When a dose of a COVID-19 vaccine leaves a U.S. manufacturing plant, its path can be traced all the way to the hospital or clinic representative signing for the shipment at its destination. What happens next is not always clear.
Federal agencies overseeing the rollout are relying on a tangled web of aging state vaccine registries complicated by state laws and practices.
Data collection has improved since the national vaccination campaign began in December, with county-level reporting in most states. But gaps and tech issues remain that could compromise equitable distribution of doses, analysis of vaccine protection, and identification of pockets of vaccine hesitancy, experts said.
It is a monumental task as the national vaccination campaign gathers steam with an average of 2.4 million shots going into arms each day and rising, and some 196 million doses distributed since December.
As the vaccine rollout opens to all American adults, analysts will be watching whether the less advantaged lose out.
"Are we achieving our equity goals?" said Dr. William Moss, executive director of the International Vaccine Access Center at Johns Hopkins University. "That would be very hard to tease out at a federal level, given the variation in how states are reporting."
The uncoordinated nature of data collection in Marin County, California, across the Golden Gate bridge from San Francisco, "makes it virtually impossible for me to have that global view that I need to be able to see who is getting vaccinated and who isn't," said Dr. Matt Willis, county public health officer.
The U.S. vaccine data system has two main parts: recently developed federal software from Palantir Technologies Inc that closely tracks distribution of doses, and a range of systems used by states that report into decade-old federal systems developed for limited tracking of child vaccinations.
"We know where every single dose was delivered; we know when it was delivered; we know who ordered it; we know who signed for it; we know who dropped it off at the location," said one person involved in tracking vaccine distribution. "Where we lose sight of it is when (the providers) take it."
'IT'S NOT PERFECT'
Matthew Ritchey, an epidemiologist and data expert at the U.S. Centers for Disease Control and Prevention (CDC), said vaccine data collection has improved significantly since the beginning of the rollout. The CDC, which is leading the nation's vaccine data collection, now has a more detailed view of inoculations across the country.
"Does that mean perfect? No, it's not perfect. But the amount of information that we're collecting now on a daily basis is pretty astounding," he said, with most vaccinators reporting shots within the required 72 hours.
Last week, the CDC also publicly released county level data for the first time since the rollout began. A Kaiser Family Foundation (KFF) report using the data found counties with high Black and Hispanic populations had lower vaccination rates than others, confirming what many health experts had feared.
However, KFF was only able to analyze about 72% of the counties due to low quality or incomplete county-level data from a dozen states, including Colorado, Georgia, and Virginia.
The CDC itself has a Texas-sized gap in its own data. The federal government is not receiving the same detailed information about vaccinations of the Lone Star state's 29 million residents that it's getting from other states, because Texas statutes prevent it from sending that data to the federal government. Instead, Texas is sending aggregate reports.
Lynn Gibbs-Scharf, the CDC's co-lead for data monitoring and reporting for its COVID-19 vaccine taskforce, said the agency had no immediate plans to replace systems from the early and mid-2000s that were developed for tracking childhood vaccinations and repurposed for COVID-19.
"We want (the states) to have systems that can accommodate their unique needs for managing vaccination at the local level, but that conform to a standard that allows them to exchange data beyond their jurisdiction," Gibbs-Scharf said.
Marin county's Willis sees much more to be done.
"It says a lot about how poorly the nation is equipped to manage the data challenges when we're having these problems in the Bay Area, with all our tech and informatics innovation. If anyone should be able to get this right, it's California," he said.