Pandemics are as much about logistics as they are about public health

At some point, trying to manufacture and distribute a vaccine for a brand new virus, keeping track of who’s gotten it, where it’s going, how long it’s taking and how much you have, is a logistics and data problem — a big one. 

Enter Salesforce, whose whole job is organizing data. The company has introduced new products during the pandemic under the name Work.com. First, it was organizing employees returning to work. Then it offered it to schools as students go back. And now, it’s trying to sell that system to health care organizations and even governments to organize vaccine distribution. That gets the company close to something like electronic medical records, or EMRs. But CEO Marc Benioff told me he’s just trying to solve the one major issue. The following is an edited transcript of our conversation.

Marc Benioff: Think about it like this: You need a command center. You need inventory management for PPE. You need vaccine appointment scheduling. You need to record who have you vaccinated and who haven’t you [and] how often did they get the vaccination. You have to be able to notify them; they need to be able to notify you. You’re going to have a lot of information. And, by the way, this isn’t just going to be the vaccine for COVID-19. This is also going to be basic things like the flu shot, where we’re already working with Texas [and] Chicago, and using our platform for flu. So this is something that everybody has to kind of get ready for the next level of automation, because we’re going to try to do something as one humanity here that hasn’t been done ever, which is vaccinate everyone against COVID-19.

Molly Wood: It sounds like this will be a super useful product, but then will everybody have their sort of individual cloud, their walled-off version of this database, or will they be able to use it collaboratively?

Benioff: Well, it all depends on the actual user themself. They’re going to have to be able to make that decision. Do they want to share this information? How would they share the information? What information would they share? In terms of integrating with EMR systems, that’s a core part of what we do. That idea that you want to be able to have, if you will, a patient relationship management system, the idea that it’s integrated even with your contact tracing system, and now you want to be able to share that information with your electronic medical records. Yes, all of that has to be an option. But different organizations have different levels of privacy requirements. The public themselves, especially in the United States, especially in Europe as well, has the right to say if that information is going to be released or not.

Wood: To be clear, it is a tricky data-sharing situation, but I feel like that’s part of why this is kind of a — is this a little bit of a minefield to walk into, what is approaching, at least what sounds like, electronic medical records?

Benioff: This is absolutely a minefield. This is a situation that is a global pandemic. I mean, this is complicated. This is my first pandemic, I don’t know about you. We have learned a lot just in six months. But I think as we’ve deployed major industrial strength contact tracing, for example, in states like California or Texas. California, where we have 10,000 contact tracers battling this pandemic over the last six months — this has been extremely difficult for the state, for the governor and also for local NGOs who are involved in trying to help bring this all under control. We also have to do our part at Salesforce.

Wood: On that note, actually, Work.com is a for-profit. It’s a product. Do you have a mechanism to make any of these services available for hospitals or governments that maybe can’t afford it?

Benioff: We actually do. We make a lot of accommodations. We have never walked away from any organization who could not afford it. We will always work with every customer. By the way, in this world, this is not just governments we’re talking about. We have a lot of SMBs — small- and medium-sized businesses, even large businesses who are under duress. Of course, we are a company that is going to make accommodations for that customer. We’re never going to walk away from a customer. It’s not part of who we are.

Wood: The equitable distribution of this vaccine is one of the biggest questions out there. Although on its face, no one’s asking you to create a product that will help ensure that, and yet because of Salesforce’s mission, I wonder how you see this playing into solving this big global problem?

Benioff: Well, these are areas that I really cannot bring expertise into. My expertise is really going to be building and deploying the systems rapidly to help us fight the pandemic. That’s where I found my greatest usefulness, and that’s really my focus area today.

Wood: So Work.com has evolved. It started out as a company-focused product, and then move to schools and now has a vaccine component. I feel like you’re going to find yourself in a position where somewhere in your various data centers, you’re going to have information about who’s at work, who’s at school and who’s been vaccinated. But presumably, that information can’t be shared. Is that a strange position to be in, where you potentially have a data loop that can be incredibly valuable?

Benioff: It’s not our data, number one. So you have to remember, we’re just providing information management systems. This is very similar to how we operate with all of our customers. We would never look at a customer’s data. That would be the last thing that would ever happen at Salesforce. If we ever found an employee who was looking at a customer’s data, we would fire that employee. Our job is to make sure the data is safe, that it’s secure, that our customers can share it if they want to, that they can share it with who they want to. But when you look at who our customers are — small businesses, medium businesses, large businesses, governments around the world — we don’t want to look at the data. It’s not our data. We have no right to look at that data. If those customers want to share that data, we will work with them to share that data. But our business is managing the information, managing the applications. And that is what we are focused on: our customer success.

Related links: More insight from Molly Wood

To this entire point, my colleague David Brancaccio and the team at “Marketplace Morning Report” have been doing a series of stories for about a month called “Fast-Track Vaccines” about what a big logistical undertaking  the COVID-19 vaccine is and will be. 

The Atlantic has a piece from earlier this week that’s also about how complicated this campaign is, including a deep dive into the science of the most promising vaccine candidates. Both of them are based on the mRNA technology that we talked about on the show a few months back — a long-promised technology that makes it easier to make and distribute vaccines. In fact, their development has been superfast. Moderna and Pfizer are already moving into clinical trials, but the magazine reports the vaccine candidates are also extremely fragile. They have to be frozen at temperatures as low as minus 94 degrees Fahrenheit, so shipping them is just one challenge, especially shipping small numbers of doses to rural areas because the logistics of cooling trucks and packages that much are tricky at best.

The mRNA vaccines require two doses per person, meaning more shipping and more glass vials, which are scarce. Then, there will be all the stuff Benioff mentioned: inputting data about who’s been vaccinated and getting that data into electronic medical records, sometimes in public health departments that are still using fax machines, as we’ve reported.

It is a logistical nightmare, and as much as I respect the idea of trying to create a for-profit tech solution to help keep track of it all, it would also be reassuring to know that there could be a government response that would help and not actually hurt.