Outbreaks bring risks that go beyond the disease of concern. “Twice as many children died of measles than of Ebola, during the last Ebola outbreak,” UNICEF’s Chief of Immunizations, Robin Nandy, told The Lancet recently. The medical journal warned that the COVID-19 pandemic has disrupted vaccine delivery across the world.
Physical distancing makes it hard to attend clinics, The Lancet reports, while many healthcare systems are stretched as staff are reassigned to fight the pandemic. Similarly, gaps in vaccine coverage could cause more health problems in the long-run.
However, in the midst of this disruption, the pandemic could also bring a silver lining. Immunisation programmes are frequently hampered by paper-based record-keeping. It is possible that COVID-19 will accelerate the move to digital systems.
The drawbacks of a paper system
Good record-keeping is vital to an effective vaccine programme but paper-based systems have lots of drawbacks. The records have to be stored somewhere, for a start, which requires space and secure facilities.
If health workers are travelling to remote locations to administer vaccines, then they need to take the records with them. For migrant or nomadic populations, who might not be seen at the same location each time, a paper-based system can be ineffective.
Paper-based systems can also be more error-prone. Records can be lost or simply missed by a busy worker. With overstretched systems trying to combat the spread of a pandemic, such errors are even more likely.
An acceleration of digital healthcare
There have been more than five million identified cases of COVID-19 worldwide, with the number still rising. The result has been an acceleration in the digitisation of healthcare driven by a need to find new ways of delivering healthcare and to identify preventive and therapeutic interventions. Some measures are relatively simple, such as a wider adoption of telemedicine apps. In the US, Amwell, which enables video chat between physicians and patients, saw usage increase by 158% as the virus spread.
In less wealthy countries it’s possible that COVID-19 could also accelerate the progress of digital record keeping for immunisation programmes. With vaccinations disrupted, or halted entirely, an electronic records system can keep track of which children have been missed because of the disruption. As Sibomana Hassan, from Rwanda’s Ministry of Health, told Gavi, “We’re hopeful that even though there will be a reduction in the children vaccinated after the lockdown we will be able to identify each and every one we’ve missed, and vaccinate them.”
The benefits of a shift to digital
Digital record-keeping can offer many more benefits than mitigating the effects of disruption. It can be much more efficient and effective than its paper predecessor in almost every way, particularly once set-up costs are dealt with. And when integrated with other systems, such as vaccine stock management, can provide additional value, by enabling health authorities to plan and monitor vaccine supply levels more efficiently.
With the system in place, all a medical team needs is a tablet computer and the records are at their fingertips. It’s simple to search for a particular record or to identify particular trends. In Tanzania, for example, health workers can use the Electronic Immunisation Registry to find those children who are missing out or defaulting from immunisations.
Information about who is missing can then be used to send reminders to parents, which can be very effective. For example, in Vietnam, researchers found that SMS reminders increased immunisation coverage and timeliness of vaccination, with 93% of interviewees saying they would be willing to pay for text reminders.
These are some of the benefits that have led to the growth of digital record-keeping in recent years. As we deal with the COVID-19 pandemic, digital systems also have potential to make tracking and responding to the virus easier. In time, perhaps, digitisation will become part of our ‘new normal’.