Vaccine advocate-turned-software developer Tiffany Tate saw her life’s work coalesce before her eyes in February while observing a well-run Baltimore County COVID-19 vaccination site. Like the rest of Maryland’s local health departments, the clinic was using the paperless clinic software Tate designed — PrepMod.
People moved easily through the clinic. There were no lines, no waiting, she said, and PrepMod supported the workflow as “the quietest thing in the room.”
“It just came all together for me; I’ve created something that is just an extension of the expertise, courage, the hard work,” that helps vaccinators do their jobs, she said.
Tailored to the needs of vaccine clinics, the end-to-end product manages registrations, appointments, consent forms, back-end inventory and reporting. More than two dozen states, including Maryland, are using her software to sign people up for COVID-19 vaccinations and manage their clinics. If a state purchases the license, they can share it with local health departments and other vaccination providers, as Maryland has done.
All of Maryland’s health departments and one-third of the state’s acute care hospitals are using PrepMod, according to Tate.
The software is manufactured by Maryland-based Multi-State Partnership for Prevention LLC, a for-profit subsidiary of an immunization advocacy coalition and nonprofit Maryland Partnership for Prevention (MPP). Both organizations are headed by Tate, with “about 30” employees, she said.
Before COVID-19, revenue was scarce. In the nonprofit’s 2017 tax filing, the most recent available for review at IRS.gov, MPP reported earning $171,754 in revenue and operating at a loss of more than $146,000.
MPP, first incorporated in 1999, runs annual flu vaccination clinics across the state with local health departments. Tate says it is during these clinics she recognized a need to automate a paper-and-pencil process and started designing her own product.
“I created it out of necessity, not because I wanted to become a software mogul,” said Tate, who had no previous software design experience.
Last spring, the software caught the attention of the Centers for Disease Control and Prevention, which asked Tate to present the product to them and their consultant, Deloitte Consulting. According to a February New York Times article, the CDC passed on PrepMod and instead the U.S. Department of Health and Human Services awarded Deloitte two no-bid contracts worth $44 million to create and build a vaccine registration and sign-up software.
Several states are now using Deloitte’s creation — the Vaccine Administration Management System, or VAMS — which has received lackluster reviews.
In August, Tate sent Deloitte and the CDC a cease and desist letter accusing them of stealing her idea.
But the legal pursuit ended there. When asked why she didn’t sue, she answered because she’s “busy helping people save lives.”
Expansion in the states
Undeterred, Tate sold her software to individual states, including Maryland, which relative to what other states paid, got a deal.
The Maryland Department of Health in September announced a $1.5 million immunization initiative in partnership with MPP to promote routine childhood and flu vaccinations. As part of the deal, they purchased PrepMod’s software for $300,000 to share with local health departments, federally-qualified health centers and other state agencies, according to health department spokesman Charles Gischlar.
Colorado paid $395,512 for its contract with PrepMod which is being used by approximately 10% of the state’s vaccination providers, according to a spokeswoman for the Colorado State Joint Information Center.
Virginia spent over $1.4 million on two licenses, one for vaccination providers connected to the health department and one for hospitals and health care systems outside of the health department to conduct community vaccination clinics for people that are not routinely patients or staff, according to Virginia Department of Health spokesman Logan Anderson.
But Tate’s new public health tool advertised as “the nation’s only end-to-end pandemic response management system” has not been embraced by all its end-users.
Massachusetts’ registration system crashed after eligibility was expanded, an instance Tate blames on a flood of website traffic overwhelming the state’s system, not PrepMod’s. But despite the jam, Tate says 60,000 people were still able to register. Massachusetts now ranks 4th in the highest percentage of doses administered, according to CDC data.
The state paid $318,000 for the PrepMod license and another $120,531 for additional project management and development, according to ABC affiliate WCVB.
The state of Pennsylvania paid $852,000 to share PrepMod with its local health departments, according to state documents. But the City of Allentown’s health director said three weeks after they started using it, they ditched it and went back to their annual flu clinic software because PrepMod allowed people to share appointment links. As a result, multiple people would show up for one vaccination appointment.
“We were afraid that if it continued to happen, we would just have a lot of unhappy folks who could not be taken care of that day,” Health Director Vicky Kistler told Maryland Matters.
But that complaint is not news to Tate, who said a software glitch is not causing people to share appointment links during a health crisis. “That’s a people problem.”
Montgomery County officials complained of the same issue in February.
Tate said an optional feature has since been added that allows clinics to email single-use appointment links to patients.
A history in Maryland
As MPP’s executive director, Tate has established herself as an authority in Maryland’s immunization community and is a charter member of the Statewide Advisory Commission on Immunization, a group tasked with monitoring and improving statewide access to flu vaccines and routine children’s immunizations.
State officials hailed MPP as an experienced, technically capable partner in the lead up to the COVID-19 vaccine roll out in a September 2020 press release.
The state in February awarded MPP an additional $1.4 million to cover “the support team and necessary enhancements to PrepMod,” according to Gischlar.
Tate’s longtime colleague and Baltimore County Health Officer Dr. Gregory Branch credits the online interface with expediting his COVID-19 vaccination clinics. The veteran public health officer says before PrepMod he was running his annual mass flu vaccination clinics with paper and pencil.
He called Tate, who he has known since 2006, an “extraordinarily brilliant woman” and a visionary.
“You may be talking to her about a project going on this year, but I can guarantee you that Tiffany is probably thinking and envisioning what’s going to happen 10 years from now,” he said.
Tate, 50, grew up in San Diego, and came to Maryland in 1994 to attend the Johns Hopkins University’s school of public health. It was never part of her plan to become a software designer. But she said she’s been planning for a pandemic not just her entire career, but her “whole life.”
“I’ve always wanted to serve,” she said. “I’ve always wanted to be able to make a difference.”
Through her nonprofit, the Maryland Partnership for Prevention, a statewide coalition of vaccination providers, she coordinates flu vaccination clinics in public schools with local health departments.
“It’s just been a way for us to exercise our plan for preparing the community for any type of pandemic,” she said.
MPP board member and executive director of the Association of Immunization Managers Claire Hannan said Maryland is one of only a few states that regularly practices mass vaccinations. Hannan’s role with AIM gives her a national bird’s-eye view of immunization practices.
On top of being a dedicated public servant and public health champion, Hannan said Tate “sees what other people don’t see, and then she makes it happen.”
And for the past four years, Tate has been using PrepMod’s digital predecessors to run Maryland’s flu clinics.
Mixed record on successes
Tate credits PrepMod with facilitating the rollouts of some of the fastest vaccinator states. Minnesota, North Dakota and Massachusetts, use PrepMod and are ranked in the CDC’s top four highest percentages of doses used.
But Maryland, ranked 31st on Wednesday, also kicked off their rollout with PrepMod and lingered at the bottom of efficiency rankings for the first two months. With someone like Tate in their backyard, drilling local health departments and fine tuning mass vaccinations for years, why wasn’t the state leading the pack?
Looking back on the last three months, state legislators and county leaders blame the rocky start on a lack of leadership, responsibility and preparation.
Sen. Clarence K. Lam (D-Howard) told Maryland Matters the state was too quick to expand the vaccination provider network without having the supply to sustain them.
“You’re basically cutting the pizza pie in 2,000 different pieces — 2,000 different providers — without really expanding the pie itself,” said Lam, who is also a medical doctor.
He also said a lack of a centralized registration process created confusion for residents and left them in a “Hunger Games scenario” to hunt for vaccination appointments across multiple providers’ websites.
Less than a week before the first vaccines would roll off a pharmaceutical company lot, Tate appeared on MSNBC to talk about the logistics of Maryland’s pending rollout.
Tate told anchor Chris Jansing there’s a difference between making a vaccine and injecting a vaccine into the arms of millions of people. Public health officials, she said, are not trained in logistics, managing facilities, parking, tents, heaters. Her words now seem like warnings.
Still, confident in Maryland’s years of pandemic preparedness efforts, she told Jansing, “We’re prepared in Maryland.”
But when the vaccines did start to roll into hospitals and health clinics, Maryland’s operation fell flat, at one point, administering available doses slower than almost every other state.
When asked why Maryland fell behind, Tate repeated what she told Jansing those many months ago. She attributed the weakened state response to historically anemic public health budgets across the country, including here in Maryland.
“There hasn’t been a budget for people to travel to these conferences where they can network and make relationships with people across the country and learn about pandemic planning, logistics, vaccine rollout, vaccine storage, scheduling,” Tate said. “No one (in public health) knows this stuff.”
Hannan said this is “unquestionably” true. The steady drip of federal funding for immunizations has been just enough for statewide groups to maintain but not enough to plan improvements, invest in technology or to innovate, Hannan said.
“For them to really think outside the box, to talk with each other, to go to conferences to look at different vendors to look at different solutions — just no opportunity to do that,” said Hannan.
Despite the high throughput of his vaccination clinics, Branch agreed with Tate’s assessment. The logistics underpinning mass vaccination clinics do not just appear. He said, “that’s exactly the reason why we’re behind.”
Reaching new communities
State leaders are still seeking answers on Maryland’s uneven vaccine distribution along racial lines. The Black population of the state has lagged fourfold behind the white population.
The Hogan administration created a Vaccine Equity Task Force to focus on reaching vulnerable populations across the state. But leaders say these efforts aren’t getting vaccines to those who need them most fast enough.
Sen. Mary L. Washington (D-Baltimore City) criticized Maryland’s disproportionate model in an email sent to Maryland Matters. “The data shows us that our haphazard system favors white, affluent, and younger populations to the detriment of African Americans, Latinx, rural and older Marylanders.”
Tate said in a February interview that not enough resources have been invested in getting the vaccine to marginalized populations.
“If you’re committed and you’re sincere about doing it, then you need to devote a lot of resources,” she said.
Tate’s company has donated a PrepMod license to every historically Black college and university in the country, allowing them to become vaccination hubs for Black communities.
“This population has been socially, medically, economically most disadvantaged by this pandemic than any other group — people of color — and we owe it to them to invest in their health and their awareness,” she said.
She hopes that as a Black woman in technology and vaccine advocacy, her presence and passion for immunizations will inspire positive messaging about the vaccine in Black and Brown communities. Tate has lost one close relative and three friends to the virus.
“Every Black person I know knows someone who’s died of COVID — every Black person I know,” she said. “This is a disease that hit home.”
Editor’s Note: This story was updated to clarify issues with the Massachusetts registration system.
Brenda Wintrode is a contributor to Maryland Matters. She can be reached at [email protected]