Systems Thinking Accelerates COVID-19 Vaccine Testing

The scientific community has learned how to respond to urgent mass-health matters at ‘pandemic speed’ by ditching linear thinking.

If you begin researching practical applications for systems thinking, you’ll quickly notice how much adoption has happened in the healthcare and medicine world.

The scientific method can be accelerated by thinking non-linearly, practicing instead a layered systemic approach. For many, the mindset shift is harder than the practice, because we’re accustomed to almost everything in our lives represented by and related to linear thinking methods. Time is a line, and there are points along that line, etc. But the actual world, and especially in the pandemic world, in which many complex variable influence outcomes, thinking in systems and dimensions is necessary.

A paper released by the New England Journal of Medicine in 2020 helps explain the process.

Typically, vaccine development is a lengthy, expensive process with high attrition and failure rates. Because of these anticipated stumbling blocks, developers use painfully detailed linear testing methods, pausing frequently for data analysis and other process checks. Each step in the timeline represents confidence in those that came before.

But that lengthy process doesn’t provide solutions for COVID victims or their families fast enough.

If you’ve managed a project before — even the coordination of household chores and improvements over time — you have experience making compromises between quality, time, and cost. It’s no different in the vaccine-testing world. For example, rapid testing adds financial risk because more vaccine must be clinically developed and manufactured before testing is complete.

This is a great simplification of a complex approach to modern vaccine testing, but represents the difference between traditional vaccine development and a pandemic paradigm.

The traditional vs pandemic testing paradigms, from nejm.org

The pandemic paradigm requires multiple activities to be conducted at financial risk to developers and manufacturers and without knowing whether the vaccine candidate will be safe and effective, including very early manufacturing scale-up to commercial scale before establishment of clinical proof of concept.

The diagram above helps us understand the process, but also (importantly) helps us acknowledge some ways in which we misunderstand the approach and outcomes related to systems thinking. As linear thinkers trained in a predominantly linear system, ‘faster’ means ‘speeding up or removing steps in a process’ when what is actually occurring is adding dimensions to the process in order to learn more things in the same amount of time.

On Sunday, John Oliver’s Last Week Tonight had a segment about vaccines and testing, and referred to the pandemic paradigm methodology — code name Operation Warp Speed, no joke — with a clip of a researcher from the University of Pittsburgh explaining how they’ve been working. “Things that we would normally do in a linear fashion, like A to B, we start doing F and E at the same time.”

It’s not about rushing the science, it’s about thinking simultaneously instead of sequentially.

Oliver jokes, “I’m envious of that level of efficiency. I wish I could shit, shower, shave, eat breakfast, brush my teeth, and kiss my family all at the same time, unfortunately I’ve only ever been able to do three of those at the same time.”

John would not be shitting, showering, shaving, eating, brushing, and kissing faster, he’d be shitting, showering, shaving, eating, brushing, and kissing at the same time.

He’s joking — good luck on getting to that fourth thing, John — but the analogy is absolutely perfect. By breaking the linear mindset, we can understand the paradigm as a system: shitting, showering, shaving, eating, brushing, and kissing as nodes that orbit John, opposed to discrete tasks to be completed over time.

You might say, “But we all agreed that testing vaccines was a complex system with multiple variables, how can simultaneous processes handle that?” Again, it’s not about ignoring the complexity, it’s about jumping in and agreeing to the compromises required. Vaccine testing is more complicated in the linear paradigm than in the systemic or ‘pandemic’ one. The system of influencing factors (socio-economic, manufacturing, statistical, attrition, placebo, geographical, etc.) are exactly what make the one-dimensional linear process a broken solution.

More Reading & Learning

Last Week Tonight with John Oliver, Sunday, May 2, 2021

Application of Systems Thinking in Health: Opportunities for Translating Theory into Practice

Systems Thinking About SARS-CoV-2

5 Principles of Systems Thinking for a Changing Healthcare Ecosystem

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