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Ben Moscovitch, director of the health information technology project at the pew charitable trust, said :" you don't want someone to get the first dose of one brand vaccine and the second dose of another ."

Assuming that the U.S. Food and Drug Administration (FDA) approves vaccines after reviewing data later this month, States will receive Pfizer and biontech vaccines on December 15, and Moderna vaccines on December 22. Since then, it has been up to the States to distribute the vaccine. Both require two doses, given several weeks apart, and may circulate at the same time. In addition, other multi dose vaccines are still under development.

Claire Hannan, executive director of the Association for immunization managers, says there are several ways doctors and patients can maintain the right dose. In the simplest solution, everyone who gets the covid-19 vaccine will also be given a card telling them which vaccine they have received and when their next dose should be. But this is the last line of defense in a complex vaccine tracking system. "As a backup of the backup, they issue cards," Hannan said.

Ideally, these cards would not be necessary because patients and doctors would be able to rely on electronic records and digital registration systems to track who was vaccinated with which vaccine and when. Through this pandemic, states in the United States struggle with digital systems in other key areas, such as covid-19 detection - sometimes relying on fax machines and incomplete handwritten forms to send information from checkpoints to local health authorities. But Hannan said immunization data collection systems at the state level in the United States are ready to manage the amount of information expected from an unprecedented mass vaccination campaign like the one that is about to begin in the country. Most of the tools were in place even before the outbreak. "All of our state systems are not connected at one point, nor are we using paper at one point," Hannan said.

When someone is vaccinated with the first dose of covid-19 vaccine, information can be collected in several different ways. Some places may use specialized vaccination clinic software at an early stage: a hospital may use a program that sends a link to eligible employees to register for vaccination appointments, and then sends a reminder when they should get a second dose. Other health systems may use their patient electronic health records for the same function.

Howard Forman, a professor of public health, management and economics at Yale University, said a large health system with powerful electronic health record management might be able to do this more easily than a small clinic. "They're used to tracking patients for follow-up appointments," he said.

Health systems and clinics will then need to report their vaccine data to the state. Each state has its own immunization information system (IIS), a centralized registry that tracks each vaccine received by everyone in the state. Vaccination outpatient software and electronic health record systems also enter these registration systems to help doctors track the vaccination records of each patient, and to provide states with big data on vaccination rates for each community.

The state-level integrated information system can also inform doctors and patients when people need a second dose of vaccine. Hannan said they have been used to track doses of Japanese encephalitis vaccine. "It takes multiple doses and there are two different brands, and they can't be interchanged," she said.

in addition to simply tracking individual patient doses, the digital registry is a way for the state – and the federal government – to see how many people have been vaccinated if any group or region lags behind vaccine coverage. Moscovitch says the administration of vaccine dose information varies from state to jurisdiction. Some may be better prepared than elsewhere, and not every place has the same number of experiences using these systems to track vaccination. There may be some areas where vaccine registries are often used for children, but not as frequently as adults. "It could be a challenge for COVID-19, where we want to gather information about adult immunization ," he said. Children are just beginning to be included in COVID-19 vaccine trials, so early vaccination waves will be targeted at adults.

The system used to track vaccination is more advanced than it was in 2009, when the United States struggled to distribute and track the H1N1 flu vaccine. Only a few states use their IIS program. Many states have to rely on surveymonkey to connect with healthcare providers about vaccine delivery. This is unlikely to happen this time because of the systems developed over the past decade, but ensuring that they work as they should be is a resource intensive challenge. "We've come a long way, but it's a double-edged sword," she said. "The downside is that it's more complex, it's more expensive, and it takes longer to build."

For example, all electronic systems from the state level down can work more effectively together if they collect patient information in a standard way. Moscovitch says any place that gives vaccines - doctor's offices, pharmacies, etc. - should collect the same data from patients. This makes it easy to match records if someone needs to go somewhere else for a second shot. But there is no standard for that data.

Moscovitch and the Pew Charitable Trust are pushing the federal government to adopt better standards that will help match patients with their vaccine records. Moscovitch said there are still open questions about how well this might work for the covid-19 vaccine. "There is a lack of clarity. With the vaccine expected to be around the corner, these issues need to be adjudicated and made public so that we can match patients correctly, "he said.