Design – like your life depends on it . . .

Design is constantly talking about the blurring of boundaries, the smashing of silos, and adding some new prefix to the term “disciplinary” to prove that it impacts all facets of life. As a professor in one of those ______disciplinary programs, I also fielded a lot of questions from students about their future: “what, exactly, can I do with a ‘Design Studies’ degree?”

My answer to that was something along the lines of “you can do whatever job you want to – just better.” I meant that they could take jobs in any corporation, any school, fill any role, and they would have a leg up on how to make things better.

Including Healthcare.

The news (pretty much everywhere) has been dominated by stories of the vaccine rollout, and how (pretty much everywhere) it has been a slow one. There has been an effective vaccine available for about a month now, and the arrival of these “silver bullets” has been talked about for many more months.

Yes, there are (some, just a slight puff) political headwinds. Yes, there are realities of how the vaccine needs to be preserved. Yes, there are varied compatibilities between geographies and health networks. Israel has exploited many of its inherent cap/abilities to lead the world by vaccinating just about 40% of its population, and the UAE is doing the same to see just about a quarter of its people vaccinated (all numbers as of Jan 23). After that, the numbers get more and more sobering: the UK (#3, just under 10%), the US (#5, just over 6%), and when the list hits #7 (Germany) the percentage drops below 2% of their population being vaccinated.

That said, there was one story in the US that really pointed out the critical – downright life-impacting – need for design knowledge in all areas of an organization.

The headline read, “[US President] Biden wants to squeeze an extra shot of vaccine out of every Pfizer vial. It won’t be easy.” This article – and a flurry of others – goes on to describe a series of current, known medical facts:

  • Injected medicines are shipped in vials.
  • These medicines are dispensed using syringes.
  • Commonly-used syringes cannot expel the entirety of the medicines in them.
  • Commonly used syringes are single-use, and are disposed along with the residual medicine in them.
  • Pharmaceutical companies ship vials of medicine with sufficient “extra” volume to account for this known waste issue.
  • Given the extreme pressure placed on pharmaceutical manufacturers to deliver as many doses of vaccine as quickly as possible, these manufacturers (had the audacity to) want to “count” the overfill amount as an additional dose.
  • This “overfill” volume is equal to a 20% increase in the number of available doses.
  • But – the only way to dispense these doses is with “specially-designed” syringes, which are – of course – not readily available.

Crazy as it sounds, let’s put COVID-19 aside for a moment . . .

Many are aware of the “Pharma Bro”, Martin Shkreli, who raised the price of a medicine in his portfolio of drugs by a factor of 56 times. (This is a price discussion, not a delivery one – I know that his was a pill, not an injectable. I now return to delivery-related drugs.)

Many others (in the US especially) are much more painfully aware of the not-even-close-to-the-cost-of-water cost of insulin. More than eight million people in the US, and some half a billion people worldwide take some form of injected insulin. For those in the States, a vial of insulin costs around US$300.

And, depending upon how that insulin is being delivered, some US$60 worth of every vial is being thrown away.

The cost of life-saving medicines has been a topic of discussion for years – decades, even. It has always been seen as some mix of government intervention, insurer control, and industry greed. There has always been an element of “process design” in these discussions, who pays for what, when, and how; but to see this very obvious Design 101 flaw is a sobering thing.

Even before the COVID-19 vaccine became available, people were writing about syringes: this article estimated that some 4-8% additional doses could be extracted from the same number of vials that were ordered, if the more efficient syringes were used. For a month now, those doses – around the globe – have been thrown out. For many more years, many other drugs have also met the same fate.

I try to impress upon all students the costs of waste – in materials, in manufacturing, in transportation, in energy consumed. I’ll have to add an additional category.

In lives.