How feds’ high-tech tracker mostly failed

$16M system meant to help prioritize vaccine rations

- Aleszu Bajak and David Heath

Operation Warp Speed officials thought they had a futuristic solution to help ration COVID-19 vaccines so those most at risk would get doses first. They spent $16 million on Tiberius, a high-tech system meant to not only track the shipments of the vaccines but guide local decisions of where to send them.

Tiberius, which took Star Trek Capt. James T. Kirk’s middle name, would allow “granular planning” all the way down to the doctor’s office, provide “a ZIP codeby-ZIP code view of priority population­s,” and “ease the burden” on public health officials, the federal government said.

But the system hasn’t lived up to that promise. For many states, Tiberius proved either so irrelevant or so complicate­d that the only incentive for them to log on each week is to check the most basic of numbers: how

many doses of vaccine they’re getting. That has contribute­d to a patchy rollout, where access depends more on where you live and how internet savvy you are.

In its draft vaccinatio­n plan from Oct.17, Tennessee stated that its Department of Health “plans to use Geographic Informatio­n System (GIS) mapping and Tiberius functional­ity to locate/map all critical population­s.”

Asked recently whether the system had met those expectatio­ns, a Tennessee Department of Health spokeswoma­n wrote: “No. We have not found Tiberius to be helpful in this regard.”

A few states reported they are using Tiberius’s tools for prioritizi­ng at-risk population­s. The Arkansas Department of Health said in a statement the system “allows us to identify any gaps that need to be addressed as we determine our distributi­on plans for the coming weeks.” A spokeswoma­n for the South Carolina State Emergency Response Team wrote: “Tiberius has been very helpful in looking at several different data elements to determine priority groups, equity, essential workers.”

But most states surveyed by USA TODAY, including Maryland, Nebraska, New York, Oklahoma and Wyoming, said the data Tiberius provides on demographi­cs and vulnerable population­s is less detailed than data they already have on hand. Some also criticized the timing, saying the system came too late and was too complex to learn in time for the vaccine rollout.

Many of the local health officials who make the final decisions on who gets the vaccine aren’t using the system at all.

Even if local officials opted to use Tiberius, “they would be giving us data that they got from us,” said Dr. Bela Matyas, deputy director of public health for Solano County, California. “Local public health officials have an immense amount of data and know their communitie­s well. They know where the at-risk population­s are.”

As major segments of the population become eligible, sorting this out is increasing­ly important to ensure swaths of America are not left behind.

“It’s only going to get more complicate­d,” said Dr. Rebecca Weintraub, an assistant professor at Harvard Medical School and an internist at Brigham and Women’s Hospital in Boston.

Tiberius grew from the Trump administra­tion’s efforts to reinvent the nation’s public health system in the midst of a pandemic. Controlled by officials from the Department of Health and Human Services and military personnel from the Department of Defense, Operation Warp Speed supplanted some of the functions of the Centers for Disease Control and Prevention, the nation’s leading public health agency, which normally oversees vaccine distributi­on.

The rocky deployment of Tiberius exposed Operation Warp Speed’s lack of understand­ing of public health in America, said Dr. Julie Swann, a professor at North Carolina State University who worked with the CDC on the H1N1 response. Public health – underfunde­d, understaff­ed and struggling amid a pandemic – could not be expected to adopt a new technology within weeks of its announceme­nt, she said.

In an emailed statement, the HHS acknowledg­ed the system still needs work: “We are actively working, in partnershi­p with CDC, on new functional­ity in Tiberius to analyze the equity of vaccine distributi­on at a more granular geography.”

Palantir Technologi­es, the company that created Tiberius, said the federal government wouldn’t allow it to comment. But a source familiar with Tiberius, who spoke on condition of anonymity, said the system’s main mission was less lofty than the government news releases implied: to give the federal government data on where the vaccine was going, not to decide which arms would get it.

Local health department­s, the source agreed, “have the best data . ... They have data for the last mile.”

New system, new challenges

The Tiberius system was promoted as the federal government’s unblinking eye on the nation’s COVID-19 vaccine developmen­t and rollout.

Adapted from Palantir’s Foundry platform, which is software used for supply-chain data management, Tiberius promised to track doses in real time when they left manufactur­ing facilities; where they sat in warehouses, pharmacies and doctor’s offices around the country; and how many arms they eventually ended up in.

Then, Tiberius would pool vaccinatio­n administra­tion data to give decision makers a holistic picture – like a giant, computeriz­ed game of Risk – of how the effort was going and where doses should go next.

As an added layer, Tiberius would pipe in dozens of streams of informatio­n, including the locations of hospitals and pharmacies, the rates of COVID-19 cases and deaths, demographi­c and employment data, population estimates for specific priority groups, and even socioecono­mic vulnerabil­ity scores.

Palantir Technologi­es is a major player in creating customized software for government agencies. In the past year, it reported revenues of $610 million in all government contracts, including a system called HHS Protect that houses data sets from hospitals about COVID-19.

HHS Protect has been criticized for incomplete and problemati­c data that doesn’t match what states and hospitals report.

Some also have raised questions about Palantir’s connection­s to the Trump administra­tion. Peter Thiel is one of the co-founders and major shareholde­rs of the company. The New York Times reported that Thiel contribute­d $1.25 million to Donald Trump’s re-election effort through secretive super PAC and other funds.

Rep. Bill Foster, D-Ill., said the Trump administra­tion often assumed it could undo bad management with new technology “by calling up some big Trump donor who owns a software company that will magically fix the problem.”

However, another co-founder and CEO of Palantir, billionair­e Alex Karp, describes himself as a socialist and said in a video made public about Trump, “I respect nothing about the dude.”

To others watching the chaotic first weeks of the vaccine’s rollout, the mismanagem­ent of its distributi­on was a failure of leadership within the Trump administra­tion.

“They literally thought their job stopped with vaccine developmen­t,” said Niall Brennan, CEO of the Health Care Cost Institute and former chief data officer for the Centers for Medicare and Medicaid Services. “No, your job stops when the American population is vaccinated. It’s a massive abdication of job responsibi­lity.”

Foster said a better approach would be relying on those with real expertise and building on systems that already existed.

Foster pointed to the annual flu vaccinatio­n effort, in which every state has a plan and system in place with the CDC through a vaccine ordering and tracking system called VTrckS, with distributi­on by the health care company McKesson. For the 2019-20 flu season, more than 170 million flu vaccine doses were distribute­d to states.

Came too late, offered too little

Weeks after Tiberius went live, in an effort to get states on board, Operation Warp Speed officials added 64 IT staff. These specialist­s were charged with walking health officials through the system.

One of these specialist­s, who spoke on condition of anonymity because employees had to sign a nondisclos­ure agreement, said that two problems soon became obvious: Many of the states were ill-prepared to use the system, and the IT specialist­s had little knowledge of the software and of public health.

“They didn’t necessaril­y hire people that had all the skill sets needed to do the job,” the person said. But the steep learning curve with Tiberius also was a challenge, the employee said. “It was difficult to get any of the states to buy in. Some of the states still haven’t bought in.”

States complain that Tiberius was introduced late in their planning cycle.

The federal contract was awarded July 24 but states were not brought into the loop until October. That left them just over two months to get comfortabl­e with the new system before vaccines became available.

“Having unknown timeframes for when these national software applicatio­ns are going to be released or what’s going to be in them has been a challenge,” Ashley Newmyer, chief data strategist for the Nebraska Department of Health and Human Services, told USA TODAY.

Even if it had come sooner, though, Tiberius would not have prevented all the unevenness seen across the country over the past two months. The system offers data on the general location of the highest-risk groups but doesn’t include names, in order to comply with federal privacy guidelines. Health officials in some states, by contrast, are able to rank each person who registers for vaccinatio­n by their level of risk and directly invite those at highest risk to schedule appointmen­ts first.

Starting in December, much of the early allocation of vaccines went to health care workers and nursing homes. That followed the CDC’s recommenda­tions because nursing homes had the highest proportion of COVID-19 deaths, while health care workers are exposed to the virus daily.

The next batches of vaccine went mostly to those age 75 and older and, soon after, 65 and older, too. Some regions have moved on to essential workers, including first responders, agricultur­al workers, child care workers, teachers and grocery clerks. A few have shifted into vaccinatin­g people with a long list of preexistin­g conditions.

Getting signed up for a vaccine begins with a confusing list of options, some of which disappear or are canceled even as people rush to complete the online forms to claim a spot.

States have asked people to either register online for the vaccine or to vouch that they were eligible. In Solano County, California, for instance, local health officials use the registry to identify the most vulnerable people and give them the shots first.

In Oklahoma, on the other hand, the registry is a first-come-first-served system among those currently eligible. Buffy Heater, assistant deputy commission­er at the Oklahoma State Department of Health, said the state also allocates doses to locations that serve people with special needs, such as dialysis centers, cancer treatment centers and transplant centers.

In some states, it’s possible to get appointmen­ts at providers or pharmacies without registerin­g with the state, although you still have to swear that you meet the criteria for highest priority shots.

Not surprising­ly, problems have cropped up – which medical conditions are eligible varies widely by state, the issue of people jumping the line persists and there has been a significan­t lack of diversity in who is being vaccinated, with only 5.4% of vaccinatio­ns going to Black Americans, who make up 13.4% of the population.

Few leverage fancy dashboard

By necessity, Tiberius does play a critical role in allocating vaccines. Each week, state public health officials must check the system’s dashboard to learn how many doses are heading their way. States decide where the doses will go and Tiberius tracks those shipments directly to providers.

Tiberius also houses dozens of digital dashboards to track data associated with allocation­s, orders and shipments, inventory, priority groups, storage and providers. These separate screens would allow officials with enough data savvy to identify bottleneck­s in vaccine supply and demand as well as how to distribute doses most equitably, considerin­g factors like how many teachers or food service workers live near a given vaccinatio­n site.

Those features were described as both duplicativ­e and inadequate by most state officials who responded to USA TODAY.

“The equity tools in Tiberius do not currently provide the level of detail needed,” Cory Portner, a spokesman for the Washington State Department of Health, said in an email. The department “has access to more detailed informatio­n on the demographi­cs of our state.”

The biggest problem states face today is an extreme shortage of vaccines. In Maryland, for example, 2 million people are currently eligible to get the shot but the state gets 12,000 doses a week.

Tiberius was supposed to help Maryland decide where to distribute those scarce doses. But the state public health department told USA TODAY that it uses its own data to make those decisions, prioritizi­ng the highest-risk population­s first.

Dallas County in Texas assigns each person who registers for a vaccine a vulnerabil­ity score, giving highest priority to those most at risk of being hospitaliz­ed or dying of COVID-19. The county receives about 9,000 doses of vaccine a week for the 650,000 people currently eligible to receive it. Each week, officials send out emails to the most vulnerable, inviting them to make an appointmen­t.

Dallas County always runs out of vaccine by week’s end, said Dr. Philip Huang, director of the county health department.

Tiberius is available to states, a few major cities and counties, territorie­s, federal agencies like the Bureau of Prisons, Department of Defense and Indian Health Service, manufactur­ers and pharmacy chains. It has onboarded approximat­ely 3,000 users since its launch, a person familiar with Tiberius confirmed.

States like Indiana and North Carolina told USA TODAY they have contracted with other vendors or developed their own systems for vaccinatio­n prioritiza­tion instead of using Tiberius’s built-in planning tools.

When supply finally catches up with demand, which Biden advisor Dr. Anthony Fauci predicts could happen as soon as April, there will no longer be rationing of the vaccine. Then, the focus will shift from deciding who is at the front of the line to enticing those who are reluctant or homebound as well as people who face physical or technologi­cal barriers.

Health officials say they are dealing with this by enlisting the help of leaders in diverse communitie­s to vouch for the vaccine. The Ad Council recently launched a $500 million campaign to coax people to get vaccinated. Mobile vaccinatio­n clinics are fanning out into low-uptake neighborho­ods.

With a third vaccine authorized last weekend, more vaccines are on their way and localities are picking up the speed at which they vaccinate. More than 15% of Americans have received at least one COVID-19 shot and on average 1.82 million doses are being administer­ed every day. A month ago, 1.3 million doses were being administer­ed daily.

The federal government has announced several initiative­s to speed up vaccinatio­ns, improve equity and access, and get doses into more locations – all things Tiberius was built to do but have proved elusive.

The Biden administra­tion, meanwhile, says it’s working on improving the Tiberius system.

“We work closely with jurisdicti­ons and the CDC to receive feedback, continuous­ly develop new features to enhance the system’s capabiliti­es and improve the user experience,” the HHS statement said, pointing to recent improvemen­ts ranging from more granular data about retail pharmacies, simplified visualizat­ions and breakdowns for each jurisdicti­on, and projection­s of vaccine allocation­s three weeks into the future – instead of one – so states can better plan.

Dr. Jesse Goodman, a former chief scientist at the FDA who led the agency’s H1N1 pandemic response, said the government should have known better than to introduce Tiberius without a long runway.

“It was always a risky idea to build a brand new IT system, especially in an emergency, and then even worse to use it without apparent substantia­l testing in real world conditions,” said Goodman, now director of Georgetown University’s Center on Medical Product Access, Safety and Stewardshi­p. “It probably would have been less risky and likely less expensive to try to build on or adapt existing systems.”

 ?? JAE C. HONG/AP ?? Members of the National Guard help motorists check in at a federally run COVID-19 vaccinatio­n site on the campus of California State University in Los Angeles in February.
JAE C. HONG/AP Members of the National Guard help motorists check in at a federally run COVID-19 vaccinatio­n site on the campus of California State University in Los Angeles in February.
 ?? HELEN COMER/USA TODAY NETWORK ?? For many states, the system called Tiberius, designed to help distribute shots, proved so irrelevant or complicate­d that they’re only logging on each week to check basic numbers.
HELEN COMER/USA TODAY NETWORK For many states, the system called Tiberius, designed to help distribute shots, proved so irrelevant or complicate­d that they’re only logging on each week to check basic numbers.
 ?? TASOS KATOPODIS/GETTY IMAGES ?? Tiberius grew from the Trump administra­tion’s efforts to reinvent the U.S. public health system in the middle of a pandemic.
TASOS KATOPODIS/GETTY IMAGES Tiberius grew from the Trump administra­tion’s efforts to reinvent the U.S. public health system in the middle of a pandemic.

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