40x Growth in 90 Days

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With a keen interest, I’ve been watching arguably the most audacious scalability effort I’ve seen in my lifetime.

I’m talking about 40x growth in 90 days… in physical goods and the in-person service industry… starting from a base of 100,000 units per day to 4 million per day in under 90 days (as of a few days ago).

If you’re committed to scaling your SaaS business, you’d be crazy not to study other scalability efforts in a variety of fields. There are always lessons to learn.

Now, what is the example I’m referring to? It’s the number of COVID-19 vaccination doses given to patients per day in the United States.

At the start of 2021, the country was giving approximately 100,000 doses per day. A few days ago, we hit 4 million doses per day several days in a row.

While I felt that the U.S. vaccination effort started off much slower than necessary, things are now moving at a rapid clip.

Here are a few observations of what could have been done better and what is going well now.

Before I dive into the details, I’m approaching this situation from two perspectives. By day, I’m an independent board member and CEO coach for founder CEOs in fast-growing SaaS companies. By night, I’m a volunteer first responder and public health worker. I’ve been working at COVID-19 testing and vaccination clinics since March 2020. I’m both an outside observer of the system and a participant within it.

So, what didn’t go well?

1) Early vaccination efforts were very disorganized and not well-honed. As early as March 2020, it was clear that a vaccine would be a key tool, if not the key tool, to breaking the back of the pandemic.

What didn’t happen that should have happened in Q2 2020 was location selection, staffing plans, and workflow procedures designed for mass vaccination clinics.

2) Since public health in the United States is largely executed at the county level, the 3,000 public health departments should have been briefed and given templates for how to run a variety of vaccination clinics (such as a drive-thru clinic, outdoor clinic, indoor clinic, urban high-density clinic, etc.), staffing requirements, and supply requirements.

Obviously, such an effort would require labor… a lot of it.

The process would also require skilled and licensed labor. Only a few professions are legally allowed to inject a manufactured substance into people.

An analysis should have been done to determine if the existing health care infrastructure could be used to deliver the 300 million doses (or 600 million if two doses were needed).

Could existing medical facilities take another 300 million or 600 million patient appointments over a three- or six-month process?

[It doesn’t take a PhD to realize that the existing medical infrastructure couldn’t handle such an effort and would need to be supplemented somehow.]

3) It was also clear that such an effort would require a prioritization and/or queuing process.

Either patients would need appointments, or it would be first come, first served.

If scheduled, a scheduling system is needed. The obvious solution would be to use a web-based software system end-to-end, but some people don’t use computers (elderly) or have access to the internet (low-income). An analog scheduling process would be needed as well.

4) Centralized vs. Decentralized — A decision needed to be made early on regarding which parts of the vaccination process would be centralized (at the federal level) versus decentralized (at the state or county level).

Who handles the communication process? Who handles the scheduling process? Who delivers the vaccine itself?

All of these issues were readily anticipatable issues in April 2020.

All were true regardless of which vaccine would end up being effective.

Key Takeaway:

To scale rapidly, you need to anticipate problems and start working on them before they actually appear.

With my CEOs running SaaS companies growing ARR in excess of 100% per year, I have them identify revenue growth opportunities in 2022 (not 2021) and the obstacles to growth that require lead time. Those activities need to be in the 2021 plans.

Now let’s look at what went well on the vaccine side of things.

1) Multi-sourcing and pre-buy contracts worked well. At the federal level, the government contracted with multiple vendors, bought early, and committed dollars early.

This reminds me of Apple’s supply chain strategy for buying enormous quantities of critical components such as high-performance screens and chipsets.

I think the U.S. did a good job here. There’s a time and place to use your balance sheet to produce the outcome you want. This was one of them. There is a time and place to pay a premium for speed (and to provide capital to suppliers to scale their own capacity or revenue guarantees to satisfy suppliers’ lenders that in turn provided capacity-expansion capital). This is one of them.

2) Local-level scalability plans also went well, after a delayed start. As a volunteer public health worker, I’ve seen my local clinic get their operations really dialed in today and at scale. It’s super impressive.

To be specific, I appreciate that, today, there’s documentation, procedure manuals, workflow diagrams, self-service training, onboarding new staff, etc.

[One of the most valuable roles in a high-scalability operation is the technical writer.

If you want to scale, you have to rely a lot more on procedure and protocols than on talent.]

Seeing the 40x growth in vaccine doses injected in arms U.S.-wide, I am making a bit of an assumption that this level of organization must be happening elsewhere as well.

[While scaling efforts at local levels have improved dramatically, I think it would have been better to handle some of this at the federal level.

For example: Rather than have 3,000 technical writers in the 3,000 county-level public health departments tasked with running a vaccine clinic, it would have made more sense to have one technical writer at the federal level create the initial templates for how to run a high-capacity vaccine clinic.

Rather than having the 3,000 county public health departments run 3,000 vaccine clinic beta programs, it would have been better to have initial alpha and beta programs mocked up and run at the federal level in April 2020, rather than locally in late December 2020.]

3) Volunteer efforts have been quite remarkable. I’ve seen retired nurses come back to help. Doctors, physician assistants, and nurses have been volunteering at vaccine clinics on their days off. I’ve met several retired military veterans who have devoted 2020 and 2021 to work on the pandemic response.

I live a few miles outside of the Seattle city limits in a town with a population of 20,000 people. In my community, 600 people have volunteered at our vaccination clinic. That’s 3%, or one out of every 33 residents. Our clinic takes patients from anywhere in Seattle. We also staff clinics for a neighboring county that doesn’t have the infrastructure and volunteer pool that we do. We have a mobile clinic for patients who are disabled or have mobility issues. It’s really quite incredible to see people from all walks of life contribute toward a shared goal.

I’ve seen similar volunteer efforts throughout the Seattle metro area. Local hospitals put out a call for volunteers to help with vaccine efforts. They were flooded with responses and shut down the program within a matter of days because they had more volunteers than they needed.

The last few years have been incredibly polarizing. Between culture wars, social media algorithms, and an “us versus them” mentality, it has been nice to see a coming together around volunteering to support vaccination efforts.

It is a reminder that together, “we” are stronger and more resilient than divided. I’m glad my kids get to witness some of that.

Overall, the U.S. vaccination effort has been by no means perfect, but I do very much see a light at the end of the tunnel. I do hope the U.S. will continue and expand its efforts to help other nations with their efforts.

COVID-19 variants continue to be a threat (even with vaccines). Even at the global level, “we” are more resilient together. I hope there’s greater action taken in recognition of that going forward.

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