States have struggled with programs to manage the rollout of Covid-19 vaccinations, reporting such hiccups as lost appointments. Here, health workers at the Hartford Convention Center in Connecticut review a tracking program as they prepare to administer second doses of the Pfizer/BioNTech vaccine.
Joseph Prezioso/AFP/Getty ImagesAs state health agencies struggle with glitches and disarray distributing Covid-19 vaccines, they’ve also been beset by another challenge: vendors pitching expensive vaccine-tracking computer systems that can create problems of their own.
“We get vendors, vendors, so many contacting us, wanting to show us how their products are working,” said Claire Hannan, executive director of the national Association of Immunization Managers, a nonprofit that helps government agencies around the country administer vaccines. “I can’t tell you the number of vendors that contact states saying, ‘We can solve your problems.’ Some of them get the ear of the governor. And then it turns out their software doesn’t work. We have complete disarray.”
Difficulties with immunization rollouts are emerging around the country, leaving the economy exposed to the prospect that the postpandemic era won’t come quickly. So far, two vaccines have been approved for use in the U.S. and an estimated 14% of the adult population has been vaccinated. Fed Chairman Jerome Powell has said there is nothing more important to the economy than vaccination success. Live entertainment, retail commerce, manufacturing, and other industries affected by the pandemic won’t truly recover until vaccination is widespread and Americans can return to normal activities.
Amid overwhelming demand for vaccinations and tricky protocols for delivering the injections, states are trying to adjust how they register and track immunizations. In California, after problems with the initial tracking software, the governor recently announced a new pair of agreements worth up to $42 million for a vaccine and records system based on an agreement with Accenture, which won the contract after its submission was chosen over proposals by Deloitte and Crowe LLP.
An attorney specializing in government contracting, and the head of a company specializing in vaccine records technology, agreed to a request by Barron’s to review the California Accenture documents. Both say that the California deal, dubbed My Turn, lacks clear performance standards and invites cost overruns. In North Carolina, providers say an Accenture vaccine-tracking system involving the same vendor as the one in California is so cumbersome that it has slowed down immunizations.
“Accenture and the client have worked together in an effort to accurately track program costs,” the company said in a statement. “As the program has evolved, the client has provided us with periodic updates to the project’s scope of work, and we continue to help support their objectives.”
Avoiding the Alternative
An alternative is the federal government’s vaccine-tracking system, built with the help of no-bid contracts with Deloitte worth up to $48 million. According to procurement records, the Centers for Disease Control and Prevention said that no other type of supplies or services satisfied agency requirements. The platform has been shunned by health officials in all but nine states. Detractors say the national Vaccine Administration Management System, or VAMS, is hard to use and fails to schedule vaccination appointments properly.
South Carolina, meanwhile, is moving from the Deloitte/CDC platform to a new system it is developing. “We, like many states, and like many of our vaccine providers, and like many of the public, have been frustrated with the federal VAMS system,” said Brannon Traxler, South Carolina’s interim director of Public Health for the Department of Health and Environmental Control, during a Jan. 25 immunization briefing on the move to a new system.
A Deloitte spokesman acknowledged users are reporting challenges, but said “Deloitte is working to enhance the system based on user feedback and the priorities of local healthcare providers.”
The CDC didn’t respond to requests for comment.
With the federal vaccine-tracking system falling out of favor, Hannan says the urgency of the immunization effort leaves states vulnerable to failures and cost overruns. “A big part of it is, somebody with a lot of money is banging on the door saying, ‘Don’t go with that product. I‘ll give you another one,’” she said. “It looks great when I see a demo, but I don’t know how it will work.”
Steve Murchie, co-owner of Envision Technology Partners, a Denver-area maker of immunization systems not involved in the aforementioned projects, concurs. He said big software contracting firms see a business opportunity in taking over the type of project previously built by experts in immunization technology, without acknowledging that it’s a highly specialized field. “There’s blood in the water so the sharks come out,” he said.
Justin Cohan-Shapiro, chief strategist at the California Department of Technology, says inoculating the state’s 39.5 million people requires a robust system that not every vendor can provide. Here, a mass vaccination site at Levi's Stadium in Santa Clara, Calif., on a recent day.
David Paul Morris/BloombergIn California, Democratic Gov. Gavin Newsom, under threat of a possible voter recall for a haphazard vaccine rollout, announced Jan. 25 a new system to sign up and keep track of vaccinations that would “leverage California’s spirit of innovation and technology.” The new system was to replace a platform called PrepMod that has been used in early phases of the vaccine rollout that focused on the elderly.
The executive director of Ararat Nursing Facility in Mission Hills, Calif., and the director for emergency preparedness with the California Association of Health Facilities, told Barron’s the online system was complicated to use, while PrepMod’s maker said it was never intended for use by disabled elderly patients.
A close look at the contract documents for the new system shows agreements that were vague about precisely how the system would come together, didn’t indicate whether the vendor had experience or expertise in vaccines, and were written in a way that invited cost overruns favoring contractor Accenture, according to the two people who reviewed the California documents at Barron’s request.
History of Hiccups
Accenture has managed two recent computer projects that have made headlines for delivering less than promised and ballooning in cost. In 2015, California’s state auditor released a report saying an Accenture system to streamline license records for doctors, auto shops, and small businesses in other regulated industries worsened the process and ended up costing more than three times the initial $28 million price. In response, the state Department of Consumer Affairs told the auditor it had ended its contract for creating the project because “it was not sustainable in terms of both financial and human resources.”
In 2020, the auditor sounded the alarm on another Accenture contract, this one aimed at centralizing the state’s accounting systems. The project, whose estimated cost started at $617 million in 2012 and went to more than $1 billion by last year, created a system so complex and time-consuming that it undermined California’s financial reporting, even threatening the state’s credit rating, the auditor said.
Accenture didn’t directly answer a question asking what steps it had taken to avoid problems with these types of earlier problems with its California immunization project, instead issuing a statement saying that the company has a record of success, that big government information-technology projects are complex, and that the company works closely with customers to “make refinements and adjustments.”
Justin Cohan-Shapiro, chief strategist at the California Department of Technology, said the Accenture proposal offered an effective way to inoculate California’s 39.5 million people, something he says the previous software wasn’t well suited for. “We’re a nation-state in terms of size,” he said. “We want to make sure the system is able to support that.”
“ I can’t tell you the number of vendors that contact states saying, ‘We can solve your problems.’ Some of them get the ear of the governor. And then it turns out their software doesn’t work. We have complete disarray. ”
While Accenture has drawn earlier controversy in California with what critics say were deficient, overbudget systems, Cohan-Shapiro said the priority during the pandemic is to do his best with what’s available. “We’re focused on making the thing work that we’re trying to make work. We made a decision as a state, and we’re going forward,” he said.
The agreement between California and Accenture, obtained through a records request, shows the state is at risk of the same sorts of problems that plagued those other software contracts, according to the two experts who reviewed them for Barron’s. The Accenture vaccination-tracking agreement is vague and open-ended enough to allow for future add-ons and cost overruns, and details no expertise or experience with the highly specialized field of vaccines, said Mike Popovich, CEO of STC Health, a Phoenix maker of immunization information systems which didn’t bid on the project, and hasn’t competed specifically with Accenture for business.
“This is bad for the state and good for the vendor. The contract does not hold Accenture to any deliverable item for any fixed cost,” Popovich said. “It makes it completely open-ended as this process supports the many changes that are likely to occur in each step through state input and they equate to more time and money.”
Scott Amey, general counsel of the Washington, D.C., watchdog group Project on Government Oversight, said the initial agreement worth up to $17.3 million was already amended to increase by $24.6 million before the project rollout, the first of what could be more price increases. “California entered into a necessary contract, but one that includes a lot of risk for the state,” he said. “I’m not finding any taxpayer protections that will prevent this work from climbing further or being behind schedule.”
Accenture said in a statement that its contract was competitively bid, and that its work “is being done with the knowledge and approval of California Department of Public Health leadership.”
California government officials have repeatedly been criticized over failures to include safeguards in tech contracts. “There has been a lack of accountability for agencies that shepherd these types of IT projects,” said Adam Summers, a research fellow at the Independent Institute, a California policy think tank.
Jim Nielsen, vice chairman of California’s Senate Budget and Fiscal Review Committee, said there is little political interest in holding to account state officials or vendors involved in IT contracting failures. Nielsen, a Republican, said that at a recent committee meeting he failed to get answers from state officials about whether the new vaccine contract would guarantee the public and legislators information about the rollout’s performance.
“With these millions and billions of dollars of new tech applications and upgrades in California, most, if not all of them have had problems, some of them huge,” he said. “We’re the high-tech capital of the world, and we’re incompetent.”
‘Burdensome and Ineffective’
In North Carolina, where Accenture has already built a vaccine-scheduling system, with Salesforce software as in California, providers have said the system is so difficult to use and has so many technical problems that they’ve had to develop workarounds. The system “is burdensome and ineffective, creating an unnecessary bottleneck in the delivery of vaccines,” according to a Jan. 25 letter from North Carolina’s hospital association to the state’s governor.
An Accenture spokeswoman didn’t respond directly to questions about the North Carolina system, instead pointing to a previous statement saying, “Accenture is committed to our clients and has supported the successful delivery of numerous major IT-modernization programs.”
Bill Patterson, who oversees customer-relationship management software at Salesforce, said the company had been providing software for projects related to the pandemic to 35 international, state, federal and local agencies, and continues to refine its offerings as customers struggle with quickly vaccinating large populations.
In a Jan 26 public coronavirus briefing, North Carolina’s health secretary, Mandy Cohen, defended the Accenture system, saying it had tracked 800,000 vaccinations at that point. “But we are always trying to improve that system and make it more efficient,” she said.
U.S. states, tribes, and territories have the option of using the CDC’s VAMS program. But a lot of them aren’t taking the federal government up on its offer because of the complaints about breakdowns. Deloitte, too, has drawn criticism over the years for government software contract problems, including $94 million of work for California’s unemployment agency that state officials say failed to modernize its systems.
Deloitte sent a letter responding to state legislators who had criticized the work, explaining that the company had been hired only to modernize part of the department’s IT system, and that it had done that work successfully. “Many system functions were not modernized as they were not part of our contract,” the letter said.
Regarding VAMS, a Deloitte spokesman said that nine states are using the system and that it had logged 1.4 million vaccinations by Feb. 2 despite being launched in a “fast-moving environment with a lot of unknowns.” Failures that had drawn complaints, such as appointment cancellations, weren’t due to VAMS’ technology, “but rather, changes in a clinic’s vaccine supply or staff availability,” the spokesman added.
Write to Matt Smith at matt.smith@dowjones.com
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