In light of the lessons of the COVID-19 pandemic, we outline the need for a balanced approach between readiness for future pandemics and supporting routine immunization functions.

The COVID-19 pandemic underscored the importance of immunization information systems (IIS), with widespread use in jurisdictions across the U.S. IIS, also referred to as immunization registries, support every U.S. state and territory and have evolved substantially over the last four decades. Throughout that time, IIS have supported providers in immunizing patients as well to provide comprehensive bases for population-level surveillance of vaccine uptake.

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Until the COVID-19 pandemic, IIS focused primarily on capturing childhood immunizations, with increasing emphasis on adult immunization capture more recently. During the pandemic, IIS were universally used to capture the rapid deployment of COVID-19 vaccines to the majority of the U.S. population. IIS were effectively used to furnish surveillance data for COVID-19 vaccine uptake on a near real-time basis. Notably, mandates for these data far surpassed any prior requirements, both in terms of the size of data involved, as well as the speed with which IIS data were required. Opportunities and pitfalls for this expansion in IIS role are covered in our commentary.

The pandemic created an enormous demand for rapid and comprehensive information which exposed a growing number of IIS data quality issues.^1-3 We saw a dramatic increase in consumer demand for near real-time access to up-to-date vaccination records. At the same time, IIS struggled to address problems with data completeness, deduplication of both patients and vaccine doses, and inaccurate age, race, and geographic data. Public health managers likewise demanded timely and accurate information, both for internal use as well as public-facing dashboards, contending with these and other data quality problems.^4-6

Our concern is that the pandemic response has created expectations that IIS can produce instant and comprehensive surveillance data going forward for all vaccinations and populations, and not just pandemic COVID-19. However, pandemic COVID-19 vaccination data management was not similar to other IIS reportable vaccinations; not only in scope, but also in the close tracking of vaccine shipments, monitoring of provider vaccine activity, and required IIS reporting of vaccine usage. In contrast, beyond pandemic COVID-19 there is no comprehensive IIS tracking of vaccine shipments or use. Vaccine reporting mandates are also not universal across jurisdictions, and most existing mandates lack any provider penalties for non-reporting.

During the pandemic, we also witnessed the importance of electronic data interoperability between vaccination providers and IIS. This real time connectivity promoted timely reporting of vaccinations, as well as complete histories of primary and booster doses at the point of service. Our hope is that continued progress with interoperability between providers’ electronic health record (EHR) systems and IIS will show sustained benefits long after the pandemic. But we feel that the pandemic was also instrumental in revealing numerous problems for IIS – and those remain significant today. A persistent issue will be how can IIS be responsive to requests for data with rapid turnaround, yet still provide accurate and complete information.

We are also concerned with the stability of IIS funding in the post-pandemic period; state IIS are dependent on federal funding, and recent cuts to this funding based on federal budget reconciliation are short-sighted. We believe that ensuring the continuation of non-pandemic IIS operations through sustained funding is imperative. Sustaining the quality of IIS data to support day-to-day operations should not be compromised by efforts focused on supporting pandemic-response data sets on a national scale. We explore this in our commentary, where we outline the need for a balanced approach between readiness for future pandemics and the ongoing need for quality support of routine immunizations. 

References

1. Dong E, Ratcliff J, Goyea TD, et al. The Johns Hopkins University Center for Systems Science and Engineering COVID-19 Dashboard: data collection process, challenges faced, and lessons learned. The lancet infectious diseases. 2022;22(12):e370-e376.
2. US Department of Health and Human Services. Challenges With Vaccination Data Hinder State and Local Immunization Program Efforts To Combat COVID-19 2023. January 2023. https://oig.hhs.gov/oei/reports/OEI-05-22-00010.pdf
3. US Department of Health and Human Services Office of Science and Data Policy. Quality of Federal COVID-19 Data. 2022. March 2022. https://aspe.hhs.gov/sites/default/files/documents/8467add5edfbaa06f70ade5e4f829655/covid-data-quality-ib.pdf
4. California Department of Public Health. Statewide vaccination data. Accessed September 14, 2023. https://covid19.ca.gov/vaccination-progress-data/
5. Oregon Health Authority. Oregon COVID-19 Vaccine Effort Metrics. Accessed September 14, 2023. https://public.tableau.com/app/profile/oregon.health.authority.covid.19/viz/OregonCOVID-19VaccineEffortMetrics/StatewideProgress
6. Michigan Department of Health & Human Services. Michigan Data. Accessed September 14, 2023. https://www.michigan.gov/coronavirus/stats

Dr. Kevin Dombkowski is a Research Professor with the Child Health Evaluation and Research (CHEAR) Center at the University of Michigan.  His background is in public health and information systems and has extensive experience with immunization registries as well as other public health, clinical, and administrative data management systems.

Dr. Noam Arzt is a leading national figure in health informatics. He brings an innovative, assertive, and creative approach towards solving systems and data interoperability challenges. An active blogger and author, Dr. Arzt brings a national leadership perspective on IT quality and solutions with a unique focus on public health.

Steve Robison is an immunization epidemiologist in the Oregon Health Authority. He has served as a scientific expert on immunization surveillance for the CDC and has also chaired workgroups and committees for the American Immunization Registry Association.