A national system to prioritize COVID-19 vaccines has largely failed as states rely on their own systems

Operation Warp Speed thought it had a futuristic solution to help ration COVID-19 vaccines so those most at risk would get doses first. It 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 code-by-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.

More: US struggles to make it easier to find COVID-19 vaccination appointments

The Trump administration’s embrace of Tiberius was one part of its broader effort to project competence and planning expertise as the government took on one of the most massive and complex logistical challenges in U.S. history. The ensuing friction between Operation Warp Speed, the entity leading the federal government’s vaccine planning, and state efforts was typical of the finger-pointing that emerged as the rollout became reality.

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 in an email: “No. We have not found Tiberius to be helpful in this regard.”

She continued: “We run our own allocation code and use Tiberius only for tracking allocated vaccines.”

A few states reported that they are using Tiberius’s tools for prioritizing at-risk populations. The Arkansas Department of Health said in a written statement that 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 health officials who make the final decisions on who gets the vaccine, at the county, city and other local levels, 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 becoming increasingly important to ensure swaths of America are not left behind.

“The states that have done well have built in this kind of hyper-local, detailed data that we need to replicate for the nation for a sense of equity and as we add in more vaccine candidates because it’s only going to get more complicated,” said Dr. Rebecca Weintraub, an assistant professor at Harvard Medical School and a practicing 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 brought 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 – all served to Operation Warp Speed officials and state health departments alike.

“The jurisdictions will work inside the Tiberius platform to decide where every allocated dose will go,” said a Defense Department press release from November.

“Tiberius can provide a zip code-by-zip code view of priority populations, including frontline workers and nursing home residents,” said another press release published a month later.

Palantir Technologies, which went public last year after 17 years of doing business, 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 sophisticated system called HHS Protect that houses a multitude of data sets from hospitals about COVID-19.

HHS Protect has been heavily criticized for incomplete and problematic data that doesn’t match what states and hospitals are reporting. According to a CDC evaluation of the system, there are “major flaws” in its data collection, which is managed by TeleTracking Technologies, a private company hired by the Trump administration’s coronavirus task force to take over the CDC’s role in collecting hospital data.

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.” Federal Election Commission records on campaign donations show that the company and its employees tend to donate more heavily to Democrats.

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.

“Certainly, the initial experience with Tiberius, it did not get rave reviews,” Foster said. “If they were going to set up a whole new system, they should have done it a whole lot more rapidly.”

Tiberius 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 – for each of the states and territories, plus federal agencies and some regional managers. Hired through OptumServe Technology Services, these specialists were charged with walking health officials through the system.

One of the specialists, who spoke on condition of anonymity because those hired 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.

In written testimony to a House subcommittee hearing on Feb. 2, the chief medical executive of Michigan’s health department said the state had “struggled with Operation Warp Speed’s Tiberius system.”

“The system is very complex and required multiple staff to undergo training in a short period of time to learn how to navigate it effectively,” Dr. Joneigh S. Khaldun testified.

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, to comply with federal privacy guidelines. Health officials in some states 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 pre-existing 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.

A fancy dashboard that few leverage

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 receives only 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. Many cities, counties and providers do not yet use the system.

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.

More: Amid a chaotic COVID-19 vaccine rollout, states find ways to connect shots with arms

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.”

Aleszu Bajak is a senior data reporter and David Health is a reporter on the USA TODAY investigations team. Contact Bajak at abajak@usatoday.com or @aleszubajak, or on Signal at (646) 543-3017. Contact Heath at dheath@usatoday.com or @davidhth, or on Signal at (240) 630-1962.

This article originally appeared on USA TODAY: COVID-19 vaccine: Distribution system fails to live up to promise