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Earlier this month, New York-based photographer Hee Jin Kang woke up at 3 a.m. and went online to enroll her elderly parents for the coronavirus vaccine.
She created accounts on five different websites, including portals for state-run immunization programs as well as hospitals, pharmacies and primary care facilities. After hours of clicking and refreshing various landing pages, she secured time slots for both parents.
“It’s just crazy,” she said. “There is no centralized system. I just couldn’t stop thinking, if you’re not tech-savvy, it would just be impossible – they make you jump through so many obstacles.
People across the United States have compared registering for a vaccine in recent weeks to refresh a page for coveted concert tickets. In Michigan, a website for vaccine registrations collapsed almost immediately after the state expanded access to vaccines to people 65 and older. The site, which handles 900 appointments each day, has seen more than 25,000 people trying to register. In Texas, a website saw 9,000 appointments fill up in less than six minutes. Minnesota users have reported similar issues. Some Florida health services are using the Eventbrite ticketing site, raising concerns about ticket scalpers buying slots and reselling them.
The Trump administration promised in November that 20 million Covid-19 vaccines could be distributed by 2021. As of this week, only 18.5 million people have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention, and approximately 3.2 million people have been fully immunized.
New doses of vaccine can only be produced so quickly, but supply is only part of the problem. For Americans whose vaccines aren’t organized at their workplace, planning can be a major setback.
Most states do not have a centralized appointment registration system, and those that do exist are plagued by problems. Both of these hurdles have made it difficult for those who are not tech savvy and those who don’t have the time to refresh an online registration all day long to secure a potentially vital immunization window.
In fact, online registrations raise a number of ethical concerns, say public health experts. Most states in the United States are in the second stage of vaccines, which means people aged 65 and over are allowed to get vaccinated. This poses problems for elderly patients and others unfamiliar with the technology, said Susan Lee, a primary care internist in New York City. “The only elderly patients who have been able to get appointments – my parents included – are those who have someone who can stand up for them,” Lee said. “It’s heartbreaking.”
Additionally, millions of Americans do not have high-speed internet access, and only 51% of seniors report having high-speed internet access at home. These statistics are further affected by race: only 58% of black Americans and 57% of Hispanics own a computer at home, compared to 82% of whites.
Biden pledged to increase vaccine distribution to 1.5m doses per day over the next three weeks and said anyone wanting a vaccine will be able to access it in the spring, but America’s rambling healthcare system presents unique challenges. One of the only high-income countries in the world without universal health care, the United States depends on a mix of private and public health resources. The logistical challenges are compounded by the fact that states under the Trump administration were left to roll out their own vaccine distribution plan with little national leadership. At the federal level, the Trump administration’s reluctance to share data has slowed vaccine deployment, the Biden administration said.
In a new 200-page report outlining the deployment of a vaccine, Biden said his administration would facilitate “new technology solutions” for planning Covid vaccines. “The federal government will provide technical support to ensure these systems meet mission critical requirements to support a robust response,” the report said.
Streamlining vaccine distribution and the planning process as soon as possible will be integral to controlling and ending the coronavirus pandemic, said Seju Mathew, primary care physician and public health expert based in Atlanta, Georgia. .
“We need 85% of the United States vaccinated to get herd immunity, so the next few weeks will be huge,” he said. “The only way to fight this deadly pandemic is to vaccinate people very quickly.”
In the meantime, some states are taking action, private companies are multiplying and community efforts are emerging. California, where the state government has come under heavy criticism for slow vaccination rates, has just launched a statewide portal called My Turn, which will alert residents of vaccine eligibility. It comes after a public site in California called VaccinateCA organized volunteers to call state pharmacies to determine who provides vaccines to whom and post what they learn.
Google announced Monday that it would put vaccination locations on its Maps feature. Private companies like ZocDoc, a platform used to record traditional medical appointments, are offering their infrastructure to schedule vaccines. ZocDoc works in partnership with large hospital systems and local governments to better facilitate planning. Amazon has also offered to help with vaccine logistics and is drafting an official proposal to the Biden administration, a spokesperson said on Saturday.
It is essential that the government allow for better logistics planning, as the two vaccines approved in the United States – from Moderna and Pfizer – require two doses to be effective. Mathew, the primary care doctor, said based on what he has heard from reports and directly from his patients, he is concerned that people who have struggled to get an appointment for a vaccine are more reluctant to schedule a follow-up appointment.
“Planning a vaccine should be as easy as booking a ride on Uber or a dinner reservation on OpenTable,” he said. “Otherwise, we lose patients.”
This won’t be possible without a more streamlined technological approach, said Seema Yasmin, physician and director of the Stanford Health Communication Initiative. The system must also keep in mind the inequalities that exist in the US healthcare system and in the spread of Covid-19 in the United States.
“The same communities that die disproportionately from Covid-19 are vaccinated at a slower rate than white, wealthy citizens,” Yasmin said. “When something as basic as being able to make an appointment for vaccination or even knowing when you might be eligible for a vaccine poses such enormous challenges, it can foster distrust of the immunization system and people. vaccines themselves.
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