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 / Autumn 2008 / Issue 52(originally published by Booz & Company)


Smarter Medicine

Diagnosing the Problem
Just as sure as humidity would blanket Philadelphia every July, Kim Lane, a manager for the CDC’s national immunization programs, would get an e-mail informing her that once again, the City of Brotherly Love’s vaccine line of credit was running low. Philadelphia’s public health vaccine stock would soon be depleted. The message, coming as it always did on the cusp of the school year, would set off an emergency response within Lane’s team at the CDC.

Lane possesses an intensity and a 90-yard stare that make it clear when things need to be cranked up a few notches. Every July, things got cranked up. Philadelphia always got its money and vaccine — Lane and her team made sure of it. “But it drove me crazy,” Lane says, shaking her head inside her small office in the CDC’s Atlanta headquarters. “I just remember thinking, ‘There has to be a better way of doing this.’” But from Lane’s perspective, as the VFC program grew, tracking the physical distribution and ensuring proper storage of the lifesaving vaccines across the entire United States was becoming more and more problematic. Philadelphia wasn’t the only place with difficulties. There were literally hundreds of points of potential failure in other cities and states, any one of which could, and often did, interrupt the regular flow of vaccine to VFC grantee offices.

To take on the challenge of revamping a decade-old system involving every state and U.S. territory, tens of thousands of doctors, thousands more health-care workers, billions of dollars in funding, and the health of millions of children takes courage. To attempt it within the federal government takes persistence. To pull it off takes imagination, persuasiveness, and, above all, the rare ability to translate a felt need into actual results. Lane possessed all of those qualities. In 2003, she proposed to her boss, Bill Gimson, that the agency borrow from the best practices of both private industry and government to build an entirely new system — a new supply chain, really — for vaccinating children.

When dealing with a health-care program with the breadth and depth of VFC, few people have the capac­ity to see the scope of what needs to change or why it needs to change at all. Lane, Gimson, and the people they pulled into the VMBIP project early on had that dual perspective. Some had spent decades working for the CDC, both in the field and at the Atlanta headquarters. They knew that the problem wasn’t that children lacked access to vaccine; the vast majority did have access. The problem rested with the vaccine delivery system, which was outdated and overburdened and which relied on the superhuman efforts of thousands of health-care workers to function, especially in an emergency.

For Lane, the defining moment occurred on a cold night in January 1996, when she was assigned to the CDC’s office in Harrisburg, Pa. A basement alarm in a downtown building prompted a 3 a.m. phone call to her home. A recording on the line screeched, “Alert! Alert! Alert!” letting her know the refrigerator in the state health building had failed and the precious vaccine inside was about to lose its viability and be rendered useless. Lane, eight months pregnant with her first child, and her husband piled into their Chevy and negotiated the icy streets to the state health building. Lane’s husband worked until dawn moving boxes of vaccine from one refrigerator to another while she supervised. Everything was saved.

Lane knew she and others could not always count on an alarm to tell them the vaccine was at risk. While coordinating the children’s vaccine program in Puerto Rico in the 1980s, Gimson and his co-workers devised additional methods to keep close tabs on their vaccine-packed refrigerators and freezers. With an eyedropper, they’d carefully place a dot of red food coloring in a butter dish filled with water and freeze it. If they came back after the weekend, and the red dot had changed shape in the block of ice, they knew the electricity had been down for a time and the vaccine in the freezers might be compromised. The problem of unreliable power and faulty refrigerators persisted in these fragmented distribution centers.

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  1. Bill Jackson and Conrad Winkler, “Building the Advantaged Supply Network,” s+b, Fall 2004: Collaborative strategies with examples from aircraft, consumer products, and auto manufacturers, plus advice for step-change planners.
  2. Dan Jones and Jim Womack, Seeing the Whole: Mapping the Extended Value Stream (Lean Enterprise Institute, 2000): Practice guide with diagrams and techniques for mutual analysis and lean thinking.
  3. Keith Oliver, Dermot Shorten, and Harriet Engel, “Supply Chain Strategy: Back to Basics,” s+b, Fall 2004: The best practices of companies that do supply chain management well. 
  4. Association of Immunization Managers Web site: Further information about immuni­zation policy development, partnerships, programs, and program management.
  5. Centers for Disease Control and Prevention Web site: Provides background and resources on the CDC’s goals and operations, including detailed information on vaccine and immunization programs.
  6. For more articles on supply chains, sign up for s+b’s RSS feed.
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