Earlier this month, the New York-based photographer Hee Jin Kang woke up at 3am and went online to register her elderly parents for the coronavirus vaccine.
She created accounts on five different websites, including portals for state-run vaccination programs as well as hospitals, pharmacies and primary care locations. After hours of clicking through 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 are not tech literate this would just be impossible – they make you jump through so many hoops.”
People across the United States have likened signing up for a vaccine shot in recent weeks to refreshing a page for highly coveted concert tickets. In Michigan, a website for vaccine sign-ups crashed almost immediately after the state expanded vaccine access to people 65 and older. The site, which processes 900 appointments on a typical day, saw more than 25,000 people trying to register. In Texas one website saw 9,000 appointments fill in less than six minutes. Users in Minnesota reported similar issues. Some health departments in Florida are using the ticketing site Eventbrite, leading to concerns about ticket scalpers buying up slots and reselling them.
The Trump administration promised in November that 20m Covid-19 vaccines could be distributed by 2021. As of this week just 18.5 million people have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention, and about 3.2 million people have been fully vaccinated.
New vaccine doses can only be produced so quickly, but supply is just part of the problem. For Americans whose vaccines are not being arranged through their workplace, scheduling can be a major setback.
Most states have no centralized system to register for appointments and those that do exist are rife with glitches. Both these hurdles have made it difficult for those who aren’t tech savvy and people who don’t have time to refresh an online sign-up all day to get a potentially life-saving vaccine slot.
In fact, online sign-ups raise a number of ethics concerns, public health experts say. Most states in the US are in the second stage of vaccines, meaning people aged 65 and older are allowed to be vaccinated. That poses issues for elderly patients and others with little tech literacy, said Susan Lee, a primary care internist in New York. “The only elderly patients who have been able to get appointments – my parents included – are those who have someone able to advocate for them,” Lee said. “It is heartbreaking.”
In addition, millions of Americans lack access to broadband internet, and just 51% of seniors say they have high-speed internet at home. These statistics are further affected by race: only 58% of Black Americans and 57% of Hispanics own a computer at home, compared with 82% of whites.
Biden has pledged to increase the vaccine distribution to 1.5m doses a day within the next three weeks and said that anyone who wants a vaccine will be able to access it by spring, but America’s disjointed healthcare system presents unique struggles. One of the only high-income countries in the world without universal healthcare, the US relies 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 plan for vaccine distribution with little national direction. On a federal level, a hesitancy from the Trump administration to share data has slowed vaccine roll out, the Biden administration has said.
In a new 200-page report outlining a vaccine rollout, Biden said his administration will facilitate “new technology solutions” to Covid vaccine scheduling. “The federal government will provide technical support to ensure that these systems meet mission critical requirements to support a robust response,” the report said.
Streamlining vaccination distribution and scheduling process as soon as possible will be integral to controlling and eventually ending the coronavirus pandemic, said Seju Mathew, a primary care physician and public health expert based in Atlanta, Georgia.
“We need 85% of the US vaccinated in order to get to herd immunity, so the next few weeks will be huge,” he said. “The only way to take care of this deadly pandemic is to vaccinate people very quickly.”
In the meantime, some states are taking action, private companies are stepping up, and community efforts are emerging. California, where the state government has been fiercely criticized for slow vaccination rates, just launched a state-wide portal called My Turn, which will alert residents of vaccine eligibility. This comes after a crowd-sourced site in California called VaccinateCA organized volunteers to call pharmacies across the state to determine which are providing vaccines to whom and publish what they learn.
Google announced on Monday it would put vaccination locations on its Maps feature. Private companies like ZocDoc, a platform used to register traditional doctor appointments, are offering their infrastructure to schedule vaccines. ZocDoc is partnering with large hospital systems and local governments to better facilitate scheduling. Amazon has also offered to assist with vaccine logistics and is drafting an official proposal to the Biden administration, a spokesman said on Saturday.
It’s crucial the government enable better scheduling logistics because both vaccines approved in the United States – from Moderna and Pfizer – require two doses to be effective. Mathew, the primary care physician, said based on what he has heard from news reports and directly from his patients, he worries people who have struggled to get an appointment for one shot will be more hesitant to schedule a follow-up appointment.
“Scheduling a vaccine should be as easy as booking a ride on Uber or a dinner reservation on OpenTable,” he said. “Otherwise, we are losing patients.”
This won’t be possible without a more streamlined technological approach, said Seema Yasmin, a doctor and director at the Stanford Health Communication Initiative. The system must also keep in mind the inequities that exist in the US healthcare system and in the spread of Covid-19 in the US.
“The same communities disproportionately dying from Covid-19 are being vaccinated at slower rates than white and wealthy citizens,” Yasmin said. “When something as basic as the ability to book a vaccination appointment or even to find out when you might be eligible for a vaccine pose such huge challenges, it can foster mistrust in the vaccination system and the vaccines themselves.”