SSRN Id3909792

Submitted to
manuscript
Optimal Scheduling and Policy Design of Two-Dose

Vaccination Rollout
Chaithanya Bandi
NUS Business School, National University of Singapore, Singapore, bizchaba@nus.edu.sg
Sarah Yini Gao

Lee Kong Chian School of Business, Singapore Management University, Singapore, yngao@smu.edu.sg
Rajeeva Moorthy
The Institute of Operations Research and Analytics, National University of Singapore, rajiv@nus.edu.sg
Kelvin Bryan Tan

The Ministry of Health, Singapore, Kelvin Bryan TAN@moh.gov.sg
Chung-Piaw Teo
NUS Business School, The Institute of Operations Research and Analytics, National University of Singapore,
bizteocp@nus.edu.sg
Problem Definition: The rollout of the COVID-19 vaccine presents a complex challenge that involves coor-
dinating supply scheduling, capacity planning, and demand management. Vaccines are in limited supply
and often have irregular schedules, while appointment bookings significantly influence vaccine take-up and
demand. Effectively releasing appointment slots is crucial to reducing blockages in the booking system, min-
imizing waiting times for vaccination, and maximizing vaccination rates.
Methodology/Results: This study proposes an optimization framework for controlling the release and
booking of two-dose COVID-19 vaccine appointments and optimizing invitation schedules. The framework
aims to maximize vaccination rates while minimizing appointment waiting times, considering limited vaccine
supplies and uncertain demand patterns. The framework is integrated into a simulation tool that generates
vaccine take-up estimates based on optimized appointment bookings and invitation schedules, enabling the
evaluation of various vaccination rollout policies for policy guidance.
Managerial Implications: The optimization model and simulation tool developed in this study provide
support for the Singapore Ministry of Health in vaccine rollout and policy evaluations. Notably, the Singapore
government implemented a policy to double the interval between the first and second vaccine doses during
the campaign to enhance the vaccination rate. Our policy evaluation indicates that this interval-stretch
policy could save 30 days in vaccinating 4 million residents with at least one dose, compared to the non-
stretch policy. By implementing this interval-stretch policy at the appropriate time, Singapore significantly
accelerated its vaccination rate, ensuring a vaccination rate of over 75% by September 2021, just before
the Delta variant outbreak in the country. The successful implementation of this policy was one of the key
factors contributing to the low number of deaths in Singapore.
Key words : COVID-19 | Vaccine | Optimization | Copositive program
Electronic copy available at: https://ssrn.com/abstract=3909792

: Optimal Scheduling and Policy Design of Two-Dose Vaccination Rollout
2 Article submitted to ; manuscript no.
1. Introduction
Since the publication of the genetic sequence of SARS-CoV-2, the coronavirus responsible for
COVID-19, significant efforts have been dedicated to developing vaccines against this epidemic
disease and identifying priority groups for vaccination, aiming to protect lives and curb the spread of
the virus. The ability to swiftly translate vaccines into vaccinations has been pivotal in the fight to
restore normalcy. Early on, the primary bottleneck in this endeavor was the supply of vaccines, given
the global demand and the time required for production and distribution scale-up. Many countries
faced potential delays or shortages due to limited production rates and logistical constraints. On
the demand side, vaccine hesitancy resulted in not all eligible individuals coming forward to receive
vaccines. Furthermore, public attention and discussions surrounding immunization mechanisms,
potential side effects, and associated risks led to preferences for specific vaccine types or, in some
cases, a complete aversion to vaccination (Booth and Adam 2021, Dai and Song 2021). These
factors, namely vaccination hesitancy and the mismatch between vaccine supply and preference,
posed significant barriers to achieving a rapid and efficient vaccination process. Consequently,
certain vaccine types faced longer waiting times while others experienced higher rates of leftover
and expired doses. Overcoming these challenges necessitated a well-coordinated supply chain and
synchronized demand planning to achieve a high vaccination rate.
The majority of authorized COVID-19 vaccines require a two-dose regimen with specific recom-
mended intervals (e.g., 21 days for Pfizer vaccines and 28 days for Moderna). The recommended
time intervals require a careful design of the rollout policy such that individuals can complete two
doses adhering to the timing requirement. The challenge is to ensure the availability of vaccines
for the second dose given that future supply may not be sufficient. Pertaining to this unique chal-
lenge, various vaccine rollout policies were proposed and implemented in different countries. For
instance, Singapore initially adopted a conservative “holdback” policy, following the manufacturer-
recommended two-dose interval, which reserved an extra dose for every recipient of the first dose.
This policy aimed to eliminate the risk of vaccine shortages in case of supply constraints but resulted
in a slower uptake of first doses. A similar holdback policy was also initially implemented in the
United States. In an effort to accelerate the vaccination rate, the U.S. government transitioned to
a “stock-release” policy, which eliminated intentional reserves for second doses (Murray 2021). On
the other hand, the U.K. government opted for a “stretch” policy, extending the two-dose interval
from the manufacturer’s recommendation to 12 weeks (GovUK 2020). Other countries, such as
Canada, followed similar strategies after observing a surge in cases. Both the release and stretch
policies, compared to the holdback policy, expedite the administration of first doses, enabling
more individuals to acquire partial immunity sooner. However, these policies come with the risk
of delaying the administration of second doses, particularly during supply shortages. To enhance

Article submitted to ; manuscript no. 3
vaccine coverage and respond effectively to the evolving situation, healthcare authorities need to
dynamically adjust their policies at different stages of disease control.
1.1. Research Scope

Our research is based on Singapore’s experience in rolling out COVID-19 vaccinations to its pop-
ulation and is conducted in collaboration with the Singapore Ministry of Health (MOH).
Singapore authorized the use of the Pfizer vaccine for individuals aged 16 years and older on
December 14, 2020, marking the initiation of the country’s vaccination campaign (MOH 2020).
The vaccination program was implemented in a phased manner, prioritizing specific subgroups of
the population who were at higher risk of exposure or more susceptible to the virus. This approach
aimed to provide early protection to vulnerable populations. To ensure a systematic and organized
process, the population’s participation in the vaccination program was managed through daily
caseloads. Invitations for vaccination were sent out, and appointments were scheduled using the
centralized National Appointment System. Residents were able to book appointments for both their
first and second doses simultaneously and select their preferred vaccination center (VC). In order
to maintain consistency and prevent vaccine mixing, each VC offered only one type of vaccine.
As Singapore faced a surge of COVID-19 cases in early 2021, the priority was to ensure a larger
number of individuals received at least partial protection against the virus in a timely manner.
This raised the question of whether an aggressive rollout strategy, aimed at increasing the rate of
first-dose vaccinations, such as reducing second-dose reserves or stretching the two-dose interval,
was necessary and when it would be appropriate to initiate such a switch. While release and stretch
policies have been implemented in other regions, the risk-benefit analysis of single-dose versus full
protection has been the subject of ongoing studies and debates, without a clear consensus (e.g.,
Robertson and Sewell 2021, Robertson et al. 2021, Moghadas et al. 2021, Voysey et al. 2021).
However, more recent scientific evidence has emerged in support of delaying dosing strategies (e.g.,
Voysey et al. 2021, Payne et al. 2021, Hall et al. 2022, Martinez and Ooi 2022). The aforementioned
studies primarily explore the clinical implications at an individual level from the perspective of
vaccine efficacy. Nevertheless, the success of a vaccination program heavily relies on its practical
implementation, which is complicated by operational considerations (Mak et al. 2022, Dai and
Song 2021, Silva et al. 2021, Moghadas et al. 2021). Paltiel et al. (2021) specifically emphasizes
that “factors related to implementation will contribute more to the success of vaccination programs
than a vaccine’s efficacy as determined in clinical trials.” For example, an aggressive policy may
not be feasible due to limited vaccine supply. Simultaneously, aggressively accepting vaccination
appointments could lead to bottlenecks in the booking system and long queues at vaccination
centers. Perceptions of vaccine inaccessibility and inconvenience may further exacerbate vaccine

hesitancy. It is essential to explore analytical approaches that address these operational challenges
and evaluate policy performance concurrently with clinical studies. In the following, we summarize
the primary operational decisions faced by Singapore vaccination rollout implementations.
In the context of vaccination rollout, a critical decision that significantly impacts the performance
of the rollout policy is determining the number of daily first-dose and second-dose appointments
to be released in the appointment booking system, referred to as the ”daily appointment booking
limits” for each dose. For instance, under the holdback policy, the first-dose booking limit is set as
half of the available vaccines, while the release policy increases it to match the current stock level.
These two policies represent the extremes of a design spectrum, with one being overly conservative
and the other carrying higher risk. The number of the first doses administered is strategic to
the performance of a rollout policy. Specifically, the current first-dose bookings determine future
second-dose bookings with the strict dose-interval requirement, which, in turn, affects (blocks) the
capacity to accommodate future first doses. This endogeneity is difficult to address by myopic
approaches such as holdback or release policies that either hold a full reserve of the second doses
or none at all. A systematic approach that accounts for the endogeneity between first and second
doses and models it dynamically would enable better control and coordination of the vaccination
process.
Invitation Schedules and Booking Pattern. Controlling the number of eligible people in
each invitation wave is another way to manage demand for vaccinations, in addition to booking
limits. In the countries that allow walk-ins, no control over demand arrivals is imposed. It may put
a great challenge to the vaccination center’s operation when vaccination capacity is limited. Singa-
pore mostly uses invitation-only appointments to shape the demand and consumption of vaccines.
The invitation is extended to each eligible subgroup in phases and suitably staggered to avoid
appointment competition and delays. Long lead time has been shown to discourage appointment
bookings and lead to a high rate of appointment cancellation and no-shows (Green and Savin
2008), thus exacerbating vaccine hesitancy. Designing a reasonable invitation schedule that reduces
the appointment waiting time without slowing down the vaccination rate is crucial to an effective
rollout policy. Another phenomenon that adds to the complexity of the problem is that not all
invitees immediately book appointments on the nearest date available. There are time lags between
the time of receiving an invitation and the time slots selected by the invitees. Figure 1 shows the
typical booking patterns (time needed to take up a slot in the system) for three early invited groups
in Singapore. It shows booking patterns peak one to two weeks after an invitation. These factors
should be taken into account when designing invitation schedules.
We support the MOH on vaccine rollout policy design by developing an “optimization + simu-
lation” framework. For a given policy, optimization models are formulated to optimize operational

decisions, including appointment booking slot release and invitation schedule to minimize the peo-
ple’s waiting time to get the first dose appointment and maximize the vaccination rate. This is
followed by a simulation model that projects future vaccine take-ups under the optimized oper-
ations and evaluates the policy performance in terms of vaccination rate and others that matter
to the policy-maker. By comparing various performance measures simulated for policy candidates
under the optimized operations, the framework provides policy recommendations.
1.2. Contributions and Policy Implications

The key results and contributions are summarized as follows.
COVID-19 Vaccine Rollout Optimization Framework: The proposed optimization frame-
work introduces a vaccine rollout policy that incorporates two operational elements: appointment
booking limits and an invitation schedule. This policy is designed to meet the unique challenge
posed by the two-dose requirement of the COVID-19 vaccine. Rather than basing administration of
the first and second doses solely on current stock levels, the model utilizes future supply projections
to manage the demand for both doses. The invitation schedule adds another layer of control, aim-
ing to minimize the waiting time for booking appointments. Our flexible framework can generate
multiple policy options accommodating different risk levels.
Linear and Conic Programming-based Open-source Simulation Tool: We demonstrate
that the problems of designing booking limits and scheduling invitations can be formulated as a
linear program and a conic program, respectively. By redefining waiting time in accordance with
each individual’s arrival sequence in the booking system, we can effectively model the propagation
of appointment booking delays. This approach bypasses the challenges traditionally associated with
modeling such phenomena in standard appointment systems. The optimization framework, when
combined with a subsequent simulation model, has been developed into an open-source simulation
tool, named “Vaccination Appointment Optimization Suite” (VaxOS). This tool supports vaccina-
tion operation decision-making, allowing policymakers to adapt policies according to the evolving
pandemic situation, and to evaluate different policy parameter combinations. Crucially, VaxOS is
not exclusive to COVID-19 vaccinations; it can be adapted to schedule any scarce resource requiring
multiple usages with time-interval constraints.
Figure 1 Actual booking patterns for three early priority groups in Singapore. The values on the y-axis are blinded
due to the sensitive nature of the data.

Policy Implications: Using the optimization and simulation framework in the context of Sin-
gapore, we evaluated various vaccine rollout policies, considering different levels of second-dose
reserves and two-dose intervals. As of March 2021, our framework helped us study numerous alter-
natives and we found that a shift in mid-May towards an aggressive policy of a 6 (8) week stretch
interval for Pfizer (Moderna) with a 3-week reserve would save 30 days in vaccinating 4 million
residents with at least one dose, without risk of vaccine stockout. Interestingly, Singapore did tran-
sition from a holdback policy to a stretch policy that doubled the two-dose interval in May 2021.
As a result, they achieved a 75% vaccination rate by September 2021, fortuitously just before the
arrival of the first major wave of the Delta variant in the country (see Figure 2). The course of
history may have been significantly different had this change in policy not been implemented in a
timely manner.
Figure 2 (Color online.) Color-coded curves are vaccination take-up rate (full regimen) by age group. The data is
extracted from Data.Gov.Sg; The black curve shows the daily reported COVID-19 Cases (OurWorldIn-
Data 2023). It shows that more than 75% of the population was vaccinated before the first major
COVID-19 wave of infections hit Singapore in September 2021.
2. Literature Review
Our paper makes a significant contribution to the existing body of literature that explores oper-
ational challenges in the COVID-19 vaccination process. The unique two-dose regimen of the
COVID-19 vaccines necessitates a departure from the results obtained from studies primarily
focused on single-dose vaccines (e.g., Chick et al. 2008, Arifoğlu et al. 2012, Yamin and Gavious
2013, Arifoğlu and Tang 2021). In a different context, Duijzer et al. (2018) addresses the allocation
of a general vaccine in both single and multi-dose settings.
Recent work by Oceguera-Castillo et al. (2022) offers a systematic review of COVID-19 vac-
cination research, encompassing elements such as vaccine allocation, storage, distribution, and
administration operations. Dai and Song (2021) outlines key challenges encountered in COVID-
19 vaccination operations, including the management and matching of supply and demand, and

the allocation of first and second vaccine doses. Additionally, they highlight the complexities of
appointment scheduling. In a similar vein, Zhang et al. (2021) delves into the optimization of pub-
lic policies in light of individual responses and addresses the question of vaccination prioritization
amid limited vaccine inventory. Bennouna et al. (2022) proposes the incorporation of COVID-19
case predictions into vaccine allocation optimization. Chen et al. (2020) presents a study on the
allocation of the COVID-19 vaccine among different age groups under limited supply. Innovative
solutions such as the use of drone technology for equitable vaccine distribution are explored by
Wang et al. (2023), while Karakaya and Balcik (2023) designs a national pandemic vaccination
calendar to maintain a reliable schedule in the face of uncertain supplies. A closely related study by
Mak et al. (2022) sheds light on the unique two-dose challenge and investigates its implications on
the effectiveness of vaccine rollout by comparing three existing rollout policies: holdback, release,
and stretch, under limited supply. Our paper builds on these insights by proposing a methodology
for deriving the optimal rollout policy. While Tuite et al. (2021) also compares rollout policies under
limited supply, they do not consider operational decision-making. Bai et al. (2023) explores the
allocation of limited vaccine supplies between first and second doses, focusing on the comparison of
prioritizing first-dose and second-dose usage. Calafiore et al. (2023) optimizes the administration of
first and second doses under uncertain vaccine supplies to maximize vaccine coverage. In contrast
to the aforementioned studies, our research seeks to integrate operational decision optimization,
such as daily dose administration and invitation scheduling, with vaccine rollout policy evaluation.
Our ultimate goal is to provide a comprehensive decision-support tool for policymakers.
Our paper finds considerable alignment with the expansive body of literature on immunization
scheduling and appointment scheduling. However, it specifically addresses the unique challenges
associated with the COVID-19 vaccination process, which are characterized by an urgent timeline
and a limited supply of vaccines. These challenges are generally not present in the scheduling
problems associated with other vaccines, which are typically not administered under pandemic
conditions (see, for example, Engineer et al. 2009, and the references included therein). For a
detailed review on appointment scheduling, the readers can refer to Cayirli and Veral (2003), which
presents an extensive review on appointment scheduling in outpatient services, and Gupta and
Denton (2008) that highlights various healthcare issues and challenges. The majority of works
studied in appointment scheduling literature consider a single appointment for each patient. The
subsequent repeat visits are considered new arrivals that are independent of previous visits. The
two-dose requirement feature cannot be captured. A more related paper, Yu et al. (2020), considers
the appointment scheduling for patients with a “series” of appointments. They highlight an issue
faced in such an appointment scheduling system similar to the “blocking phenomenon” we observe
in the two-dose vaccination context that the follow-up visits take up capacities to get new patients.

They optimally determine the staffing levels to maximize the healthcare system’s revenue. Given
that the staffing level that constrains the available appointment slots is on a daily basis, an MDP
model is adopted. The key difference in the context of vaccine appointment bookings is that we need
to control the waiting time and consider vaccine supplies which constraints the total appointment
bookings across periods.
The principle of booking limits is widely utilized across various applications in revenue manage-
ment, such as airline scheduling and capacity allocation (Talluri and Van Ryzin 2004), particularly
when limited capacity or supply must be apportioned across multiple demand streams. In the sce-
nario of COVID-19 vaccination, strategic allocation of the vaccine supply is crucial for both first
and second doses. This paper takes the concept of booking limits a step further by applying it to
cases where each demand necessitates two units of “products”, which must be fulfilled within a set
time interval.
Organization of the Paper

The structure of this paper is as follows: §3 introduces the optimal framework, including appoint-
ment booking limits optimization and invitation schedule design. The simulation model for policy
candidate evaluation under optimized operations is discussed in §4. §5 provides a numerical study
for insights into the optimal operational decision, while §6 presents a case study of COVID-19
vaccination rollout conducted for the MOH. The paper concludes in §7, and all proofs can be found
in the E-Companion EC.1.
Notations. bold letters denote vectors, ˜· indicates a random variable, and T refers to the transpose
operation. ⟨A, B ⟩ represents the inner product of two matrices, while ◦ denotes the Hadamard prod-
uct. diag(A) refers to the diagonal elements of matrix A. A ≽cp 0 or A ≽co 0 signifies that matrix
A is a completely positive or a copositive matrix, respectively. Completely positive and coposi-
tive programs are N P -hard problems, defined as linear programs over completely positive cones
and copositive cones, respectively. These can be approximated by tractable cones in a sequence of
approximation hierarchies. Here, we approximate the copositive cone by an inner approximation,
involving an SDP cone and a nonnegative cone (de Klerk and Pasechnik 2002, Parrilo 2000).
3. Optimization Models
We consider a policy candidate parameterized by two parameters: (i)“safety lead time” denoted by
k, representing the number of days of reserve kept in the system for future second-dose appoint-
ments, and (ii) “two-dose stretch interval” denoted by I, representing the interval in days between
the first and second doses. These parameters determine the level of conservatism in the vaccine
rollout policy. In this session, we introduce optimization models that optimize key operational

decisions for a given policy. Specifically, for a policy with parameter (k, I), the goal is to determine
the optimal number of slots to release (i.e., booking limits) and the optimal number of people
invited (i.e., invitation schedule) into the system for appointment booking. In the next session, we
will present the simulation model so that it facilitates the performance comparison among policies
(with optimized operations) of different parameters (k, I).
3.1. Appointment Booking Limit with Second-Dose Reserve

The objective of the booking limits is to achieve a high throughput (i.e., first-dose vaccination rate)
while minimizing waiting time. Notice that the throughput is highest when all the population is
invited at once on Day 1, and we call this one-wave invitation schedule “throughput-maximizing.”
To ensure that the obtained booking limits can maximize vaccination throughput, we consider
only the booking limits associated with the throughput-maximizing invitation schedule as feasible
policies in the appointment booking limit optimization problem. Within the set of throughput-
maximizing booking limits, our aim is to identify the one that provides the best appointment-
waiting experience. Therefore, the objective of the optimization problem is to minimize the total
cumulative number of people waiting for their first doses under the throughput-maximizing invita-
tion schedule. It is worth noting that if there are multiple authorized vaccine brands (denoted as
B), the booking limits are solved separately for each vaccine type and represent aggregated limits
across all vaccination centers offering the same vaccines.
T Planning horizon of the first-dose appointments (in days). r Population take-up rate of vaccine invitations.
Parameter
N Total number of eligible population. B Number of types of vaccines.
µt the expected proportion of the invited population choosing appointments on Day t.
Appointment Booking Limit Optimization
I Two-dose interval (in days). Ct Vaccination capacity on Day t.
ms Mini-stretch interval (in days). sut Amount of vaccine supplies arrive on Day t.
Parameters
k Safety lead time. slt Amount of vaccines that are expired on Day t.
Number of individuals prefer an appointment on Day t Number of individuals waiting for the first-dose appointments
Dt wt
under throughput-maximizing invitation schedule. on Day t.
Number of people having the first-dose appointment on Day t
xt The first-dose appointment booking limits on Day t. zt,t′
Decision and the second-dose appointment on Day t′ .
Variables yt The second-dose appointment booking limits on Day t. vt The buffer of expired vaccines on Day t.
Invitation Schedule Design
Iˆ Invitation interval. λ Weight in the objective function of the unfilled booking slots.
Parameters
M Number of invitations (waves) in the planning horizon. li The proportion of people that prefer vaccine type i.
Random
p˜t Random variable denoting the choice probability of an appointment on Day t.
Variable
Decision
nm Number of individuals to invite in Wave m.
Variable
Table 1 Parameters and Notations
The notations and parameters used in the model are summarized in Table 1. Let T denote the
planning horizon for the first dose (in days). Therefore, the second dose is administrated over
t = I, ..., T ′ days, where T ′ = T + I + ms . The mini-stretch, denoted by ms , offers flexibility in
the operation. In the case of a strict two-dose interval requirement, ms = 0. There is a total of N
eligible population to invite, and the take-up rate is r. Hence, a total number of rN individuals will
book the appointments. Let µt denote the expected proportion of the invited population choosing
appointments on Day t, and Dt denotes the throughput-maximizing demand arrival pattern, that

is the estimated number of individuals who prefer to book a first-dose appointment on Day t if
they are invited on Day 1, i.e., Dt = rN µt . Note that the actual booking day might not be the
same as their preferred booking day if the booking limit is not enough to accommodate everyone
sharing the same preference. In this case, they have to book the next available slots, and this time
gap amounts to waiting time in our context.
The demand arrivals (upon invitation), i.e., µt , are estimated from historical appointment book-
ing data (e.g., Figure 1) considering an estimated response rate to reflect vaccine hesitancy. Given
that such booking pattern data was collected during the phase when vaccine supply and the VC
capacity were sufficient compared to the number of the eligible population in the subgroup, the
booking patterns were not censored and reflected the general booking behavior when residents have
been invited to the appointment system. Note that the throughput-maximizing demand arrival
pattern is not the actual demand arrivals. It is the hypothetical input for the booking limits opti-
mization to guarantee high throughput. Therefore, in the design of the booking limits, which is a
tactical operation decision, Dt is given and deterministic. It is also worth mentioning that under the
throughput-maximizing invitation schedule, the waiting time to get an appointment will be very
large. Therefore, we need to leverage the invitation schedule optimization (introduced in Section
3.2) to optimally stagger the demand arrival to further reduce the waiting time without sacrificing
throughput. In that optimization problem, we have to control the actual demand arrivals, which
are random. With the historical data on demand arrival patterns (Figure 1), we estimate partial
distribution information of the random daily arrival and adopt a distributionally robust model.
Let sut be the number of projected vaccine supplies that arrive on Day t. We treat sut to be the
supplies taking into account the supply uncertainty, such as worst-case supply quantities. Note
that such a treatment using the conservative estimate for supply sui is equivalent to adopting a
robust model. Let slt be the expired amount of vaccines at time t, which can be obtained given the
supply schedules and expiry date information. Ct denotes the vaccination capacity on Day t.
The key decision variables are the first and second-dose booking limits on Day t, denoted by
xt , t = 1, ..., T and yt , t = 1, ..., T ′ . The objective is to minimize the total cumulative number of
individuals waiting to get the first-dose appointments, denoted by Z(x, D). Let Z ∗ be the optimal
value, and we have the following formulation of the optimization problem.
Z ∗ = min Z(x, D)
x,y,z,v
s.t. zt,t′ = 0, t′ ̸= t + I, ..., t + I + ms , (1a)

X
zt,t′ = xt , t = 1, ..., T, (1b)
t′
X
zt,t′ = yt′ , t′ = 1, ..., T ′ , (1c)
t

min{t+k,T ′ }
X X X
(xi + yi + vi ) + yj ≤ sui , t = 1, ..., T ′ , (1d)
i:i≤t j=min{t+1,T ′ } i:i≤t
min{t+k,T ′ }
X X X
(xi + yi + vi ) + yj ≥ sli , t = 1, ..., T ′ , (1e)
i:i≤t j=min{t+1,T ′ } i:i≤t
′
xt + yt ≤ Ct , t = 1, ..., T , (1f)
xt , yt , zt , vt ≥ 0, t = 1, ..., T ′ . (1g)
where zt,t′ , t = 1, ..., T, t′ = 1, ..., T ′ denotes the number of individuals having the first dose at t and
the second dose at t′ , vt denotes the buffer for accounting the expired vaccines. The first three
constraints establish the two-dose interval requirement with a mini-stretch. Specifically, it ensures
that if the first-dose appointment is made on Day t, the second-dose appointment can only be made
on Day t + I to t + I + ms . The fourth constraint ensures that the vaccine supplies are sufficient
to fulfill the first and second booking limits and the next k days second-dose future bookings. The
fifth constraint models the expiration of the vaccines, and the last one is the capacity constraint.
The reformulation of Z ∗ requires a characterization of the objective function Z(x, D). To char-
acterize the waiting time, we adopt a reformulation technique in appointment scheduling literature.
For intraday appointment scheduling, patients arrive according to the appointment time, and the
waiting time captures the difference between the arrival time and the service starting time. Patients,
once they arrive, prefer to be served soonest. Therefore, to directly apply the reformulation tech-
nique, the following assumption is required.
Assumption 1. The individuals arrive in the appointment booking system on the day of their
most preferred appointment day.
However, this assumption generally does not hold in our context. Specifically, the “waiting time”
we consider is defined as the delay to get the first-dose appointment from the individual’s desired
appointment day to capture how the actual appointment deviates from the individual’s preferred
slot. For example, an individual enters the appointment booking system on Day 1 to book an
appointment two days later on Day 3; however, he can only find an available slot on Day 5. The
waiting time is (5 − 3) = 2. Assumption 1 implies an overestimated waiting time of (5 − 1) = 4.
In general, tracking the waiting time of each individual in such an appointment system is complex.
It may be driven by the desire of the individual to book an ideal appointment slot later into
the calendar, for instance, a preference to find a slot on a weekend vs. a weekday. Hence not
all the physical waiting times experienced in the appointment system are driven by scheduling
issues. Furthermore, the booking process of different individuals may crisscross in the system —an
individual who logs in to the appointment system later may actually get an appointment earlier

than those who enter the system earlier than him. To overcome this challenge, we can show that
Assumption 1 can be valid by a simple exchange of appointment slots for those who crisscross each
other if people prefer to have the closest appointment to their preferred day. Consider, for example,
invitee A arrives on Day 1 and prefers an appointment on Day 4; invitee B arrives on Day 2 and
prefers an appointment on Day 3. Currently, there is no slot available on Day 3 and only one slot
left on Day 4. Given that invitee A arrives early, he can take the one slot on Day 4. Invitee B can
get the earliest appointment on Day 5 and incur a waiting time of 2 days. With this assumption,
we interchange the arrival sequence of A and B, so that invitee B is assumed to arrive early on Day
3 and takes up the only one slot on Day 4 with a waiting time of one day. Invitee A is assumed to
arrive on Day 4 and fails to book his desired slot and get an appointment on Day 5 with a waiting
time of one day. Despite the deviations in tracking each individual’s waiting time, this assumption
does not affect the calculation of the total waiting time for all the individuals. Given that all the
individuals prefer to have the closest appointment to their preferred day, we can exchange any
two individuals in the system —the overestimation and underestimation offset each other. That is,
we can re-assign the appointment slots to different individuals to ensure that first-come-first-serve
holds in the appointment system, without affecting the aggregate waiting times of all in the system.
This simple transformation simplifies the problem significantly, but the price to pay is that we only
have aggregate waiting time information and could not piece together the individual’s waiting time
experienced in the system. With this, we can ensure the validity of Assumption 1.
In the rest of the paper, instead of directly working on the total waiting time for the first doses,
we consider minimizing the cumulative number of people waiting for the first doses. The average
waiting time can be obtained from the cumulative number of people waiting by factoring in the
throughput, using Little’s Law. Under Assumption 1, we can iteratively characterize the objective
function, Z(x, D), that is, the total cumulative number of people waiting for the first doses. Let
wt denote the number of people waiting for the first dose on Day t, t = 1, ..., T .
w1 = max{0, D1 − x1 }, w2 = max{0, D2 − x2 + w1 }, ..., wt = max{0, Dt − xt + wt−1 }.
We can reformulate Z ∗ as the following linear program.

T
P
min wt
t=1
s.t. w1 ≥ D1 − x1 ,
wt − wt−1 ≥ Dt − xt , t = 2, ..., T,
wt ≥ 0, t = 1, ..., T,
(1a) - (1g).
The appointment booking limits can, therefore, be efficiently solved. The average waiting time
T
for the first doses is the optimal value divided by the total first-dose booking limits, i.e., Z ∗ / x∗t .
P
t=1

3.2. Invitation Schedule Design

The booking limit optimization model maximizes throughput, by imposing a limit on the number
of first-dose appointments the system can accept each day, based on the supply schedule of the
different types of vaccines that the government has negotiated with the manufacturers. However,
given that the actual demand is driven by the invitation sent out to the citizens, we next improve
the waiting experience in the appointment system, by staggering the booking invitations sent
out over multiple periods. Specifically, the invitation schedule design takes the optimal first-dose
appointment booking limits as inputs and determines the number of people to invite in each wave
so that the experienced waiting time for appointment booking can be further reduced. Having
periodic invitations in batches also allows the policymaker to dynamically adjust and calibrate
their policy based on the responses. This can be done by solving the invitation schedule in a rolling
horizon manner, and it provides guidance based on updated information, such as demand arrival
patterns, vaccine preference, response rates, etc.
There are two properties we impose when designing an invitation schedule. Firstly, the invitation
schedule is designed to minimize the total cumulative number of people waiting for the first doses.
Secondly, the demand arrivals induced by the staggered invitation schedule can utilize the optimal
booking limits as much as possible. The first property is to control the waiting time to get an
appointment, and the second property ensures the multiple-wave arrival pattern can be shaped
according to the optimized booking limits designed to guarantee a high vaccination rate. Therefore,
the objective is to minimize the total cumulative number of individuals waiting to get the first
doses and minimize the unfilled first-dose appointment booking slots.
In general, the authority does not dictate which vaccine type an individual chooses. Therefore,
the invitation usually is not done for each vaccine type. If the preference over vaccine types is not
prevalent, the invitation schedule can be designed considering the aggregated booking limits across
multiple vaccine types. In the case that populations display a strong preference over one type, the
invitation schedule design needs to take the preference as an additional input so that the invitation
schedule can match the optimal booking limits of each vaccine type. In the following derivation,
we first study the case without vaccine preference and denote the aggregated booking limits as
B
x∗ := x∗ (i) , where x∗ (i) is the optimal first-dose booking limits of vaccine type i. We will present
P
i=1
the case with vaccine preference in Section 3.4.
3.3. Without Vaccine Type Preference

The model’s inputs consist of the obtained optimal first-dose booking limits, x∗ , from the appoint-
ment booking limit optimization model and a pre-specified invitation frequency; for example, the
invitation can be issued once every two weeks. We denote Iˆ as the interval between two consecutive
invitations and let M be the total number of invitations issued within the planning horizon T .

We assume once an invitation is issued, invited individuals have preference over the first-dose
appointment date represented by a choice probability, i.e., for an appointment on Day t, an indi-
vidual i will prefer it with probability pit . We model the heterogeneous choice probability among
different individuals by treating the choice probability as a random variable, denoted as p̃t . Given
that it is difficult to fully and accurately characterize the joint distribution of p̃t , t = 1, ..., T , we
assume only the first two moments are known, denoted as µ and Σ. Note that µ is proportional to
D in the previous section. We adopt a distributionally robust perspective and optimize the invi-
tation schedule to hedge against the worst-case scenario of distribution. Specifically, let P + (µ, Σ)
denote the uncertainty set of p̃t , defined as follows.
 
 E[p̃] = µ, E[p̃p̃T ] = Σ, 
P + (µ, Σ) = p̃ = (p̃t )Tt=1 P
T
 p̃t = 1, a.s., p̃ ≥ 0, a.s.. 
t=1
Assume that µ and Σ take values such that

the uncertainty set is nonempty, i.e., the first-two
T
1 µ
moments satisfy 1′ µ = 1, 1′ Σ1 = 1, ≽cp 0. The first-two conditions guarantee the total
µ Σ
probability is 1, and the completely positive conic condition ensures any realization of p is non-
negative (Natarajan et al. 2011). The optimization objective is to determine the number of people
invited in each wave, denoted by nm , m = 1, ..., M , to minimize the worst-case expected total num-
ber of individuals waiting to get the first-dose appointment and unfilled first-dose booking slots.
Let Z(n, x∗ ) denote the weighted sum of the total cumulative number of individuals waiting for
the first-dose appointments, Z w (n, x∗ ) (with a weight 1 − λ), and unfilled first-dose booking slots,
Z x (n, x∗ ) (with a weight λ). We have the invitation scheduling design problem as follows.

∗
min max E[Z(n, x )]
p̃∼P + (µ,Σ)
M
P (2)
s.t. nm = N,
m=1
nm ≥ 0, m = 1, ..., M.
T
x∗t + wT − rN , where wT is the number
P
Note that the total number of unfilled booking slots is
t=1
of individuals waiting for an appointment at time T (the end of the horizon). Therefore,
Z(n, x∗ ) = (1 − λ)Z w (n, x∗ ) + λZ x (n, x∗ )

T T
= (1 − λ) wt + λ( x∗t + wT − rN )
P P
t=1 t=1
−1
TP T
x∗t − rN )
P
= (1 − λ) wt + wT + λ(
t=1 t=1

Z(n, x∗ ) can be similarly reformulated as a linear program using the iterative waiting time deduc-
tion. The following is the dual problem of the linear program. Due to strong duality, it is an
equivalent characterization of Z(n, x∗ ).
!
T ˆ
t/P
I+1 T
Z(n, x∗ ) = max rnm p̃t−(m−1)Iˆ − x∗t αt + λ( x∗t − rN )
P P
αt ,βt t=1 m=1 t=1
s.t. αt − αt−1 − βt = −(1 − λ), t = 2, .., T, (3)
−αT − βT +1 = −1,
αt , βt ≥ 0, t = 1, ..., T.
3.3.1. Copositive Program Reformulation We rewrite the inner linear problem (3) in a
general form as follows with a proper definition of coefficient matrices, A, B and C(n) which is
linear in the first-stage decision n.
T
Z(n, x∗ ) = max p̃T C(n)α − x∗ T α + λ( x∗t − rN )
P
αt ,βt t=1

α (4)
s.t. A B =b
β
αt , βt ≥ 0, t = 1, ..., T.
The inner distributionally robust problem, max E[Z(n, x∗ )] is therefore, a problem of find-
p̃∼P + (µ,Σ)
ing the moment bound of a linear optimization problem with random objective coefficients. To
solve this problem, the main challenge lies in the evaluation of the expectation under the worst-
case distribution. This requires us to obtain an explicit characterization of the ambiguity set P + .
There has been development in the distributional robust optimization field on reformulations using
completely and copositive programs (e.g., Natarajan et al. 2011, Xu and Burer 2018a,b). Following
the same line, we can show that inner distributionally robust problem, max E[Z(n, x∗ )] is also
p̃∼P + (µ,Σ)
equivalent to a completely positive program.
Consider the following completely positive program with decision variables, qα , qβ , Xα , Xβ , Yα , Yβ
and Xαβ . Proposition 1 establishes the equivalence between this completely positive program and
the inner distributionally robust problem.
T
max ⟨C(n), Yα ⟩ − x∗ T qα + λ( x∗t − rN )
P
t=1
qα
s.t. A B = b,
qβ
Xα Xαβ T
diag A B T AB = b ◦ b, (5)
Xαβ Xβ
T T T 
1 µ qα qβ

 µ Σ Yα Yβ 
 q Y T X X  ≽cp 0.
α α α αβ
qβ YβT Xαβ
T
Xβ
Proposition 1. max E[Z(n, x∗ )] is equivalent to the completely positive program (5).

p̃∼P + (µ,Σ)

By considering its dual copositive program, we have the following theorem that reformulates the
invitation schedule design problem.
Theorem 1. Problem (2) is equivalently characterized by the following copositive program.

T
ρ + ν T µ + ⟨Θ, Σ⟩ + ϕT b + γ T (b ◦ b) + λ( x∗t − rN )
P
min
n,ν,Θ,ϕ,γ t=1  

ρ ν /2 ϕ A B /2 T 0 T0T −x∗ T /2
 0
 −  0∗ O C(n)/2 O

s.t. ν/2 Θ O  ≽ 0,
O  co

T T  −x /2 C(n)/2 O
A B ϕ/2 O A B diag(γ) A B 0 O O O
M
P
nm = N,
m=1
nm ≥ 0, m = 1, ..., M.
where O stands for a zero matrix with a proper dimension.
3.4. With Vaccine Type Preference

Considering multiple types of vaccines and population preferences over different types, we modify
the general model introduced above as follows. Denote the proportion of the targeted subpopulation
B
P
that prefers type i over the others as li , ∀i = 1, ..., B such that li = 1. The invitation schedule
i=1
design problem is as follows.
B
(i) ∗ (i)
P
min max E[Z (n, x )]
+
i=1 p̃∼P (µ,Σ)
M
P (6)
s.t. nm = N,
m=1
nm ≥ 0, m = 1, ..., M.
where
! !
T ˆ
t/P
I+1 T
∗ (i) (i) (k)
(i)
x∗t (i) − rN li )
P P
Z (n, x ) = max rnm li p̃t−(m−1)Iˆ − xt αt + λ(
t=1 m=1 t=1
(i) (i) (i)
s.t. αt − αt−1 − βt = −(1 − λ), t = 2, .., T,
(i) (i)
−αT − βT +1 = −1,
(i) (i)
αt , βt , ≥ 0, t = 1, ..., T.
Applying the same reformulation technique, Problem (6) can be reformulated as a copositive
program.
Theorem 2. Problem (6) is equivalently characterized by the following copositve program.

B B B B B B P
T
(i)
νi )T µ + ⟨( ϕi )T b + ( γi )T (b ◦ b) + λ(
P P P P P P
min ρi + ( Θi ), Σ⟩ + ( xt − rN )
i=1 i=1 i=1 i=1 i=1 i=1 t=1
T
 

ρi νiT /2

ϕTi A B /2
 0 0T −x∗(i) /2 0
s.t.  νi/2 Θi O
 0 O li C(n)/2 O
−  −x∗(i) /2 li C(n)/2
 ≽co 0, i = 1, ..., B,
(7)
 
T T O O
A B ϕi /2 O A B diag(γi ) A B
0 O O O
M
P
nm = N,
m=1
nm ≥ 0, m = 1, ..., M.

3.5. Alternative Models

While the optimization framework proposed for the booking limit optimization is based on simple
linear programs, more advanced robust methods can be applied to address key uncertainties. For
instance, we currently use a conservative estimate for the supply schedule, sui , to account for supply
uncertainties. This is equivalent to a robust model that hedges against the worst-case supply
schedule. A more elaborate distributional robust model could be developed if more distribution
information is available. However, in our case, there is no reliable source for more distributional
information, we, therefore, resort to a simple robust treatment.
For the invitation schedule optimization, given historical demand arrivals, we are able to estimate
the first two moments of the arrival distribution. There is also a simpler linear programming
alternative that uses the average demand arrival pattern µt as inputs. In E-Companion EC.2 we
provide an illustration of the linear programming version of the invitation schedule optimization
and its reformulation. It is worth mentioning that in our collaboration with the MOH, we find that
the linear programming-based optimization model for invitation schedule optimization also works
well. Given its practical applicability, we recommend the final optimization framework for MOH
be based on simple and efficient linear programs.
Another possible extension to the current optimization framework is to incorporate the
Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model. An integrated model is
able to estimate the public health implications of operational decisions directly but would require
a more complex optimization model involving partial differential equations which may need to
be solved using heuristics. The optimal operational decisions will also inevitably depend on esti-
mated parameter inputs in the SEIR model. As the MOH Taskforce mainly uses our framework for
operational support and evaluations, we believe it is important to prioritize factors that directly
affect operational performance measures, such as throughput and waiting times. The other criti-
cal concerns, such as the pandemic spread, evolution of the viral strains, efficacy of the vaccines,
prioritization of population groups, etc., were being monitored by other expert panels, such as
EC19V advising the MOH. Coupled with the simulation model (which will be introduced next),
the operational outputs from our framework can be potentially used as inputs to an independent
SEIR model to evaluate the public health implications by the separate expert panels.
4. Agent-Based Simulation
We develop an agent-based simulator to evaluate the performance of different rollout policy can-
didates that are operated under optimized decisions, that is, with the optimal booking limits and
invitation schedules. In the simulation, each VC is modeled with finite capacities, and every invitee
is modeled as an independent agent. The inputs of the simulator consider response rate, vaccine

preference, demand arrival patterns (based on Figure 1), VC preference, the trade-off between
location and waiting time for the appointment, etc. Other inputs for the simulation are derived
from the policy settings and the optimal booking limits and invitation schedules.
Each invitee’s preference of vaccine types i, vaccination center s, and appointment time t is
generated by a discrete choice model with utility,
U j (i, s, t) = f j (i) × (g j (s) + hj (t) + ϵj (s, t))
where, for each invitee j, f j (i) ∈ {0, 1}, ∀i, represents a strict preference for one or more vaccine
types i. If an invitee j prefers Type k, f j (k) = 1 and f j (i) = 0 for all the i ̸= k. For the case
that the invitee j has no vaccine preference among vaccine types, f j (i) = 1 for all i. The location
preference is denoted as g j (s), which takes a value between 0 and 1. It can be determined by the
proximity of the vaccination site, the invitee demographic, etc. The time preference is denoted as
hj (t), which takes a value between 0 and 1. We derive the time preference from the arrival demand
patterns of early invited batches (Figure 1). ϵj (s, t) is a random noise term added to capture other
unobserved factors affecting the invitee’s preference for location and time, and we assume it follows
a normal distribution with mean 0 and standard deviation 0.05. At each time period, the invitees
are processed in a strict wave ordering to ensure that the earlier wave invitees have priority to
choose a slot over the later waves. If the model specifies a vaccine preference, it is handled by
setting f j (i) appropriately for the proportion of the invitees. The location choice is restricted to a
subset that administers the preferred vaccine type. In case of no preference, the invitee can freely
choose among all locations. Invitees will choose a slot (s, t) that gives the highest utility and move
to the second-highest if (s, t) is not available or if (s, t + I (i) ) to (s, t + I (i) + ms ) are not available
for the second dose. The availability of a slot is subject to the supply and capacity constraints, as
well as the booking limits set by the optimization output (except for the holdback policy). A slot
(s, t) can be chosen only if both the first and second slots can be booked.
We validate the simulation model using past vaccination data in Singapore. Specifically, we use
eight-week data starting from 29th March when Singapore implemented the holdback policy. Our
model is initiated with the inputs from 29th March and simulates the future first-dose take-ups if
the holdback policy is adopted. We use a simple log-normal distribution (Figure 3a) to calibrate
the expected booking pattern based on Figure 1. The sum squared error between the calibrated
curve and the average arrival pattern in Figure 1 is 0.69%. We observe the growth of first-dose
vaccinations under varying response rates. Comparing our prediction with the actual vaccination
data, we find that our model can accurately match the actual performance when the response rate
is 90% (Figure 3b). Note that the actual release of appointment slots is reviewed and updated

continuously by a team of planners in MOH, whereas our prediction is based on a single run of
the model. The degradation of the prediction accuracy reflects a shift to a more aggressive release
policy subsequently taken by the planners.
(a) Calibrated appointment booking (b) Prediction error of first dose vaccina-
arrival pattern. tions.
Figure 3 Simulation Calibration and Prediction Errors
We have developed a comprehensive system called VaxOS, which serves as a general policy eval-
uation tool. This system takes various inputs into account, including (i) policy switching times,
safety lead time, stretch interval, vaccination center (VC) capacity, and more; (ii) the current
booking status in the system; (iii) the supply schedule of vaccines; and (iv) estimated values such
as arrival distribution, response rates, vaccine preferences, and other relevant factors. VaxOS gen-
erates several valuable outputs, including (i) the optimal booking limits for first and second-dose
appointments; (ii) an invitation schedule that optimizes the vaccination process; (iii) simulated
daily appointment bookings for both first and second doses; (iv) simulated waiting times experi-
enced by individuals; and (v) additional metrics such as expected daily reserve, inventory levels,
VC occupancy, and more. The outputs from VaxOS have been utilized by the Singapore MOH
Taskforce as policy benchmarks for validation and comparison. This highlights the significance of
VaxOS in providing valuable insights and aiding decision-making processes for policy evaluation
in the context of COVID-19 vaccination.
5. Numerical Study: Synthetic Case

In this section, we apply the framework to a numerical setting based on synthetic data. We consider
a planning horizon of 10 weeks (T = 70 days) for the first-dose appointment booking. There are
two types of vaccines (B = 2), and we use superscript (i) to denote parameters with respect to
Type i vaccine, i = 1, 2. The supply schedules after factoring in the risk are given in Table 2. All
vaccines have the same expiry period of 50 days. There are 18 VCs and 5 polyclinics with a total
daily vaccination capacity of 37,000 doses, where 14 VCs administer daily 28,000 Type 1 vaccines,
and 4 VCs and 5 polyclinics administer daily 9,000 Type 2 vaccines.

Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Type 1 (×1000 doses) 60 100 100 100 100 60 60 60 60 60 40 40 100 100
Type 2 (×1000 doses) 200 0 50 0 75 0 0 150 0 150 0 200 0 200
Table 2 Vaccine Supply Schedule
Given that the supply is the bottleneck, for the booking limits optimization problem, the total
number of people considered under the throughput-maximizing invitation schedule for each vaccine
type is obtained by the total regimens of each vaccine type supplied over the planning horizon
adjusted by an assumed take-up rate, so that the total expected vaccine supply matches with the
T T′
(i)
sut (i) /2, where r is
P P
number of people who show up, i.e., for each vaccine types i,, r Dt =
t=1 t=1
set to be 80%. For the invitation schedule design problem, given that the first-dose booking limits
serve as the upper bound of the total number of people that can take vaccines, the total number of
2 P
T
P (i)
people to invite is obtained from the total first-dose booking limits, i.e., rN = xt . Invitations
i=1 t
are initiated in a biweekly manner over 5 waves, i.e., Iˆ = 14 days, M = 5. The first moment µ of
the joint distribution of p̃ = (p̃t )Tt=1 is based on the log-normal distribution (Figure 3a).The second
moment can capture the variability in the arrival patterns for different subpopulation groups. The
covariant matrix is assumed to be a diagonal matrix with the (i, i)-th entry equals µi (1 − µi ),
motivated by a Bernoulli distribution. It can be shown the uncertainty set, P + (µ, Σ), is not empty
(i)
with these first two moments. The throughput-maximization pattern, Dt , is proportional to µt ,
T T
(i)
and is obtained as (r Dt ) × µt (= ( sut (i) /2) × µt ), for i = 1, 2.
P P
t=1 t=1
We compare the optimal rollout policies under different levels of second-dose reserve specified
by parameter k, with the holdback policy. We first consider the policy that is adherent to two-dose
intervals with a mini-stretch of 4 days. In this case study, the manufacturer recommended two-dose
intervals for Type 1 and Type 2 vaccines are I (1) = 21 and I (2) = 28, respectively. We also conduct
analysis for stretch policies with I (1) = I (2) = 42 days and 49 days for both types of vaccines. Details
of stretch policy analysis are given in E-Companion EC.3.
5.1. Optimal Appointment Booking Limits

We solve the optimal booking limits for each vaccine type. The average waiting times for different
policies are presented in Table 3. The optimal booking limits are shown in Figure 4.
Policy
One-week Two-week Three-week Four-week
No-Reserve
Reserve Reserve Reserve Reserve
Type 1 14.4 17.8 22.1 25.9 -
Type 2 45.3 41.2 39.5 44.1 46.8
Table 3 Average waiting time under throughput-maximizing invitation schedule
In particular, Figure 4a shows the optimal cumulative total (first dose and second dose) booking
limits for Type 1 vaccines at various levels of the second-dose reserve, from the most aggressive
policy with no reserve (k = 0) to a conservative policy with a full two-dose interval reserve (k =

(a) Type 1 Vaccine (b) Type 2 Vaccine
Figure 4 (Color online.) The Optimal Cumulative Total Booking Limits
21). The most aggressive policy touches the cumulative supply curve and achieves the highest
throughput. It is also observed that a more regressive policy that holds fewer reserves for the second
doses can help reduce the first-dose waiting time.
Figure 4b shows the optimal cumulative total booking limits for Type 2 vaccines. Notice that all
the cumulative bookings limit curves do not touch the cumulative supply curve after Day 49 given
the limited vaccination capacity. Interestingly, under this numerical case, the most aggressive policy
that keeps no reserve performs worst in terms of throughput. Contrary to conventional belief, it also
gives rise to a longer average waiting time than, for example, the one-week and two-week reserve
policies. To understand this observation, we plot the daily first and second-dose booking limits of
the no-reserve policy and the policy with a two-week reserve (k = 14) in Figure 5. In Figure 5a,
(a) Type 2 Vaccine No Reserve Policy k = 0 (b) Type 2 Vaccine 2-week Reserve Policy k = 14
Figure 5 (Color online.) The Optimal Daily Booking Limits
no reserve policy aggressively administers the first dose from Day 1 to Day 28. The corresponding
second-dose intakes start from Day 29 given a 28-day two-dose interval. The need to administer
second doses blocks the first-dose bookings during those days under limited vaccination capacity.
The large demand for second doses also exhausts all the supply and no bookings are possible from
Day 43 to Day 49 (also can be seen in Figure 4b, there is a flat region of total cumulative bookings
from Day 43 to Day 49). This is also why the first wave of first-dose bookings ends on Day 10

because no vaccines are available for the corresponding second doses. The blocking phenomenon
leads to fewer first-dose booking limits in the rest of the horizon and hurts the overall throughput.
Interestingly, by keeping the right amount of second-dose reserve, the blocking is alleviated. For
example, in Figure 5b, firstly, we observe that the first round of first-dose bookings goes beyond
Day 10. When the total supply exhausts, we can allow the second-dose bookings using the reserve.
It would lift the constraint on the first-dose bookings from Day 10 onward. Secondly, because
of the requirement of keeping a second-dose reserve, the first-dose bookings cannot be set too
aggressively in earlier weeks. The corresponding second-dose bookings would not block the future
first doses that significantly. As highlighted in Figure 5, for the no-reserve policy, between Day
49 to Day 70, only limited first-dose bookings are allowed in order to accommodate the required
second doses. Whereas for the two-week reserve policy, we observe significantly more first-dose
bookings. Therefore, early completion of the first-dose administration is possible.
The counter-intuitive policy performance is observed for Type 2 vaccine but not for Type 1
vaccine. This is because Type 2 vaccine has a more stringent vaccination capacity and more irregular
(longer delay) supplies. In this case, aggressively administering the first doses, though, benefits the
throughput in the early days, may result in blocking that hurt the future throughput. When the
blocking is sufficiently prominent, the overall throughput might be sacrificed.
The cumulative booking curves such as those shown in Figure 4 can provide a guideline to
determine a proper level of second-dose reserve. For Type 1 vaccine where there is no significant
blocking, we can choose a k that gives a reasonable amount of reserve to hedge against the supply
risk. For Type 2 vaccine, a good choice is the two-week reserve policy where throughput is highest,
waiting time is lowest, and the reserve amount is sufficient to hedge against supply disruption. The
two-week reserve booking limits for both two vaccine types can be the recommended policies.
5.2. Optimal Invitation Schedule

We consider both the case with and without the vaccine type preference. We choose to focus on
solving the invitation schedules corresponding to two different optimal booking limits, the “one-
week risk” policy, and the recommended policy, and compare them with the holdback policy.
Specifically, the one-week risk policy is with a two-week reserve (k = 14) for Type 1 vaccine and
a three-week reserve policy (k = 21) for Type 2 vaccine, as both give a “one-week” risk compared
with full protection of the required two-dose intervals. The recommended policy is the two-week
reserve (k = 14) for both two types of vaccines. The invitations are initiated in a biweekly manner.
Over the planning horizon of 70 days, five waves of invitations are issued.
Under the scenario without prevalent preference, we solve the invitation schedule considering the
aggregated booking appointments over both vaccine types. Note that in the optimization objective,

T
P
the total cumulative number of people waiting for the first doses, wt , has a significantly larger
t=1
magnitude than the unfilled bookings, wT , a proper λ should be scaled to a high value close to 1.
In our study, we also find that the optimal invitation schedule is less sensitive when λ is far below
1. The trade-off between the waiting time and throughput becomes more salient in influencing the
optimal invitation schedules when λ ≥ 0.95. In the rest of the policy comparison, we use λ = 99.99%
to demonstrate the “best-throughput worst-waiting-time” case. For the case that the population
exhibits a prevalent vaccine preference, we study the scenario of l1 = 0.4, that is 40% of them
prefer Type 1 over Type 2. Table 4 shows the invitation schedules for the one-week risk and the
recommended two-week reserve policies compared with the holdback policy.
No Vaccine Preference (λ = 99.99%) With Vaccine Preference (λ = 99.99%, l1 = 0.4)
Recommended Recommended
Wave Holdback 1-Week Risk 1-Week Risk
Policy Policy
1 225000 355524 377122 376477 390724
2 156000 130106 120147 185803 183442
3 147000 74171 72243 87790 84387
4 169000 90759 88176 235431 247931
5 169000 251315 269420 16374 20624
Table 4 Optimal Invitation Schedules
The holdback policy invites people purely based on the supply schedule. Therefore, it does not
respond to the vaccine preference information. One-week risk and recommended two-week reserve
optimal invitation schedules are more aggressive for both cases with and without vaccine preference.
When there is no vaccine preference, the optimal invitation schedule aggressively invites people in
the first two waves to achieve higher throughput. Later waves are mild to control waiting time,
and the last wave catches up. When there is a vaccine preference for Type 2 over Type 1, more
people would be waiting for the first dose of Type 2 vaccines, and more unfilled booking limits for
Type 1 vaccines. The “best-throughput worst-waiting-time” optimal invitation schedules are more
aggressive so that unused Type 1 booking limits can be filled up.
5.3. Policy Comparison

We use the simulation model to compare the performance of each policy along the following dimen-
sion: total throughput, aggregate first-dose waiting time, Type 1 (Type 2) vaccines throughput, and
first-dose waiting time to get Type 1 (Type 2) vaccines. Table 5 shows the performance comparison
among the holdback, one-week risk, and recommended two-week reserve policies.
No Vaccine Preference (λ = 99.99%) With Vaccine Preference (λ = 99.99%, l1 = 0.4
Recommended Recommended
Holdback 1-Week Risk Holdback 1-Week Risk
Policy Policy
Waiting time (Day) 0.03 0.04 0.03 5.31 6.88 6.65
Overall
Throughput 691470 720340 740540 591020 610550 637730
Waiting time (Day) 0 0 0 0 0 0
Pfizer
Throughput 378970 398830 40000 277020 288840 295310
Waiting time (Day) 0.07 0.08 0.08 8.87 11.48 11.06
Moderna
Throughput 312500 321510 340540 314000 321710 342420
Table 5 Simulated Performance Comparisons

Compared to the holdback policy, the one-week risk policy that holds fewer second doses as
reserve improves the throughput at a minimal cost of waiting time. The recommended two-week
reserve policy performs the best in both dimensions even under the “best-throughput worst-waiting
time” case (λ = 99.99%), achieving the highest throughput without increasing the waiting time, as
it is designed with the second-dose reserve level that minimizes the blocking.
When a vaccine preference is not matched with the vaccine supply or capacity, both throughput
and waiting time might become worse. In our numerical study, Type 1 vaccine has a higher supply
and vaccination capacity but is not preferred compared with Type 2 vaccine (with l1 = 0.4). In Table
5, we observe a significantly lower throughput and higher waiting time for all policies compared
to their corresponding ones in the no-vaccine preference case. The throughput of Type 1 vaccines
drops by 25 − 30% due to less demand. As more people prefer Type 2 vaccine, the average waiting
time increases from 0 to 9 to 12 days.
Compared with the holdback policy, the one-week risk, and the recommended policies can effec-
tively use the vaccine preference information to improve the throughput without significantly
increasing the average waiting time (from 5 days to 7 days). More interestingly, the recommended
two-week reserve policy improves upon the one-week reserve policy by choosing the right amount
of second-dose reserve. The blocking phenomenon is more severe for the case with vaccine prefer-
ence where Type 2 vaccine supply and capacity become tighter limiting the vaccination progress.
Keeping the right amount of second-dose reserve can help alleviate the blocking and thus achieves
better performance in both dimensions.
6. Case Study: Singapore Vaccine Rollout Policy Evaluation

In this section, we present the policy evaluation study we conducted for the Singapore MOH
Taskforce. In Singapore, till June 2021, only Pfizer and Moderna vaccines were authorized for
public administration. We will only consider these two types of vaccines. Invitations were initiated
in a biweekly manner. To obtain the numerical results in this section, we use the input parameters
calibrated from model validation to match the actual vaccination data (OurWorldInData 2023) and
additional inputs from the MOH. Specifically, the demand pattern inputs are from the calibrated
log-normal distribution in Figure 3a, and a response rate of 80% is used in this numerical study.
Although the response rate we found that matched with the actual data is 90% (see the model
validation in Section 4), the MOH expert panel suggested using 80%. We follow their suggestion in
simulating the results in this section. Once people decided to get vaccinated, they had an additional
choice on the type of vaccine and preference of vaccination center. It is to be noted that in the
early days, due to popular perception, there was a higher preference for Pfizer vaccines compared
to Moderna. Further, the individual could choose which VC to get their shots from. We adopt the

utility model which specifies a vaccine preference, a random-ordered subset for VC preferences,
and preferences for the appointment time. The Taskforce carefully designed the VC distribution
in Singapore to be near population centers and it is reasonable to assume that an individual will
prefer to get an appointment at a nearby VC’s at the earliest time slot. Due to the sensitive nature
of the supply and capacity data, we have scaled and perturbed the values while performing the
optimization and simulation and masked the y-axis in the charts.
In the following, we focus on presenting the policy evaluation study we conducted to address
the real challenges faced by Singapore Taskforce when witnessing an increase in COVID-19 cases
in early 2021. Specifically, we aim to answer the following questions. First, does implementing an
aggressive policy always help improve the throughput? Secondly, when is a good time to switch
to an aggressive policy in Singapore? Thirdly, how long should the stretch interval be and how
many second-dose reserves should keep? Note that the numerical results in this study are obtained
from the simpler linear programming-based models for both booking limits and invitation schedule
optimization, which is the framework used by the Taskforce.
For the holdback policy, the booking limits and invitations are computed using a heuristic as
used in actual operations. The booking limit is set to exactly half of the supply available at
the time after discounting for existing appointments and the invitation schedule is computed by
scaling the booking limit by the response rate. For all other policy candidates, if not given specific
names, we label them based on the chosen two-dose stretch and the second-dose reserve level.
We consider the planning horizon starting from March 29th, 2021, when the holdback policy was
implemented. There were projected 8 million vaccines available for the next 20 weeks. We simulate
various policy candidates and benchmark them with adopting the holdback policy throughout the
planning horizon. Given that the main objective for the policymaker is to accelerate the first-dose
intakes facing the challenges of increasing COVID-19 cases, in our numerical studies, we focus on
the comparison of the first-dose vaccination throughput under different policies. The performance
comparisons in terms of two-dose vaccination rates are relegated to E-Companion EC.4.1.
6.1. Blocking Phenomenon

It is commonly believed that an aggressive policy, such as reducing the second-dose reserve or
stretching the two-dose interval, would help accelerate the first-dose vaccination rate. We show
that this is generally valid provided the supply schedules are properly synchronized with the appoint-
ment release policy; otherwise, blocking in the appointment system will stall the throughput in an
aggressive policy. This echoes the numerical insights we have for the synthetic data.
To see this, we compare the performance of two policies, the holdback policy and an “Aggressive
Policy” over a planning horizon of 20 weeks starting from March 29th, 2021. Specifically, the

Aggressive Policy stretches the two-dose interval to 6 weeks for the Pfizer vaccine and 8 weeks for the
Moderna vaccine, which doubles the two-dose intervals in holdback policy. It will still nevertheless
maintain enough reserve of the vaccines for the next 3 weeks of second dose appointments. Invitation
schedules were sent out to the invitees at two-week intervals.
Figure 6 Comparison of booking limits between the holdback and the Aggressive Policy. The black curve is the
cumulative vaccine supplies. The red (purple) curve is the cumulative total number of first and second
dose booking limits under the Aggressive Policy (holdback policy), with the dashed curve and dotted
curve corresponding to the first and second dose booking limits, respectively.
Figure 6 shows the optimized cumulative first, second, and total booking limits for these two
policies. Comparing the two policies based on the cumulative total and the first booking limits
curves (solid and dash lines), Aggressive Policy does not always dominate the holdback policy
throughout the planning horizon. In particular, till the end of Week 10, the total number of
appointment slots released under the Aggressive Policy is comparable with the holdback policy.
This is due to the limited supply in Singapore during Week 6 to Week 8 that capped the growth of
the booking curves. A higher growth rate becomes visible only after Week 12. However, the second
dose administration is delayed due to the long stretch under the Aggressive Policy.
Fortnightly Invitation Schedule (in thousands) Cumulative Values
Period Holdback Aggressive Hybrid Holdback Aggressive Hybrid
Supply Supply
(Week) (A) (B) (C) (A) (B) (C)
0 1,160 470 1,804 470 1,160 470 1,804 470
2 452 282 0 282 1,613 752 1,804 752
4 450 460 0 460 2,063 1,212 1,804 1,212
6 632 300 0 300 2,695 1,513 1,804 1,513
8 481 136 50 1,214 3,175 1,648 1,854 2,727
10 455 448 831 0 3,631 2,097 2,685 2,727
12 455 121 396 654 4,086 2,217 3,081 3,381
14 655 698 1,114 998 4,741 2,915 4,195 4,378
16 1117 698 908 716 5,858 3,614 5,104 5,094
18 1117 698 - 6,975 4,312 - -
20 1117 698 - 8,092 5,010 - -
Table 6 ”Holdback Policy (A)” implements the recommended stretch with full reserve, ”Aggressive Policy
(B)” implements a 6-8 Week stretch with a 3-week reserve, and ”Hybrid Policy (C)” implements the Holdback
Policy for the first 8 weeks followed by the Aggressive Policy.
The downside of implementing such an aggressive policy can be illustrated by the corresponding
optimal invitation schedule shown in Table 6. The table shows fortnightly invitation schedules

for different policies until 5 million invitations are reached. With the assumed 80% response rate,
an estimated 4 million people will be vaccinated which is the maximum with the 8 million doses
available in the planning horizon. Under an Aggressive Policy (B), a large number are invited in
the first wave. This, together with the slow supply, leads to a long pause afterward, and the next
group is invited only after week 8. This is in contrast with the holdback policy that has more
steady and regular invitations. The comparison shows that an aggressive policy implemented too
early when supply cannot catch up may not realize the benefits as expected. The long pause of
the first dose appointment due to supply shortage in Aggressive Policy is undesirable: It leaves
an impression of vaccine inaccessibility and would result in serious public implications over the
vaccination campaign. The large initial invitation wave also results in a longer lead time for an
individual to book an appointment and negatively impacts their booking experience.
To show the robustness of the insights, we simulated the first-dose intakes of other stretch
policies, such as 4(5)-week stretch for Pfizer (Moderna) with 3-week reserve, and 5(7)-week stretch
for Pfizer (Moderna) with 3-week reserve. Though they are less aggressive with shorter stretch
intervals, the growth patterns are similar if the corresponding policies had been implemented at
the beginning of the planning horizon. Details are given in E-Companion EC.4.2.
6.2. Switching to Aggressive Policy

Opting for an aggressive policy at the beginning when supply is constrained, therefore, may not be
ideal. We further make a comparison with another policy that implements two different schemes
at different times during the planning horizon. We name this dynamic policy “Hybrid Policy” in
which the Aggressive Policy is only rollout 8 weeks later. We can observe the optimal invitation
schedule from Table 6 that for this policy, the blocking disappears thanks to the synchronization
between the increased demand and increased supply expected from Week 16. Carefully coordinating
the policy in response to the supply schedule allows for a smoother vaccination program while
achieving a higher vaccination rate. We observe that the Hybrid policy (C) can achieve 5 million
invitations (i.e., 4 million responded invitees under 80% response rate) 4 weeks earlier than the
holdback policy (A) while avoiding the pitfalls of Aggressive Policy (B).
In Figure 7, we present the simulated performance from VaxOS of two dynamic policies with
different switching times from the holdback policy to the Aggressive Policy. One is the Hybrid
Policy which switches on week 8 (the solid green line) and the other switches on week 4 (the dotted
green line). We find that switching early on week 4 still catches the supply shortage period as
evidenced by the flat vaccination curve during week 12 to week 14 and could not fully realize the
benefit of a high vaccination rate. Switching on week 8 gives a steadily increasing growth pattern of
the first dose intakes and, at the same time, achieves a higher first-dose vaccination rate, even with
a delay in the implementation of the aggressive policy. Therefore, synchronizing with the supply by
choosing the right timing to move to an aggressive policy is crucial to achieving high throughput.

Figure 7 (Color online.) Comparison of dynamic policies with different switching times. The purple curve is the
cumulative number of first doses vaccinated under the holdback policy. The green curve corresponds
to the Hybrid Policy (i.e., switching from holdback to Aggressive Policy in Week 8). The green dashed
curve corresponds to the dynamic policy that switches from holdback to Aggressive Policy in Week 4.
6.3. Policy Implementations and Implications

We further tested different degrees of aggressiveness in terms of the choice of stretch interval and
reserve level after the switch on week 8. Figure 8 shows the projected vaccination rate for different
classes of stretch and reservation strategies. Note that a more aggressive policy, i.e., with fewer
reserves or a longer stretch, as expected, can speed up the vaccination rate. There is a diminishing
return in such a benefit, and the Hybrid Policy performs almost the same as the 10-12 week stretch
policy with a 3-week reserve in terms of the first-dose vaccination rate. In this case, a shorter
stretch is preferred as it results in earlier completion of the full regimen.
Figure 8 (Color online.) Performance of different policies to reach 4 million total 1st Dose vaccinations. At 0W,
1 million people have been vaccinated for the first dose. The numbers on the figure are additional first
doses administered.
The intrinsic value of the policy choice becomes apparent when considering its impact on mitigat-
ing public health risks and stabilizing the economy. Throughout the COVID-19 pandemic, although
it is challenging to quantify directly, higher vaccination rates have demonstrated a reduction in
strain on healthcare systems, prompting governments worldwide to gradually ease restrictions as

a significant portion of the population becomes vaccinated. In this context, the time required to
vaccinate a substantial proportion of the population directly correlates with both the public health
risk and economic consequences. Our simulation results indicate that the implementation of the
Hybrid Policy saves the nation approximately 23 days in vaccinating a total of 3 million residents
with at least one dose, and nearly 30 days in vaccinating up to 4 million residents with at least
one dose, in comparison to the holdback policy (see Figure 8). This significant time reduction is
a testament to the efficacy of the Hybrid Policy in accelerating the first-dose vaccination rate.
Our optimization + simulation framework recommends adopting the Hybrid Policy that switches
from holdback to a policy that doubles the two-dose interval and keeps 3 weeks reserve for the
second-dose appointments in mid or later May (8 weeks after March 29). In fact, on May 19, MOH
announced a modification to its vaccination program - “those who register for COVID-19 vaccina-
tion will have their second dose scheduled six to eight weeks after the first, instead of three to four
weeks later.” This tweak is to “protect as many people as possible, and as soon as possible” (Lai
2023). This switch timing and stretch interval matched exactly with the recommended policy.
To further assess the impact of our contribution and verify the correspondence between our
predicted performance of the Hybrid policy and the actual vaccination outcome after implementing
the stretch policy, we conducted a comparison between our simulated first-dose intakes and the
public records of the first-dose vaccination data (Figure 9). Following the implementation of the
6-8 weeks stretch policy in Singapore, the number of first doses administered increased to 3 million
doses, exhibiting an average growth rate of 1.5. Subsequently, it further rose to 4 million doses
with an average growth rate of 2.7. Notably, our simulated growth rates, based on the available
information as of March 29, closely align with the actual growth rates, with values of 1.2 and 2.1
before and after the policy switch, respectively. In fact, this strategic change enabled the nation
to safeguard up to 75% of its population across all age groups by September 2021, when the first
major wave of the Delta variant hit the nation.
Figure 9 Comparing policy performance against the actual vaccination progress in Singapore.

The above analysis relies on calibrated demand arrival patterns using a log-normal distribution
and an 80% response rate. A robustness study on these inputs is given in E-Companion EC.4.3.
7. Concluding Remarks
The policy-makers have been adaptively revising the vaccine rollout policies based on COVID-
19 cases as well as vaccine availability and supply chain considerations. Effective scheduling of
COVID-19 vaccinations is crucial in reducing both the spread of the virus and the severity of its
outcomes. The optimization and simulation-based framework is critical in supporting these policy
changes, by facilitating comparisons among potential policy candidates, quantifying the impact of
each policy, and eventually providing policy recommendations. Before mid-May, Singapore adopted
the non-stretch policy that is similar to a holdback policy. Our framework shows that switching to
a stretch policy at the right timing and with a good choice of the stretch interval can significantly
accelerate the vaccination rate. In particular, the recommended hybrid policy has been shown to
save up to 30 days to reach 4 million first-dose vaccinations. In addition, the optimization framework
also provides operational guidance on how to design appointment booking systems and invitation
schedules to realize the benefits. Singapore was able to vaccinate most of its adult population before
the Delta wave hit in September 2021 with the successful switch from the holdback to stretch
policy. The 30 days’ savings paved the way to rapidly provide elderly 60 years old and above with
a booster that was critical in mitigating the impact of the Delta wave.
While the COVID-19 pandemic is waning, it has still had a significant impact on global health
and the economy. The developed open-source web service, VaxOS, integrates appointment booking
limits, invitation schedule design solvers, and a flexible simulation model. It is fully parameterized
to accommodate a range of scenarios and can be accessed through a user-friendly web-based dash-
board. The Singapore vaccination team has already implemented VaxOS to manage its appointment
booking process. We believe that these tools, which we have made available via links (withheld
during the paper review), can be instrumental in policy design and operational decision-making in
other countries and regions.
The research conducted on COVID-19 provides valuable insights for handling future pandemics
and outbreaks. These optimization tools have far-reaching applications beyond COVID-19, as they
can be invaluable in responding to any pandemic that requires rapid vaccination of population
groups while facing uncertainties in demand and supply. As most vaccines have a waning effect
and many have already followed multiple-dose regimens (WHO 2022), it is likely that the multi-
dose regimen might be followed in a future pandemic and as part of “preparedness”. In addition
to investments in vaccine development and manufacturing, it is important to ensure operational
preparedness is also prioritized. We hope that our work contributes to the knowledge base for
future endeavors.

Acknowledgments
The authors gratefully acknowledge the suggestions and support from the Ministry of Health, Singapore,
vaccine operations team in this collaboration.
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e-companion to : Optimal Scheduling and Policy Design of Two-Dose Vaccination Rollout ec1
Supplementary Materials
EC.1. Proofs of Statements
Proof of Proposition 1. Firstly, by the construction of Problem (5), it is a relaxation of
max E[Z(n, x∗ )]. Let α∗ (p̃) and β ∗ (p̃) denote the optimal solution of the linear program (3)
p̃∼P + (µ,Σ)
given a realization of p. Define
qα := E[α∗ (p̃)], qβ := E[β ∗ (p̃)]
Xα := E[α (p̃)α (p̃) ], Xβ := E[β ∗ (p̃)β ∗ (p̃)T ]
∗ ∗ T
Yα := E[p̃α∗ (p̃)T ], Yβ := E[p̃β ∗ (p̃)T ]

∗ ∗ T
Xαβ := E[α (p̃)β (p̃) ].
With the above definitions,

T T
E[Z(n, x∗ )] = E[p̃T C(n)α∗ (p̃) − x∗ T α∗ (p̃)] + λ( x∗t − rN ) = ⟨C(n), Yα ⟩ − x∗ T qα + λ( x∗t −
P P
t=1 t=1
rN ), which is the objective of Problem (5).
∗ ∗
α∗ (p̃) qα
Because α (p̃) and β (p̃) is the optimal solution, E AB = b, i.e., A B =
β ∗ (p̃) qβ
b. Considering the lifted second-order constraint, we have
T !
α∗ (p̃) α∗ (p̃) T
diag AB AB = b ◦ b.
β ∗ (p̃) β ∗ (p̃)
Taking expectations on both sides, we have

Xα Xαβ T
diag AB T AB = b ◦ b.
Xαβ Xβ
The last completely positive constraint is obtained by considering

 T  
1 1 1 µT T
qα qβT
 
 p̃   p̃    µ Σ Yα Yβ 
E
 α∗ (p̃)   α∗ (p̃)   =  qα

YαT Xα Xαβ 
β ∗ (p̃) β ∗ (p̃) qβ YβT T
Xαβ Xβ
Because p̃, α∗ (p̃), β ∗ (p̃) ≥ 0, by the definition of the completely positive matrix,
T
1 1
 
 p̃   p̃ 
 α∗ (p̃)   α∗ (p̃)  ≽cp 0.
β ∗ (p̃) β ∗ (p̃)
Given that the set of all completely positive matrices is a convex set, taking expectation preserves
the complete positiveness. Hence,
1 µT T
qα qβT
 
µ Σ Yα Yβ 
≽ 0.
q
α YαT Xα Xαβ  cp
qβ YβT T
Xαβ Xβ

ec2 e-companion to : Optimal Scheduling and Policy Design of Two-Dose Vaccination Rollout
We have Problem (5) as the relaxation of max E[Z(n, x∗ )] and the objective value of Problem
p̃∼P + (µ,Σ)
(5), Zcp ≥ max E[Z(n, x∗ )].
p̃∼P + (µ,Σ)
To see the equivalence, let qα ∗ , qβ ∗ , Xα∗ , Xβ∗ , Yα∗ , Yβ∗ and Yαβ
∗
, be the optimal solution to Prob-
lem (5), and consider the rank-1 decomposition of the completely positive matrix at this optimal
solution, i.e.,
   T
1 µT T
qα qβT θk θk
 
µ Σ Yα Yβ   p̂αk   p̂αk 
X    
=
q
α YαT Xα Xαβ   δk   δk 
k∈κ β
qβ YβT T
Xαβ Xβ δk δkβ
θk2 = 1, δkα , δkβ ≥ 0, ∀k ∈ κ. Let κ = κ+ ∪ κ0 , where κ+ = {k ∈ κ | θk > 0}, and

P
where θk ∈ R+ ,
k∈κ
κ0 = {k ∈ κ | θk = 0}.
β
δα δk
Based on the result in Proposition 3.1 in Natarajan et al. (2011), we have ( θk , θk
), ∀k ∈ κ+ be
k
the feasible solutions to Problem (4) and δkα = δkβ = 0, ∀k ∈ κ0 . Similarly, given that µ and Σ are
feasible
first-two
moments such that the uncertainty set P + is nonempty (i.e., 1′ µ = 1, 1′ Σ1 =
T
1 µ PT p̂
1, ≽cp 0), we have t=1 θkt = 1, p̂θk ≥ 0, ∀k ∈ κ+ , and p̂k = 0, ∀k ∈ κ0 . We can rewrite the
µ Σ k k
decomposition as
   T
T T T  1 1
1 µ qα qβ

 p̂k   p̂k 
 µ Σ Yα Yβ  X 2  θk   θk 
α  α 
q Y T X X = θk  δk
  δk 
α α α αβ θ

k∈κ k   θk 
T
qβ YβT Xαβ + β β

Xβ δk δk
θk θk
Assume a random vector p̃ and its corresponding feasible solutions (α∗ (p̃∗ ), β ∗ (p̃∗ )) follow the
∗
joint distribution as below.

! !!
∗ ∗ ∗ ∗ ∗ δkα δkβ p̂k
P ((α (p̃ ), β (p̃ )) , p̃ ) = , , = θk2 , ∀k ∈ κ+ .
θk θk θk
It can be easily verified this is a valid and feasible distribution that satisfies the first two moments
constraints of p̃. By the same argument as in Natarajan et al. (2011), Problem (5) is equivalent to
max E[Z(n, x∗ )]. Q.E.D.
p̃∼P + (µ,Σ)
Proof of Theorem 1. Consider the dual problem of the completely positive program (5), a copos-
itive program as follows.
T
min ρ + ν T µ + ⟨Θ, Σ⟩ + ϕT b + γ T (b ◦ b) + λ( x∗t − rN )
P
ν,Θ,ϕ,γ t=1
 

ρ ν T /2

ϕT A B /2
 0 0T −x∗ T /2 0
(EC.1)
 −  0∗ O C(n)/2 O

s.t.  ν/2 Θ O  ≽co 0
T T  −x /2 C(n)/2 O O
A B ϕ/2 O A B diag(γ) A B 0 O O O
where O stands for a zero matrix with a proper dimension.

We have the invitation schedule optimization problem reformulated the copositive program.
Q.E.D.
Proof of Theorem 2. The proof follows the exact logic as Proposition 3 followed by Theorem 2.
We omit the details here.
EC.2. Invitation Schedule Optimization - Linear Programming

Optimization Formulation
For the case without preference, we have the invitation scheduling design problem as follows.
min Z(n, x∗ )
M
P
s.t. nm = N (EC.2)
m=1
nm ≥ 0, m = 1, ..., M
T
x∗t + wT − rN , where wT is the number
P
Note that the total number of unfilled booking slots is
t=1
of individuals waiting for an appointment at time T (the end of the horizon). Therefore,
Z(n, x∗ ) = (1 − λ)Z w (n, x∗ ) + λZ x (n, x∗ )

T T
= (1 − λ) wt + λ( x∗t + wT − rN )
P P
t=1 t=1
−1
TP T
x∗t − rN )
P
= (1 − λ) wt + wT + λ(
t=1 t=1
Recall that the average demand arrival pattern is represented by the proportion of invited people
choosing first-dose appointments on Day t, µt ; and r is the response rate. We, therefore, derive the
following linear program reformulation.
−1
TP T
x∗t − rN )
P
min (1 − λ) wt + wT + λ(
t=1 t=1
s.t. w1 ≥ rn1 µ1 − x∗1 ,
ˆ
⌊t/P
I⌋+1
wt − wt−1 ≥ rnm µt−(m−1)Iˆ − x∗t , t = 2, ..., T, (EC.3)
m=1
M
P
nm = N,
m=1
nm ≥ 0, m = 1, ..., M,
wt ≥ 0, t = 1, ..., T.
Note that the first two constraints are specifically derived from the iterative relationship among
waiting times, wt .
When there is vaccine preference, considering multiple types of vaccines and population prefer-
ences over different types, we modify the optimization model introduced above as follows. Denote
the proportion of the targeted subpopulation that prefers type i over the others as li , ∀i = 1, ..., B
B
P
such that li = 1. The invitation schedule design problem can be similarly reformulated as follows.
i=1

B
−1
TP T

i i i∗
P P
min (1 − λ) wt + wT + λ( xt − rN li )
i=1 t=1 t=1
s.t. w1i ≥ rn1 li µ1 − x∗1 i , i = 1, ..., B,
ˆ
⌊t/P
I⌋+1
wti − wt−1
i
≥ rnm li µt−(m−1)Iˆ − x∗t i , t = 2, ..., T, i = 1, ..., B. (EC.4)
m=1
M
P
nm = N,
m=1
nm ≥ 0, m = 1, ..., M,
wti ≥ 0, t = 1, ..., T, i = 1, ..., B.
Similar to response rate r, demand arrival pattern pt , t = 1, ..., T , the vaccine preference parameter,
li , i = 1, ..., B, can be estimated from past vaccination data, and adaptively updated as new data
becomes available.
EC.3. Additional Numerical Results to Synthetic Case - Stretch

Policies
Under a longer two-dose interval, ring-fencing one extra vaccine for every first-dose booking is not
practical. It would result in a huge reserve and inventory, and an extremely low throughput, and
the reserved vaccines are also exposed to the risk of being expired. We study the optimal six-week
and seven-week stretch policies with different levels of the second-dose reserve and compare them
with the holdback policy.
Table EC.1 Average waiting time under throughput-maximizing invitation schedule (Stretch policy)
Six-Week Stretch Policy Seven-Week Stretch Policy
One-Week Two-Week Three-Week Four-Week One-Week Two-Week Three-Week Four-Week
No-Reserve No-Reserve
Reserve Reserve Reserve Reserve Reserve Reserve Reserve Reserve
Type 1 Vaccine 5.2 9.2 13.2 14.8 17.9 1.5 5.2 9.2 13.2 14.5
Type 2 Vaccine 30.7 30.3 39.5 37.2 41.4 22.0 26.7 34.3 34.2 39.4
The optimal cumulative total booking limits of Type 1 and Type 2 vaccines under six-week
and seven-week stretch policies are presented in Figure EC.1. The corresponding waiting times are
given in Table EC.1. Similar to the non-stretch policy, the blocking is more severe for the Type 2
than for the Type 1 vaccine. But compared with the non-stretch policy, a longer stretch would help
alleviate the blocking, and as seen in Figure EC.1, there is little blocking under the seven-week
stretch policy. The waiting time is significantly reduced compared with the non-stretch policy, and
it is shortest under the seven-week stretch policy. From the cumulative booking limits curve, we
can choose the value of k for each vaccine type based on the degree of blocking observed. Under
the six-week stretch policy, a good policy candidate would be a three-week reserve for both two
types of vaccines, which has a sufficient second-dose reserve amount and relatively mild blocking.
For the seven-week stretch policy, the policy with a four-week reserve for the Type 1 vaccine and
a three-week reserve for the Type 2 vaccine is recommended.

(a) Type 1 Vaccine (Six-Week Stretch) (b) Type 2 Vaccine (Six-Week Stretch)
(c) Type 1 Vaccine (Seven-Week Stretch) (d) Type 2 Vaccine (Seven-Week Stretch)
Figure EC.1 The Optimal Cumulative Total Booking Limits of the Stretch Policies
The optimal invitation schedules with and without vaccine preference are shown in Table EC.2.
We also generate the four-week reserve invitation schedule as a comparison with the recommended
policies. Compared with the optimal invitation schedules that are adherent to three/four-week dose
interval, the optimal stretch policies are much more aggressive due to longer dose-interval that can
accommodate more first-dose bookings.
No Vaccine Preference (λ = 99.99%) With Vaccine Preference (λ = 99.99%)

Six-Week Stretch Policy Seven-Week Stretch Policy Six-Week Stretch Policy Seven-Week Stretch Policy
Four-Week Pfizer Four-Week Pfizer
Wave Three-Week Reserve Four-Week Reserve Four-Week Reserve Three-Week Reserve Four-Week Reserve Four-Week Reserve
Three-Week Moderna Three-Week Moderna
1 403830 415758 384160 394812 506201 477830 517679 492598
2 154433 88005 213930 156935 138511 98558 137035 134898
3 69804 92247 92085 98273 30263 50846 37643 37606
4 62351 45548 55180 38085 247703 264503 272042 273003
5 303707 298424 255478 290172 71447 48245 36434 40172
Table EC.2 Stretch Policy Optimal Invitation Schedule
The simulated performance of each policy is shown in Table EC.3 and Table EC.4. Note that the
stretch policies significantly improve the throughput compared with the non-stretch policies and

holdback policy, with only a slight increase in the waiting time under the “best-throughput worst-
waiting time” case (λ = 99.99%). The recommended six-week stretch policy and the recommended
seven-week stretch policy achieve the best performance.
Six-Week Stretch Seven-Week Stretch

Four-Week Pfizer
Three-Week Reserve Four-Week Reserve Four-Week Reserve
Three-Week Moderna
Overall Waiting time (day) 0.04 0.04 0.05 0.04
Throughput 794190 750850 799590 781540
Type 1 Waiting time (day) 0 0 0 0
Throughput 441540 416810 444250 444250
Type 2 Waiting time (day) 0.1 0.09 0.1 0.1
Throughput 352650 334040 355340 337290
Table EC.3 Stretch Policy Performance Comparison(No Vaccine Preference)
Six-Week Stretch Seven-Week Stretch

Four-Week Pfizer
Three-Week Reserve Four-Week Reserve Four-Week Reserve
Three-Week Moderna
Overall Waiting time (day) 7.26 7.15 7.20 7.69
Throughput 669140 632560 673010 649530
Type 1 Waiting time (day) 0 0 0 0
Throughput 316500 298520 320420 311300
Type 2 Waiting time (day) 12.07 11.87 12.01 12.78
Throughput 352640 334040 355340 338230
Table EC.4 Stretch Policy Performance Comparison(With Vaccine Preference)
EC.4. Additional Numerical Results to Case Study

EC.4.1. Total-dose Analysis
In the main text, we have limited our results and performance analysis of the appointment booking
policies to their first-dose bookings alone. In the context of the Singapore vaccination exercise, at
the time of booking an appointment, an individual chooses both their first and second dose slots,
and hence the second dose throughput is assumed to be guaranteed, barring some no-show (we
can assume that the number of no-shows for second dose is minimal and furthermore there is no
official data available on the number of no shows).
However, for sake of completeness, we compute the total doses (both first and second) admin-
istered as this sum represents the total demand for the doses and is directly comparable to the
vaccine supply as shown in figures EC.2, EC.3 and EC.4. The gap between the total doses and the
supply is the inventory on hand and can be seen as a proxy for the second dose reserve for the
specific policy (Note: a more precise reserve can be inferred from the booking limit curves). It is
easy to observe that the aggressive policies, in general, utilize the vaccine inventory better than
the holdback (labeled “Recommended stretch with Full Reserve” in all figures) policy.

Figure EC.2 Comparing the total number of doses (first and second) under different policies applied since week
0.
Figure EC.3 Comparing the total number of doses (first and second) for the Aggressive Policy (6(8) week stretch
for Pfizer(Moderna) with 3 Week reserve) applied at different starting dates.
Specifically, in Figure EC.2, during weeks 3-5, we can observe that the second dose reserve forces
the slowing down of the total vaccines administered. It is easy to notice that any further acceler-
ation of the first dose will continue to dip into the reserve inventory, which explains the blocking
phenomenon experienced under aggressive policies with limited supply conditions. A similar phe-
nomenon can be observed in Figure EC.3 when the 6(8)-week stretch for Pfizer(Moderna) with
3-week reserve policy is applied starting from week 4 (notice the slowing of total doses administered
between week 8 and week 11).
In Figure EC.4, we compare the various dynamic policies when the Aggressive Policy is applied
at week 8. It is interesting to notice that the consequence of the total vaccine administered remains
pretty similar under varying modes of aggression, as all of these scenarios are eventually constrained

Figure EC.4 Comparing the total number of doses (first and second) under different aggressive policies applied
after 8 Weeks.
by the supply schedule. It is interesting to note that the 10-12 week policy holds slows down
starting week 16. This is because of the need to hold a 3-week reserve for the people who had their
first dose administered starting week 8. In fact, the system starts to hold reserve starting week 15
(8 + 10 − 3: 10-week stretch with 3-week reserve policy starting on week 8) even though it is visibly
noticeable only on week 16.
EC.4.2. Simulation of Alternative Aggressive Policies

We simulated the first-dose intakes of other stretch policies, such as 4(5)-week stretch for Pfizer
(Moderna) with 3-week reserve, and 5(7)-week stretch for Pfizer (Moderna) with 3-week reserve
along with the Aggressive Policy, as shown in Figure EC.5.
Though they are less aggressive with shorter stretch intervals, the growth patterns are similar
if the corresponding policies had been implemented at the beginning of the planning horizon. All
the policies give rise to the flat growth region which implies a suspension of the first-dose intakes
due to supply shortages.
EC.4.3. Robustness Studies on Model Inputs

VaxOS uses user-input parameters, some of which affect policy decisions. Two key inputs are the
estimated demand arrival patterns and the vaccine response rate. In all the results above, we use
a log-normal distribution fitted to the demand arrival patterns in Figure 1 and a response rate of
80%. We also conducted a robustness study on these inputs. Figure EC.6 and EC.7 compare the
robustness of the recommended policy (i.e., Hybrid Policy) with the Holdback Policy. Specifically,
in the robustness study simulation, we implement the recommended policy with the assumed
demand arrival patterns and 80% response rate, but the actual arrival pattern or the response rate

Figure EC.5 Observing the blocking phenomenon under various aggressive policies.
can deviate from the assumed parameters. Figure EC.6 and EC.7 show that the same degree of
parameter perturbations leads to a wider swing of changes in the holdback policy case compared
with the recommended policy. Specifically, there appear to have more regions where the actual
first-dose demand exceeds the booking limits in the holdback policy case, especially when the
actual response rate is higher than the assumed value. The recommended policy, on the contrary,
can absorb the perturbation better, and in most cases, the perturbation band remains below the
first-dose booking limits.

Figure EC.6 Sensitivity analysis: performance simulation of the different policies under varying arrival distribu-
tions. The red (blue) solid curve shows the cumulative number of first-dose booking limits under
the Hybrid Policy (holdback policy), and the red (blue) dotted curve is the simulated first dose
vaccinations under the assumed log-normal arrival distribution as planned under the Hybrid Policy
(holdback policy), and the red (blue) shaded area highlights the simulated first dose vaccinations
with 10% perturbation of the arrival pattern under the Hybrid Policy (holdback policy).
Figure EC.7 Sensitivity analysis: performance simulation of the different policies under varying response rates.
The red (blue) solid curve shows the cumulative number of first-dose booking limits under the Hybrid
Policy (holdback policy), and the red (blue) dotted curve is the simulated first dose vaccinations
under the assumed response rate of 80% as planned under the Hybrid Policy (holdback policy), and
the red (blue) shaded area highlights the simulated first dose vaccinations under 10% perturbation
of the response rate under the Hybrid Policy (holdback policy).

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Optimal Scheduling and Policy Design of Two-Dose

Sarah Yini Gao

Kelvin Bryan Tan

Key words : COVID-19 | Vaccine | Optimization | Copositive program

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1.1. Research Scope

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1.2. Contributions and Policy Implications

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Organization of the Paper

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3.1. Appointment Booking Limit with Second-Dose Reserve

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s.t. zt,t′ = 0, t′ ̸= t + I, ..., t + I + ms , (1a)

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w1 = max{0, D1 − x1 }, w2 = max{0, D2 − x2 + w1 }, ..., wt = max{0, Dt − xt + wt−1 }.

We can reformulate Z ∗ as the following linear program.

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3.2. Invitation Schedule Design

3.3. Without Vaccine Type Preference

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Assume that µ and Σ take values  such that

Z(n, x∗ ) = (1 − λ)Z w (n, x∗ ) + λZ x (n, x∗ )

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Proposition 1. max E[Z(n, x∗ )] is equivalent to the completely positive program (5).

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Theorem 1. Problem (2) is equivalently characterized by the following copositive program.

3.4. With Vaccine Type Preference

Theorem 2. Problem (6) is equivalently characterized by the following copositve program.

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3.5. Alternative Models

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U j (i, s, t) = f j (i) × (g j (s) + hj (t) + ϵj (s, t))

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Figure 3 Simulation Calibration and Prediction Errors

5. Numerical Study: Synthetic Case

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5.1. Optimal Appointment Booking Limits

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(a) Type 1 Vaccine (b) Type 2 Vaccine

Figure 4 (Color online.) The Optimal Cumulative Total Booking Limits

Figure 5 (Color online.) The Optimal Daily Booking Limits

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5.2. Optimal Invitation Schedule

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5.3. Policy Comparison

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6. Case Study: Singapore Vaccine Rollout Policy Evaluation

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6.1. Blocking Phenomenon

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6.2. Switching to Aggressive Policy

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6.3. Policy Implementations and Implications

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Assume that µ and Σ take values such that