‘A full court press’: Banking on tech backup, CDC launches nationwide VaccineFinder tool

On Wednesday, federal officials quietly opened up access to VaccineFinder, a site that allows the U.S. public to search nationwide for approved Covid-19 vaccine providers.

On vaccinefinder.org, users can enter an address or ZIP code and select a search area — say, within 10 miles — and get a list of providers with contact information, eligibility criteria, and, when available, a link to a vaccine scheduler. Critically, users will also be able to see whether each provider has doses available.

VaccineFinder is an answer to scattered and siloed systems that have made it difficult for many to find timely, accurate information about where and when they can get a shot. But the site won’t help everyone, everywhere — not just yet.

The site will only include inventory data from 29,000 providers to start, roughly a quarter of the national total. They will include locations in four states — Alaska, Indiana, Iowa, and Tennessee — along with providers registered in the federal pharmacy program. The decision to limit the initial rollout of the tool comes on the heels of several high-profile failures of state sites to enable vaccine location and scheduling, tools that couldn’t manage the crush of millions of people trying to find vaccine information at once.

There’s another important feature of the site, though, that has been up and running since the beginning of the vaccine rollout. It had to be. On its surface, VaccineFinder is a definitive tool to help the public answer one highly personal question. But buried in its back end is a dataset that allows the Centers for Disease Control and Prevention fill in its own blanks about real-time vaccine supply.

Those capabilities are thanks to a crew of public health engineers and health technologists, who rushed to build the system in just a matter of months.

Unlike many of the data systems deployed during the pandemic, VaccineFinder has been around for a while. As the U.S. was fighting the H1N1 flu outbreak in 2009, a team at Boston Children’s Hospital built a public, searchable map of vaccine providers. Over time, the tool — which is supported by a $12.7 million five-year grant from the CDC — has expanded to include a full armory of vaccines, from hepatitis to shingles to polio.

So as soon as SARS-CoV-2, the virus that causes Covid-19, began to circulate in the U.S., the team started preparing.

“We didn’t always know what role we would play, but there was always an assumption that we would do this in some capacity,” said John Brownstein, chief innovation officer at Boston Children’s and founder of VaccineFinder.

The Boston Children’s team already knew its way around the CDC. “I think in many ways we feel like one team,” said Brownstein. “We’ve been working with the same people for a lot of years.” And recently, it had used some extra CDC funding to start incorporating flu vaccine stock information into its tool, said Kara Sewalk, a program coordinator for the team.

As vaccine research raced ahead, the team realized that not only could VaccineFinder serve as a public resource, but it would have the infrastructure to systematically collect data about on-hand vaccine supply — whether at a big chain pharmacy, a local doctor’s office, or a massive stand-up vaccination site at an arena.

But as the Boston Children’s team met with the CDC throughout the summer, they recognized this would be a project that required more scale, speed, and security than they’d handled before. On Sept. 16, the CDC issued its first playbook for vaccine rollout, including instructions for states on “how to submit facility information and daily vaccine inventory reports for Covid-19 vaccination clinics to CDC’s VaccineFinder.” The infrastructure needed to support those daily reports posed a huge engineering challenge.

“It became clear that we needed a partner,” said Jared Hawkins, director of informatics in the Innovation and Digital Health Accelerator at Boston Children’s.

Help soon arrived, unbidden. In October, health care navigation company Castlight Health, which had previously worked on a Covid-19 testing locator, reached out to see if it could help build something similar for vaccines.

“That was around the time when CDC was asking for us to play a much larger role in their response than what we were traditionally used to,” said Sewalk — that meant not just displaying public-facing vaccination providers, but reporting their supply data directly to the CDC. Through its existing grant to the VaccineFinder group, CDC extended an $8 million subcontract to Castlight.

“We had a lot of trepidation about bringing in a third party,” said Brownstein. “It was a huge risk. We didn’t have time to do some big vendor search or anything like that.”

VaccineFinder would have to be ready as soon as the vaccines rolled out. The team had expanded to meet the challenge: The Boston Children’s team was 15 strong, Castlight added around 40 more, and the CDC had members of its own operational team on the job. By early November, the team had finally started in earnest to build its beefed-up provider platform. The first vaccine approval was just a month away.

To help people find vaccines, VaccineFinder first needs to identify all the places in the country doling them out, a list that is constantly growing. Today, more than 110,000 providers spread out in 64 jurisdictions have been approved to deploy Covid-19 vaccines.

Before the first shot went into the first arm, Castlight and the Boston Children’s team had to build a system to onboard each one of those sites into the VaccineFinder system, and allow them to update their on-hand vaccine supply of Moderna and Pfizer/BioNTech vaccines every 24 hours — hopefully.

“We ask them to report supply data every day,” said Sewalk. “Whether they do or not is a different story.”

Instead of registering big pharmacies individually, the team developed a way for national companies to report all their vaccine data for every location at once. “CVS, Walgreens, Walmart, all of the big chains are reporting,” said Sewalk. Of the 21 pharmacies participating in the Federal Retail Pharmacy Program, 14 report their supply at all locations directly to VaccineFinder.

From there, though, collecting data from providers gets more complicated. “The complexity is really understanding who’s going to be reporting at what level,” said Maeve O’Meara, CEO of Castlight. “For pharmacies, they are able to report on the store level, and they have often designated a centralized person who has that data being reported in from their pharmacies.”

Then there are the aggregators: Of the 64 jurisdictions in the U.S. responsible for handling vaccine deployment — states, territories, and a few cities — 31 have decided to collect data from all of their vaccine providers themselves, and report it in bulk to VaccineFinder.

That leaves the little guys: providers including solely run nursing homes, doctor’s offices, and standalone pharmacies. “For smaller entities, the providers are reporting it very directly, based on what transpired over that day,” said O’Meara. “There is an enormous burden on these organizations.”

To get the most reliable data to the CDC and the public, Castlight built the VaccineFinder onboarding process to be as simple as possible: After creating a new account, the provider could either manually input inventory or upload a spreadsheet with their daily data.

It also built the platform’s backend to be more secure than past iterations of VaccineFinder. “Any time you’re building a system with this level of visibility, you have concerns about attacks,” said Brownstein. “And there are not a lot of federal systems providing real-time data.” All data that comes from CDC and providers is stored on encrypted disks in servers that aren’t directly accessible from the internet.

All of this work — onboarding providers, establishing their data entry platform, and setting up security — had to happen between October and when vaccines hit the ground.

By mid-November, the VaccineFinder team was able to launch its initial provider platform. “It was definitely a full court press to get what we needed to get in place,” said O’Meara. The CDC did not respond to a request for comment. By Dec. 14, when the U.S. administered its first Covid-19 vaccines, VaccineFinder’s provider platform was ready and waiting for data.

Over the next two months, as the first wave of vaccines were doled out, the VaccineFinder team worked to improve the searchable map now launching. While Castlight sends its quantitative data directly to the CDC in one format, it also feeds into an application programming interface that powers the public part of the tool.

What the public sees about vaccine availability isn’t necessarily the same information the CDC receives. Providers are required to enter the number of doses on hand, but also report a public-facing statement of whether they’re in stock on a given day. A provider has the option to tell the public they are out of stock while still reporting the correct numbers to the CDC.

Along with supply information, the team is also trying to make enrollment and scheduling easier by providing links to those tools — for some providers, at least. For jurisdictions that are sending their data in bulk each day, it might not be possible to display sign-up information for every individual provider.

Of course, the team won’t be the only vaccine-locating game in town. Some states and jurisdictions will provide their own portals, which may have more detailed information available than the centralized resource. CVS recently launched a map showing where its pharmacies are delivering vaccines. And VaccineFinder is working with digital platforms including Google to integrate its data into their own products, such as Search and Maps.

Even with those tools available, the team expects a surge of site visitors bigger than any it’s ever seen, all relying on VaccineFinder as an island of verified information in a sea of confusing directives. To protect the tool, VaccineFinder’s standard resources — tools to locate 26 non-Covid-19 vaccines — will be taken offline until its old platform can be integrated with Castlight’s new backend.

And they’re planning as best they can for the unexpected. Other vaccine locators, including the one built by Broad Institute-associated Project Beacon for the state of Massachusetts, have collapsed under the load of traffic. “The team is continuing to do testing to see what number breaks the site, so that we can prepare against it,” said Sewalk.

That’s one reason why the site is launching with a limited number of states — to more safely check the limits of what they’ve built. So far, they’ve tested the site against 100 million national users over an hour. If it holds up against the surge of initial visitors, the site can open to accommodate more jurisdictions.

For months leading up to the launch, the site has displayed a simple banner letting people know what’s coming: “VaccineFinder will be updated once Covid-19 vaccination is widely available to the public to help direct people to find a vaccine provider near them.” That time, arguably, has not yet come; most states are still only offering vaccines to those over 75. But as of Feb. 24, 13% of the U.S. population had received one or both shots. Now is the moment to help the rest of them map a route to their destination.

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