Rae Woods:
From Advisory Board, we're bringing you a Radio Advisory. My name is Rachel Woods, you can call me Rae. When it comes to vaccines, there is good news and there is bad news. But today, I want to focus less on the news and more about what health care leaders should actually be doing to make vaccine rollout more efficient, and also more equitable. Since we're talking vaccines, I have, of course, brought back Brandi Greenberg, VP of life sciences and ecosystem research. But vaccination is, of course, not a unique problem here in the United States. So I've also brought Paul Trigonoplos, who leads much of our global healthcare research. Welcome back Brandi, and welcome, Paul, to Radio Advisory. We're having our favorite conversation here again today, which is all about vaccines. Do either of you know of anyone who's gotten a COVID vaccine?

Brandi Greenberg:
I do. And in fact, by the time our listeners hear this, my parents will have each received their first vaccine.

Rae Woods:
Yes.

Brandi Greenberg:
I could not be more excited. They get vaccinated in 90 minutes.

Paul Trigonoplos:
There you go.

Rae Woods:
That's amazing. Are they going to call you right afterwards?

Brandi Greenberg:
Yes. They called me every day for the last week, to give me the report from the Marin Public Health status update. And they got a phone call at nine o'clock last night saying, "Guess what? It's your turn. Can you be available tomorrow?"

Rae Woods:
Amazing.

Paul Trigonoplos:
Quick turnaround.

Rae Woods:
What about you, Paul?

Paul Trigonoplos:
Yeah. My girlfriend got her second dose a couple of weeks ago. So she's a nurse, so she got ahead of schedule, and actually, most of my cousins from Denver, most of their families are in healthcare, so they've also received at least one, if not two. So, quite a few.

Rae Woods:
I got nothing. I got a couple friends that are healthcare workers. Actually, my childhood best friend is a teacher who just got her first dose. And she actually called me to say, "Should I do this? I've got this available. Should I get the vaccine?" And I went, "Yes," but that kind of shows you what we're dealing with in terms of hesitancy, and the like, when it comes to COVID-19 vaccines. Before we get into advice for clinical leaders across the globe, I do want to take a moment to set some context for actually where we are in the vaccine rollout process. My sense here is that from the US perspective, we are a little bit behind. Is that right, Brandi?

Brandi Greenberg:
Yes. It's picking up steam, but yes. I would say latest data I've heard, I think we're over 12 million people have had at least one dose in the United States. But that compares against over 30 million doses that apparently have been distributed.

Rae Woods:
And I believe... Wasn't the goal to have 20 million vaccinated by the end of 2020?

Brandi Greenberg:
Yeah. So, we definitely did not achieve that goal. And now Biden has definitely gone on record as saying we have a new goal of 100 million vaccinations in 100 days. So even before we fixed first problems, we're now setting new ambitious goals.

Rae Woods:
That's right. So, we're a little bit behind as a country. And I should also say that the rate of vaccination looks very different state to state, as evident probably by our own personal vaccine stories. Paul, how does that compare to what we are seeing on the global stage?

Paul Trigonoplos:
I'd like to set the record straight that the US is actually doing pretty good when compared to the rest of the world. According to Bloomberg, there are only 52 countries that are actually vaccinating to date, so automatically, three-quarters of the world is not even there yet. And of those 52 countries, the US is fifth out of those 52. And if you look at, kind of who are the exemplars, who are the countries that are smaller populations, more digitally advanced centralized systems, and centralized healthcare systems, the first three on that list, Israel, the UAE, and Bahrain, are those countries, right? So, it's really the US and the UK are kind of turning things around, and then everyone else is trailing.

Rae Woods:
And you mentioned that only 52 countries have actually even started this process, so far. Are there any kind of big names that we and our audience would be surprised haven't actually started this process yet?

Paul Trigonoplos:
Yeah. Quite a few. One of the consequences of a lot of the countries that you would think of as being exemplars in dealing with COVID... This is your Taiwan, Singapore, Australia, New Zealand, one of the consequences of them being so good, is that there actually isn't that much urgency. Or relative to the US and the UK, there's not the same urgency to get these vaccines out. So, these countries are actually not starting yet. None of them have had begun, either because they've pre-purchased vaccines that have yet to be approved, or because they're consciously waiting. They're kind of seeing how the rest of the world plays out, how the data shakes out in terms of complications, any sort of adverse effects of the vaccines, so that they have this data to pad their approach when they roll it out, and can decrease skepticism from the get-go.

Rae Woods:
Let me take a minute and talk about some of those countries that you mentioned are in the exemplar category. You already mentioned one key difference between them and the US, which is that they are much smaller. I guess my question is, in that case, is there anything that the US, and maybe the rest of the world, can actually learn from these exemplars?

Paul Trigonoplos:
I don't want to say that there's nothing that we can learn from those countries, right? There's definitely some smaller anecdotes, thinking about how you expand your workforce to get vaccinations out, and some of the more tactical elements. But it's important to know that at a high level, I think that the success that these countries have seen, have been due to a variety of structural factors that are just apples and oranges to the US, and even most European countries. This is just like earlier in the pandemic, when we knew that a lot of East Asian countries were really succeeding, but the cultural differences, the fact that they had universal systems, the fact that they had centralized data repositories, things like that, it made it really hard for us to build a playbook off of their approach. And I think we're seeing that as well, here.

Rae Woods:
So then, let's talk about the EU. Because they're, I think, a little bit of a better corollary to the US, but I have to admit, I was surprised, and I'm sure our listeners might be surprised as well, that they've had such variable results so far. What do you actually make of that?

Paul Trigonoplos:
Yeah. Yeah, I was surprised too. At the head of the EU, you have Denmark who, when you look at kind of the foundational elements of how their vaccinations have set up, it's pretty good. They're really only hampered by supply, at this point. All the pieces are there, between centralization, simplified, communication, simplified scheduling, and so forth. At the other end of the spectrum, you have France, where I think half a percent of the population has been vaccinated thus far.

Rae Woods:
Oh, my goodness.

Paul Trigonoplos:
Right? So, half a percent, 3%, technically not a huge variance, but it feels huge now. And I think it actually is. I don't want to paint the picture that the EU has plenty of vaccines, and that all the problems are kind of downstream. The way the EU has approached this is that, the EU will approve, and purchase, and distribute vaccines. So it is kind of a top-down, limiting supply. The EU doesn't track how many have been distributed, like the US, so we don't know exactly what the denominator is, but last I checked only seven and a half million doses have been delivered in all of the EU.

Brandi Greenberg:
I keep hearing a little bit about vaccine nationalism, and it may have been more of a concern with the prior administration than today, but now that we are hearing that Biointech and Pfizer, in order to expand their supply, they've actually had to slow down production for a couple weeks, and they seem to have been pulling back more in some countries than others. And I just read before this, that AstraZeneca has just announced that they're going to be scaling back to supply to the EU, as well. How are you hearing this surface, in terms of the haves and the haves-nots, or equal distribution among the countries?

Paul Trigonoplos:
Yeah. This is especially prevalent in the EU, because again, there was that kind of bottleneck at the top, where the EMA, which is the European Medicine Agency, has to approve all the vaccines. I think there was an assumption that that would be the one avenue to get vaccines, and you're starting to see some countries make private deals with pharmaceutical companies. So, Hungary went ahead-

Rae Woods:
Ooh, my ethics radar. Sorry, it just went like crazy. Okay. Continue, Paul.

Paul Trigonoplos:
Yeah. So Hungary, I know, has purchased some of the Sputnik V vaccine from Russia, which the EMA has not approved for them. Serbia has also done similar things. Even Angela Merkel has said that if the EMA is going to rule favorably for the Sputnik V, that Germany might consider kind of going to them as well. So, there is definitely a looming annoyance, I think, in these countries that they don't have the supply that I think A, the rest of the world might have, but also B, that they assumed that they were going to get.

Rae Woods:
Beyond supply, one of the big challenges we're feeling here in the US, which I kind of alluded to at the beginning, is that even when vaccine doses are available, some folks just are choosing not to get it. And I think that's happening at higher rates than we would have initially anticipated. Is that something we're also seeing on the global stage?

Paul Trigonoplos:
Mm-hmm (affirmative). Yeah. So, there's skepticism and apprehension across the board internationally. And you look at the data, and I know that this data is something that you have to put a lot of salt on right now, because the willingness to get vaccinated changes so quickly. But the initial data from December and January does show at least 10 to 40%, depending on where you are, of people that do not plan on getting it anytime soon. And I will also say that skepticism is only one of the downstream factors that is kind of limiting uptake, especially in the EU. Lack of capacity in the local system, lack of supply in terms of staff, in terms of needles. Greece and Italy are running out of needles. You have kind of chaotic scheduling systems, decentralized scheduling systems, that make it pretty hard to get an appointment, and then add on that skepticism from clinicians, skepticism from patients, the downstream problems you see in the US are happening everywhere else.

Rae Woods:
And that brings us to what, actually, we need to do about it. I think it's safe to say that no one in the world has solved the vaccine rollout problem. At least, not in a way that the rest of the world can actually replicate.

Paul Trigonoplos:
Definitely.

Rae Woods:
So, let's talk about how organizations can actually solve some of these systemic challenges. I want to start with just how confusing this moment actually is for all of us, whether we are working in healthcare, or are outside of it. How do leaders actually help in navigating the mass confusion that consumers are feeling?

Brandi Greenberg:
I'm so glad you brought this point up, because in the last two weeks, outside of my work at Advisory Board, I have felt this sense of confusion viscerally, in navigating not only my parents' own vaccine experience, but my mother-in-law's, and two friends of our family.

Rae Woods:
Mm-hmm (affirmative).

Brandi Greenberg:
Three different states, three completely different experiences. And what it brought to light for me was this sense of confusion, and the opportunity that a coordinated health system, or a coordinated medical group, has to fill the void with clarity.

Rae Woods:
Yeah.

Brandi Greenberg:
I don't know if it's as simple as old-school patient journey mapping, or root cause analysis, but simply stepping back and thinking about the patient experience. And when is it my... The questions they need to ask. When is it my turn? Who's going to tell me? Where am I likely to get it? How will I know that it's safe for me to go there? Those are actually completely answerable questions by most health systems or medical leaders.

Rae Woods:
They're also not new questions. Let's not pretend that healthcare was a simple experience prior to this crisis. And so in theory, leaders should have practice being able to answer some of these complex questions when they look at a patient journey. And I get frustrated when I don't see that happening.

Brandi Greenberg:
And I think you bring up a huge point, which is why the analogy that I've used in a couple of these... But it feels like I'm watching a three Stooges movie. Where there's a little bit of he did it, no, he did it.

Rae Woods:
Who's on first, maybe?

Brandi Greenberg:
The right hand doesn't know what the left hand is doing. And that is where all of that effort at systemness, at integration, at the level of communication and outreach, all that work that you have done for years as a provider organization to reach physicians, to reach consumers, it's the same skillset.

Rae Woods:
Yeah.

Brandi Greenberg:
And even in answers where you don't know, a simple, "We don't know yet, but here's what we're doing to find out. And here's how you will be updated when we know," that stuff can go such a long way. And my fear is that too many providers are ceding, they're abdicating their role as communicators, simply because the government is purchasing, and the government is managing so much of the logistics. They need to own the communication space.

Rae Woods:
Paul, what are other health systems in other countries doing to combat this confusion?

Paul Trigonoplos:
First and foremost, they're making it easy to sign up. And there's kind of a couple anecdotes I can share here. On one end of the spectrum, you have the NHS, England's NHS, which is a national system. They have a single, central booking system. The way it works in the NHS is that, right now, you get a letter in the mail that invites you to sign up through the system, and that's their way of kind of controlling demand. So only after you get a letter, can you go sign up. It sounds kind of archaic, but in reality, most of the people getting vaccinated right now are over 80 years old. So I think they're more familiar with this letter, kind of written approach.

Paul Trigonoplos:
The other end of the spectrum, you have Israel, which is a totally paperless booking system, text and app-based, right? And even in between, I mentioned France earlier, is lagging, but they are starting to turn things around a little bit. They actually are landing on three private wellness and primary care providers, which are already really good at the booking process, to handle the countries booking systems. So now, there's three that it is clear from the public's perspective, "Okay. I go to one of them, and I book it through there." This kind of simplicity is going a long, long way.

Rae Woods:
Yeah. I appreciate that you said that the answers that are out there are simple, because I will admit, my frustration is that there's this missed opportunity, I feel, to actually be the guiding force in the market. Even in these simple ways, even if it is literally sending a letter, or leaning on other partners in the market. Brandi, you and I have talked about this, literally, four times on this podcast, that the scientific innovation, as incredible as it was, was really the first step. And it's hard, because nobody gets a Nobel Prize for the right scheduling software, but that's really the role that healthcare needs to be playing right now.

Brandi Greenberg:
And I'd go one step further, which is that not only are they missing the opportunity, I'm actually hearing stories of messed-up opportunities. So, at a moment when you could delight, you are actually disappointing.

Rae Woods:
Yeah.

Brandi Greenberg:
And that is the worst of all possible worlds here, where you have an opportunity to engage patients in new ways, to outreach to new consumers, and that front door experience of communications scheduling, coordination, matters so much. In the, "I don't have any information, come back later." Or when people are searching for vaccine scheduling, and it's like they get an "under construction" link on your website, I've heard.

Rae Woods:
Yeah.

Brandi Greenberg:
Those are moments that, far worse than a missed opportunity, they may never come back.

Rae Woods:
Hmm. So then in your opinion, I guess to both of you, when it comes to systemizing information that combats this confusion, is there one kind of easy thing that leaders in healthcare can be doing right now?

Paul Trigonoplos:
I have one thing that systems are doing. I don't know how easy it is, but I think it is something that I would put forward as a need-to-have, which is, I think to Brandi's point earlier around systemness. One of the hallmarks of systemness is having very clear governance. Who does what? Who is responsible for making which decisions? Which roles are assumed by which people? And in other countries, I think you have a lot more clarity, and it's kind of set from the top. Over, okay, the pharmacists are the vaccinators, the primary care practices are the ones who organize the letters to notify people when they need to get a vaccine, and so forth down the line. We actually saw this in West Virginia too, when they kind of made this bottom up network of pharmacists, that basically said, "Okay. Pharmacists are going to lead the charge, at least for the long-term care homes, they're the vaccinators. Let's rally around them." And I think just adding a level of simplicity over, who's making a decision?

Rae Woods:
Whose job is it? Yeah.

Paul Trigonoplos:
Whose job is it in your geography? Whose job is it not in your geography? And just telling people that is probably a good place to start, because I think the chaos at the ground level is a symptom of that, not the root cause.

Brandi Greenberg:
Paul, I'm so glad you said that, about who's doing what. Bringing it back to my parents' experience again, they went from the overwhelmed moment when the pharmacist told them to call the primary care doctor, the primary care doctor told them to call the hospital, and the hospital told them to call the pharmacy. A week later, it was from their county public health service, but it laid out, "This is the timeline. This is who is going to call you. This is how your appointment's going to work."

Rae Woods:
That's right.

Brandi Greenberg:
This is where you will get it. Their blood pressure dropped immediately on that particular communication, on the who, the how, the when. Immediate difference.

Rae Woods:
Hmm. I love that story, but Brandi, you're not going to get out of answering this question. Do you have maybe a slightly different take on kind of an easy thing, especially if Paul's answer wasn't actually easy, that leaders can be doing to combat this confusion?

Brandi Greenberg:
Yeah. I think for them, what I would say the easiest thing to do, is also to go back to core competencies. And within that same rubric of who's doing what, pick one thing that they're going to centralize.

Rae Woods:
Yeah.

Brandi Greenberg:
From that systemness perspective, is it... We're going to make sure that the digital front door, anybody that goes to our website, anybody that uses our mobile app, every single facility, every single physician, this is going to be the language that they're going to use, and a centralized webpage.

Rae Woods:
And again, we proved that we could do that once-

Brandi Greenberg:
Yeah.

Rae Woods:
In March and April.

Brandi Greenberg:
Absolutely.

Rae Woods:
And I get frustrated when I go to health system websites, and the banner at the top is unchanged.

Brandi Greenberg:
Right. But, just to add onto that, there are other systems where I've seen they have these incredibly elegant, easy to use, centralized scheduling systems, app-based. One in the Midwest, I know, was how my sisters-in-laws got a vaccine. If that's your strength, run at it, pick that thing, and say, "We're going to centralize scheduling."

Rae Woods:
Yeah.

Brandi Greenberg:
Because then, that can help them look for partners. And so, that's the other thing where they can start to focus is, as much as systemness important, systemness doesn't mean you have to do it all yourself.

Rae Woods:
That's right. And that's where we see examples of exemplars, like Zocdoc, jumping in and saying, "We will do scheduling for you, for your clinicians, or for your community, when it comes to getting this vaccine."

Brandi Greenberg:
Or even in West Virginia, where they realized that the most important thing to vaccinate their seniors in long-term care facilities, was actually skipping the mass pharmacies, and contracting with a bunch of local mom and pops in rural areas. That was the partnership that seems to be working for that state.

Rae Woods:
Confusion is really only one part of the rollout challenge. I feel like the other rate-limiting factor to just getting this vaccine out quickly, comes back to simple supply and demand. And I want to be really specific about what we mean by supply. Paul, you referenced running out of needles, earlier. What is the supply problem that we are facing on the global stage?

Paul Trigonoplos:
Aside from just vaccine doses, right? I think across the board, it is a human vaccinator supply problem. It is a staffing problem, and you're seeing a lot of countries kind of extend out from their normal healthcare staffing pools, to try to hire up, to fill these vaccination sites. They're learning pretty quickly that you cannot ask the healthcare clinicians that are dealing with a pandemic currently, especially in the US and places like the UK, to also become the vaccinators.

Rae Woods:
And I don't want to say that the problem isn't enough doses, right? Obviously, that is a rate-limiting factor. It's just not the only one here. And I want to break down this human resource kind of question, because it's the scariest thing for me. We actually had an episode last week, where we just did an update on the impact that coronavirus is having. And I'm putting it extremely lightly when I say that this is an all hands on deck approach. Which means, if we have every single available clinician, and a lot of retired clinicians, on the front lines of this virus, how do we even keep up? Or ultimately increase, which is the goal of all these countries, the rate of vaccination.

Brandi Greenberg:
Yeah. I think we need to get very creative on who can safely vaccinate. And I know in the US there's talk of dentists, there's talk of EMTs. I know in West Virginia, as I said, they really have leaned on pharmacists heavily, retirees, home healthcare workers. But there's a second question that you asked, which I'm not sure, and would love to hear from Paul if it is as applicable globally, which is even if you have people willing to get trained to vaccinate, who's going to pay them? And so the funding that... How do you get the money into the public health authorities', the health systems' hands, that they will need to expand the workforce? That's part of the reason that the Biden administration is putting forward a lot of funding for vaccination in this new $1.9 trillion plan, is to make sure that the money is available to hire that next level of people who can help.

Paul Trigonoplos:
Yeah. I actually don't think this is a huge problem in other countries. We see treasury departments being pretty forthcoming with money to beef up the public health workforce, especially in recent weeks. I think you said the UK is starting to hire retirees, talks about kind of getting Red Cross volunteers, which is kind of coordinated at the governmental level. The military, which is of course, government funded, coming in to help out. So, not an on the ground problem.

Rae Woods:
Okay. So we've talked about the supply problem of doses, and a little bit on the materials needed to administer those doses, and the massive, massive, massive problem of having enough people. But that's not the only parts of the supply problem that I'm hearing, especially when I think about the space, and the equipment that's actually needed, especially for some of the vaccines that are on the market today. How do we actually solve for that?

Brandi Greenberg:
I think out here in Los Angeles, the pop-up mass vaccination clinics at Disneyland and Dodger Stadium are good examples of finding new spaces. And I think there's a lot of experience doing that, I have to say. Remember when there was the bird flu, and the swine flu, that they used a lot of stadiums as mass vaccination sites. So there is institutional knowledge there on how to do it. The challenge, again, is that to do that well, whether it's a drive-through, or a walk-through, you actually have to hire many more people.

Rae Woods:
That's right.

Brandi Greenberg:
To navigate people through the parking lot, to get people in the line. And so they are complex, but doable operations.

Rae Woods:
Yeah. It solves one problem, but it creates another. It solves the space problem, and maybe the refrigerator problem, but you need the people. And I guess one thing we didn't mention when it came to... Paul, you used the phrase, "calling in the reserves." I just want to remind everyone that you should be vaccinating those people as quickly as possible, because we will only have the workforce needed to administer vaccines to the public if we vaccinated our workforce itself. I'm curious, have of you seen, whether in the US or on the global stage, any kind of innovative partnerships that can help solve for any of the problems that we've outlined?

Brandi Greenberg:
I think I'm just starting to read about them more than know about them, to be honest. I think there are a lot of private companies coming forward in the United States to help. Everything from Zocdoc, who you've already mentioned, is helping with scheduling, to Uber and Lyft have announced that they would like to be seen as resources for transportation. And as recently as this week, Amazon has offered its help to the Biden administration to do last mile logistics, which it may sound like hype and talk right now, but they're pretty good at last mile logistics.

Rae Woods:
Oh, yeah.

Brandi Greenberg:
So, I'm very interested. But nothing has played out beyond, like the Zocdoc scheduling example, of a partnership that's already fully fleshed out in the US, that I'm aware of.

Rae Woods:
Brandi, what about some of the retailers? I'm a little bit surprised that CVS, Walmart, Walgreens, especially those that have partnered with health plans, if you take CVS as an example, I'm surprised that they're not already out there at every CVS health hub, vaccinating people.

Brandi Greenberg:
And I think it's really just a matter, again, of where each state is in the prioritization scheme of the rollout. So CVS and Walgreens were tagged, really, and that is probably my fault for not acknowledging, that is a partnership up and running to vaccinate folks at nursing homes. CVS and Walgreens are the official partner to help do that. Interestingly, again, I think it's worth noting already said, but West Virginia made the decision not to use that established partnership in order to roll out their vaccines, because they are in so many more rural areas where those retailers aren't. But beyond that, yeah. I think they're still waiting to be told when they're going to be ready to vaccinate the public. Many states, just in the last seven days, have really moved beyond healthcare workers.

Rae Woods:
Yeah, that's right.

Paul Trigonoplos:
And internationally, I think there's a few partnerships starting to pop up that can solve a few different problems along that supply chain. We're seeing, again in the UK, systems starting to use blockchain technology with international partnerships to track the temperature of vaccines, and keep the kind of record of temperature changes recorded. So, they can rely on this very clear, and very trustworthy source of data that says, "These vaccines have not gone out of the temperature ranges. They're safe to use." You're seeing the UK, Canada, partner with tech giants, Facebook, Twitter, Google, to start to figure out what a mass anti-misinformation campaign can look like across the countries.

Rae Woods:
That's right.

Paul Trigonoplos:
And of course, to Brandi's point, you're seeing pharmacists... High Street Pharmacy, I know in the UK, is starting to step up as a private pharmacy, as an addition to just the public healthcare sector also leaning in, but it is definitely early days.

Rae Woods:
Yeah. Any world where we are seeing such a differentiated response to vaccinations, whether that's within a country, or across the international stage, it does mean that certain populations and certain people, are going to be protected faster than others, which creates a whole set of new problems. As researchers looking at this, talking to leaders literally across the world, what do you think about this?

Paul Trigonoplos:
I think at the global scale, we're already seeing this play out. I mentioned Israel earlier, as a leader in terms of logistics, and getting shots in arms in their population, but there is a big watermark on what they're doing, because they've left Palestine, at least in the initial stages, out of their vaccination pool. I know in the US, I don't think there's anything quite so overt as that, but the longitudinal kind of differences between communities and how they interact with the health care system, does leave a big vulnerability with certain groups, and how they might be able to access the vaccine sooner, rather than later. This is definitely something I would think of now, as opposed to waiting until vaccines open up to the public. This is also a reason why countries like Australia and Singapore are kind of waiting to figure out their vaccination plan. So they can really, clearly elevate vulnerable groups, and get the details right.

Rae Woods:
Brandi, you and I talked about this on a previous episode, and I'll admit that I get the sense that in the US, everyone has their ears perked to this problem, but there just aren't a lot of answers yet.

Brandi Greenberg:
Correct. One of the challenges is the initial decision to push so much of the decision-making out to the state, and regional, and local levels. And so, because we live in such a age where information is omnipresent, everybody knows what their neighbor's doing, everybody knows what another state is doing. And so, there are these perceived inequities, which are technically not inequities, just different choices that states are making. Versus the-

Rae Woods:
Yeah. How come your parents got one and my parents didn't? I'm kidding.

Brandi Greenberg:
My parents were the last of all of my family members that were 75, because California has actually made a different set of choices than Texas, or Florida, or New Jersey.

Rae Woods:
Right.

Brandi Greenberg:
So even there, I was feeling quite vulnerable, knowing that there were a lot of other people 75 and older, getting vaccinated before my parents.

Rae Woods:
Yeah. Brandi, Paul, it feels like everything we've talked about, whether it's the approach of a single health system, a state, a country, a unified government, it all comes down to this problem of systemness, which both of you have referenced before. Right? The ability to make sure that all of the different pieces are working in lockstep with consistent information, resources, all things moving towards the same goal. Is that right?

Paul Trigonoplos:
Absolutely. I would think of the vaccination process as kind of a stress test for all of the systemness, and efficiency gains, and partnerships that came together in 2020. And your chance as a leader to kind of make good use of them, and lean into them full force.

Rae Woods:
I think I take on the pessimistic role way too often when we talk about vaccines, but this makes me really nervous, because at least in healthcare, I can think of exactly zero institutions that have actually solved the systemness problem.

Brandi Greenberg:
And I would challenge you in one area, which goes back to the idea of core competencies. I don't think anybody is operating as a fully integrated system at all levels, but many of them have gotten one or two things right. And made significant progress, be it on centralized purchasing, be it on coordinating communications with physicians. And so if you take that idea, and say, "Don't try and solve systemness right now, and get yourself from a D, to an A. Pick one or two things that you are going to insist on integrating, and coordinating, and get those right."

Rae Woods:
Brandi, you are the ultimate counterbalance to my pessimism in these episodes.

Brandi Greenberg:
Oh, thanks.

Rae Woods:
I hope you realize that. Well, Brandi, Paul, I want to thank you so much for having such a candid conversation. I am certain that we will have you back, because this is a ever-changing area of our industry, but you know what is coming. My final question is, what is the one thing that you want healthcare leaders in this country, and across the globe, to be focusing on this week? Paul, let's start with you.

Paul Trigonoplos:
I think there's such a lack of clear instructions and information, and to Brandi's point earlier, even silence is kind of deafening in this space. And there's a lot of provider referentiality going on, and I think we're not doing well with the goal of getting stuff, and getting information, and making things clear for just patients. Right? Helping them navigate the system. I think that is kind of where I would lean in as a healthcare leader.

Rae Woods:
Brandi, what about you?

Brandi Greenberg:
So, my thought here is actually to tee up something we haven't talked about on this podcast yet, which is a little bit to step back, and to see the forest through the trees. And recognize the huge population health opportunity that getting the vaccination rollout right presents. Every patient interaction is an opportunity to improve that patient's health, and build that patient's relationship, either with your institution, with their physician. And so, how can you seize the moment of that interaction to check on, do they have a primary care doctor? Do they know where to go for follow-up? Have they had their screenings? And reassuring them that it's safe. Do not miss the opportunity that this crisis presents.

Rae Woods:
Yeah. I could not have said it better, myself. Thanks for coming on Radio Advisory. We'll talk soon.

Paul Trigonoplos:
[inaudible 00:36:15].

Brandi Greenberg:
Thank you.

Rae Woods:
This is not the first time we have talked about vaccinations here on Radio Advisory, and it probably won't be the last. And I find myself repeating the most important thing that our listeners can do, which is not to be passive about COVID-19 vaccines. Of course, there is a role that new administrations, and that governments, and that states, can and will be doing. But I would argue, and Brandi and Paul would agree, that every healthcare leader has a role to play in making sure that this vaccine gets in the arms of everyday Americans. So remember, we're here to help.