, and screening and development, can increase knowledge on mechanisms of vaccine hyporesponsiveness. OMIC’s data can be used to design bioinformatic tools, predicting vaccination outcomes and providing genetic and molecular “signatures” of protective immune response. It may enable signature identification of vaccine safety, immunogenicity, and efficacy/protection, informing vaccine interventions in vulnerable populations [11].

This capability, when made available with the VaaP, could form future development and research in predicting vaccine preventable disease with precision vaccines, as a “one size fits all” intervention is impractical [6].

When such precision vaccines are delivered through a person-centric and data-driven vaccination process, a new societal solution unfolds. With the resulting elimination of data non-use, we may see the eradication of VH with the hope of adding to the list of eradicated diseases beyond small-pox.

The author attests meeting ICMJE criteria for authorship. There are no conflicts of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.