As COVID-19 spreads across the nation and world, elected officials and the public in Washington state are cautiously optimistic that we are past the peak of the pandemic. Due to extensive public education, mandated social distancing, and leadership from public-health officials and health-care workers, the rate of infection and death is slowing. We, representing the King County Medical Society, are hopeful that the success of our statewide efforts will not only continue but become long-lasting through the development and implementation of an effective vaccine to prevent COVID-19.
We also remain concerned that our recent gains are transient. A new study suggests intermittent social distancing may be necessary for several years. The virus has already shown extensive and rapid spread into the global population, and the current SARS-CoV-2 virus (which causes the illness COVID-19) is mutating. There is legitimate concern that any one vaccine will not be able to effectively control spread. As variant strains of coronavirus emerge, new vaccines may need to be developed. With more than 70 vaccines currently under investigation, some vaccines are bound to be more effective than others. In fact, it is likely that certain vaccines will be effective against particular strains of coronavirus, whereas others might prove more efficacious against other strains of the virus. Knowing who has received which vaccine is therefore vital for individual and public safety, making now the most critical time for Washington state to enhance the Washington State Immunization Information System Database.
The Washington State Immunization Information System is a lifetime immunization registry operated by the state Department of Health. The King County Medical Society has been advocating for improvements to the state immunization information system for years. Within the last five years, Washington has seen outbreaks of pertussis, mumps, measles, hepatitis A and influenza. These are all vaccine-preventable infections. With our current coronavirus outbreak, the urgency for improving the immunization database is even greater.
While all immunizations administered to children are entered into safe and secure databases that can be easily accessed through the state immunization information system, there is no mandate or standard for record-keeping of adult vaccinations. As a result, most adults not only aren’t up-to-date on recommended vaccines, they also don’t know which vaccines they have or haven’t received. Health-care providers struggle to collect, collate, update and review immunization records from disparate sources.
Current guidelines recommend that health-care workers should not trust a patient’s self-reported receipt of vaccination if there is no written documentation (except for the case of influenza or pneumococcal vaccine). As a result, when patients are uncertain about their immunization status, health-care workers are forced to re-administer a vaccine that is potentially unnecessary or spend extensive time sifting through disjointed networks of health records for clarification. Ultimately, efforts at preventive care are being hamstrung by the complexity of tracking vaccines from pharmacies, hospitals, primary-care offices and sub-specialists, all practicing as a patchwork of different entities with their own unique methods of tracking and optional reporting.
As COVID-19 spreads and mutates, it will be more critical than ever that health-care workers know who has been immunized. Perhaps of equal importance will be to know who has been immunized against which strain of coronavirus and with which particular vaccine. Without an organized and coherent statewide database, it will be near impossible to implement coronavirus immunization strategies.
Now is the time to act to provide an accurate, up-to-date immunization record to prevent inefficiencies and redundant vaccinations. We must require mandatory compliance by all providers of immunizations, including hospitals, clinics, pharmacies and employee-health sites. We must make it easier to report electronically, by creating links between the databases of pharmacies, clinics, hospitals and employee-health sites.
To accomplish these essential goals, we must invest in our public-health infrastructure. Fortunately, these connections — Health Level 7 links that are standards for transfer of clinical and administrative data used by health-care providers — already exist to connect current databases to the state immunization information system registry. As such, connecting the silos of information across the state merely hinges on political will and funding to implement these links. This is an opportunity for public-private partnership to ensure the safety of our entire state. As the state with one of the first known U.S. cases of COVID-19, the first U.S. outbreak of the disease and the first vaccination trial in the country, and as the home of many strong biotech and public-health entities, we are uniquely poised to have a dramatic impact on the implementation of vaccine databases.
King County Medical Society and the Washington State Medical Association have estimated the cost to Washington state to enhance the immunization information system to be $200,000. With such financial support, the state could leverage a 9:1 matching federal windfall from the Centers for Medicare & Medicaid Services to fully operationalize and modernize our current vaccine database.
Given the undeniably high cost of the pandemic in our state so far, a modest investment to improve our immunization database should be prioritized to limit disease spread as we move to the era of COVID-19 as a vaccine-preventable illness.