Quality over quantity as a vaccination strategy: large, professional and centrally managed vaccination centers across Belgium

A well-coordinated set-up of some 70 vaccination centers

In December, our think tank indicated that, from a logistics and mobility point of view, the vaccination of the Belgian population could be carried out most efficiently through larger, professional and centrally controlled vaccination centers.

Our calculations clearly showed that the ideal number of vaccination centers for Belgium – in terms of social costs, benefits, efficiency and effectiveness – is between 40 (districts) and 73 (general practitioners’) centers. This would imply 4 to 6 vaccination centers per province or one center per 150 to 250 000 inhabitants. However, this is at odds with the vaccination strategy now proposed by the government, which opted for one vaccination center per 50,000 inhabitants or more than 200 vaccination centers throughout Belgium.

We previously concluded that primary health care workers, hospital and residential care personnel and residents of residential care centers should be vaccinated locally, in their working or living environment. People over 65 with an underlying medical conditions are also best advised to receive vaccinations via their own doctor.

“Since then, the vaccination campaign has started and the government plans to vaccinate these priority target groups before the end of March.”

Meet in the middle

From a social point of view, a complete central vaccination approach is practically unfeasible. At least for some eight million Belgians. Allowing everyone to travel to Brussels for instance, perhaps even twice as most vaccines require a double dose, is obviously not an option. Studies have shown that the number of people that take a vaccine increases when they don’t have to travel far. However, from a logistical and organizational point of view, it is not advisable to opt for a highly decentralized distribution either.

Virologists say 70% of the population needs to have had the vaccine in order to create group immunity. The decision to create more than 200 vaccination centers will undoubtedly help achieve this. However, from a logistics, mobility and organizational point of view,  it would be better to distribute the vaccine in well-organized vaccination centers, set up per district or GP outpost. Our neighboring countries implemented this approach as well.

“Our calculations show that setting up 40 to 73 vaccination centers is feasible. However, it remains a challenge at such short notice. Hence our earlier calls to start with the practical organization of these vaccination centers as soon as possible.”

An overly intricate network of vaccination centers can lead to  errors and inefficiencies

In the following weeks and months, the federal government will have to distribute 4 or 5 vaccines, all with different storage and handling conditions. Doing so to more than 200 centers in Belgium will require a very complex planning.

This combination alone means that there will be an enormous number of different ‘shipment combinations‘. In logistics, of course, anything is feasible – retailers have been doing this for years – but given the short notice, limiting the number of centers seems to be the preferable scenario.

In terms of practical organization, larger vaccination centers are easier to manage

Just consider the following:

    • The regional hubs in the hospitals need to deliver the right type of vaccine, in the appropriate quantities, with the right tools (syringes, needles and disinfectants), for the estimated attendance to each of the vaccine centers. More centers means greater susceptibility to fluctuations in attendance in those locations. Given the limited shelf life of the vaccines, this means that the regional hubs may need to review supplies on a daily basis.
    • Unplanned loss of staff due to illness can be dealt with more easily in larger centers.
    • Larger centers can be better equipped with professional medical and IT infrastructure. Staffing, administration, stock management but also crowd management can therefore be organized much more efficiently in larger centers than in smaller ones.
    • And last but not least: the more centers, the more potential vaccine loss at the end of the day, due to not being able to use up all vials.

A proposal for the optimal location for vaccination centers

Based on this conclusion, we merged our logistical and geographical knowledge from the universities of Antwerp, Ghent and Hasselt. We developed a map on which we indicate the most optimal set-up of the vaccination centers, based on a number of important  parameters such as

      • population density,
      • residential areas where older inhabitants have more road access,
      • access by public transport,
      • a minimum distance to main roads,
      • a minimum distance to parking spaces for at least 100 cars,
      • the travel time to the nearest hospital, in case of an allergic reaction after vaccination.

This analysis has led to this map of Belgium. The “greener” the area, the more it lends itself to the implantation of a vaccination center. This shows that 5 to 6 cities and municipalities in each province stand out relatively clearly. For example, for West-Flanders, it makes sense to have a vaccination center in Kortrijk, Bruges, Roeselare, Ypres, Ostend and the West Coast. For the province of Limburg, besides Hasselt and Genk, Leopoldsburg, Lommel, Tongeren and Sint-Truiden stand out as an ideal place for a vaccination center. 

“If we zoom in on general practitioners’ outposts (defined by the red borders) of Ghent, Antwerp and Hasselt, a number of locations seem to be ideal to set up a vaccination center. For example, Park Spoor Oost and Antwerp Expo, in Antwerp, the Grenslandhallen in Hasselt and Flanders Expo in Ghent.”

The aim of this map is therefore to support the government in objectifying the choice of suitable locations. In the coming days, we will create a more detailed lists of potential locations per province.

Event locations and sports centers appear to be suitable locations

We indicated earlier that the event and culture sector can play an important role in the vaccination campaign. Their extensive experience in organizing mass events is invaluable. Many of these event locations would be suitable vaccination centers that meet parameters such as accessibility, the presence of parking and a suitable surface area. Also, these centers often have sufficient administrative, storage, sanitary  and ICT facilities.

“This ICT network is important for proper administrative registration and follow-up in the government’s vaccination database. It is not inconceivable that, for example, small and local vaccination centers do not always have secure cybercrime-resistant WiFi networks at their disposal. Larger and more professional (event) locations usually do.”

Conclusion: focus on a good balance between proximity/mobility versus logistics/organization.

We do not think the current municipal bidding of mayors to organize a local vaccination center, however well-intended, is the right strategy. An intricate network of vaccination centers in Belgium will undoubtedly benefit the vaccination coverage, but the logistical and organizational challenges are enormous.

The sudden closure of a vaccination center due to logistical, administrative or organizational problems is detrimental to the credibility of the vaccination campaign among the population. The time we have left to organize these centers does not allow us to support an intricate vaccination strategy. In order to set everything up as soon as possible, limiting the number of centers seems to be the preferable scenario.

Want to know more?

All maps are available in high resolution on request. An additional analysis with a list of potential “optimally” located vaccination centers will be posted later this week. This study was conducted by researchers from UAntwerp, UGent and UHasselt and experts from the logistics and pharma sector:

  • Dr. Joris Beckers (Geographer & Transport Economist UAntwerp, Department of Transport & Spatial Economy)
  • Dr. Wouter Dewulf (Transport economist UAntwerpen, Department of Transport & Spatial Economy & Transport economist UHasselt)
  • Dr. Niel Hens (Biostatistics and statistical Bioinformatics at the UAntwerpen and at UHasselt)
  • Lars De Slover (UGent, Department of Grography, CartoGIS Research Group)
  • Dr. Roel Gevaers (Transport Economist UAntwerp, Department of Transport & Spatial Economy)
  • Wim Tiest (Director of infectious disease programme strategy of eTheRNA immunotherapies NV)
  • Dr. Nico Van de Weghe (UGent, Department of Grography, CartoGIS Research Group)
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