Most #COVID19vaccines require 2 doses (except Janssen's, which just needs 1). How is the US going to make sure that everyone gets their doses at the proper time? To answer that question, we gotta go back to the 1990s and then into ~ the cloud ~ 1/x https://qz.com/1941989/how-the-us-plans-to-track-pfizers-covid-19-vaccine-doses/

2/x In the 90s, pediatricians were getting frustrated with vaccination records. There was no way for them to know which patients had gotten which shots—esp if they switched docs. So they pushed for the creation of immunization registries/immunization information systems aka IISs

3/x For the most part IIS' are great. They allow healthcare providers to record which vaccines (incl. batch + brand) people got and when; they show population level vaccination rates; and (most of them) have query functions, so an ER doc can look up if your shots are up to date.

4/x But they're segregated by state (or island, or large city). In total, there are 61 IIS' the @CDCgov keeps track of. There's no integration of these, so if you got a jab in NYC, your PCP in DC couldn't see those records. https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html

(4.5/x why? Because we seem to be deeply, deeply committed to avoiding a national health care plan at all costs, despite the fact that so many people end up with inadequate access to healthcare this way. But I digress.)

5/x The US has noticed that state IIS' should be connected in some way; back in 2018, HHS created the IZ Gateway plan, which would function as a secure router of sorts to allow different IIS' to talk to each other.

6/x Originally, a company called @A_INQ got tapped to implement and support this kind of system; in 2019, it got $3 mil over 3 years. In 2020, it got 12 mil for 11 months to get it off the ground with the help of @AIRA_ImmReg.

7/x IZ Gateway would not just connect state IIS, but other vast healthcare systems like prisons, the VA system, etc. The problem of implementing is one of updating each state's privacy policies and making sure they can maintain HIPAA security.

8/x Amazon Web Services is hosting IZ Gateway.

9/x The idea behind IZ Gateway is that finally you'd be able to get a shot in one state, travel to another, and get your second. That'd be good for not just #CovidVaccines, but any immunization going forward. https://qz.com/1941989/how-the-us-plans-to-track-pfizers-covid-19-vaccine-doses/