In the rush to mark an indescribable vaccine indication, the remaining dose became the subject of the pandemic tradition.
Extra injections – which should be used within a few hours of being taken out of cold storage – have been distributed to drugstore customers who buy late night snacks, people who are friends with nurses and those who show up at closing hours in certain supermarkets and pharmacies. In some larger vaccination sites, the rush to use all doses triggers a flurry of phone calls later in the day.
In all cases, if the remaining dose does not find an available arm, it should go to waste.
Now, a New York-based start-up plans to add some order in a hurry to the remaining doses. Dr. B, as the company is known, is combining vaccine suppliers who have extra vaccines with people who wish to obtain them at any time.
Since the service started last month, more than 500,000 people have sent a series of personal information to sign up for the service, which is free and also free for providers. Two vaccine sites have started testing the program, and the company said that about 200 other suppliers have signed up to participate.
Dr. B is just an attempt to coordinate the chaotic patchwork of public and private websites that allow qualified people to find vaccination schedules. Critics said the current system is confusing, unreliable and generally requires access to the internet, as well as time to scour sites for a rare encounter. In many places, he also largely ignores people who are not yet eligible for a chance, wasting the opportunity to put them on a formal waiting list.
Although Dr. B does not solve all of these broader problems, if it increases in the way that some expect it to, it could serve as a model for a better and fairer way of scheduling vaccinations.
“I think it’s a great idea,” said Sharon Whisenand, administrator for the Randolph County Health Department in rural Missouri.
Whisenand said 60 to 80 people did not attend the county’s first mass vaccination event in late January, prompting his team to make dozens of calls at the end of the day to people on the waiting list. “We looked a bit like a call center for a while,” she said. Workers have finally found enough borrowers to administer most of the extra doses, but some doses have been dispensed with.
Dr. B is a for-profit effort, established as a public benefit company that includes efficient and equitable vaccine distribution in its mission. But its founder, Cyrus Massoumi, a technology entrepreneur, has yet to describe Dr. B.’s business model. He said he was financing the project out of his own pocket and had no plans to raise revenue. The company takes its name from his grandfather, who was nicknamed Dr. Bubba and became a doctor during the 1918 flu pandemic.
Massoumi is the founder and former executive president of ZocDoc, which helps patients find available medical appointments, and founder of Shadow, a company that brings together lost pets with their owners using technology and local volunteers. Like both efforts, Dr. B seeks to make connections between groups that need something from each other.
“Ultimately, patients need this vaccine and there are providers who need help to get it to priority people,” said Massoumi in an interview. “That is my motivation.”
After having the idea for Dr. B in January, Mr. Massoumi recruited several engineers from Haven, a now-defunct health collaboration between Amazon, Berkshire Hathaway and JP Morgan, to build his underlying website and database. Amazon also donated web services, Massoumi said.
The half million people who signed up for the service entered basic biographical information, such as date of birth, address, underlying health conditions and the type of work they do. If vaccine providers near them have extra doses, they will be notified by text message and will have 15 minutes to respond. So, they must be willing to travel quickly to the vaccination site.
The company’s database classifies people according to local rules on vaccine priority, giving providers better chances of administering leftover vaccines to those who need it most.
For many providers, this orderly procedure would be a welcome change from the random systems they are using now. In some pharmacies and supermarket chains, workers resorted to scouring store aisles to find people willing to receive a last-minute vaccine. Elsewhere, vaccine candidates wait in line at the end of each shift, which can pose a risk of infection, especially for the most vulnerable.
Despite some complaints about younger, healthier people skipping the queue and taking the remaining doses, public health experts and many ethicists say the most important thing is that vaccines don’t go to waste. At the beginning of the vaccine’s launch, some politicians, such as New York Governor Andrew M. Cuomo, threatened sanctions against suppliers for not precisely following the rules of priority, and a doctor in Texas lost his job after giving expired doses to people with health problems, including his wife.
For those who receive a last-minute vaccine, “that person shouldn’t say no because they want him to go to someone else,” said Dr. Shikha Jain, an assistant professor of medicine at the University of Illinois at Chicago, and a colleague – founder of IMPACT, a group that has been working to improve equitable distribution of vaccines. However, “it is very important to be intentional and equitable,” she said.
Massoumi said he has taken several steps to ensure that the service is fair. This included refusing the media’s first requests for mainstream publications and, instead, promoting Dr. B’s connections in Zoom with representatives of groups such as black churches and Native American community groups, as the pandemic disproportionately affected non-white groups.
“It was very important for him to allow these communities to have a potential place on the front line or to get the information in advance,” said Brooke Williams, who is black and a member of New York’s Resistance Revival Chorus. She joined one of Zoom’s first calls and started spreading the word.
“Hearing about shots being fired was just heartbreaking and annoying,” she said.
The service suffers, however, from some of the same barriers that have hindered vaccination efforts so far. Although registration is simple, it requires an Internet connection and immediate access to a cell phone. Due to the last-minute nature of the remaining doses, participants must have flexible hours and access to transportation.
“It still depends a lot on the internet, so it will depend on who will hear about it,” said Arthur Caplan, a specialist in medical ethics at the Grossman School of Medicine at New York University. “It looks like he is trying to solve a problem and do something good, but I am sad that governments – counties, cities, national organizations – have not prepared themselves for this and have not reacted more quickly to give advice and guidance.”
Mr. Massoumi noted that the site allows people, as volunteers from the community, to sign up on behalf of others. The website is also available in Spanish.
He noted that the program’s configuration, which allows people to sign up and wait for a notification based on priority, is better than other sites that require hours of updating the sites in the likelihood that they might have a rare opening.
What you need to know about the vaccine launch
Some local health officials, including Washington, DC and West Virginia, are switching to a similar pre-registration system, which can help level the playing field.
“There’s this feeling that you don’t know where you are, and the only way to secure your place is to update a browser,” said John Brownstein, a researcher at Boston Children’s Hospital who runs VaccineFinder.org, an online portal that helps people schedule vaccines .
For Brittany Marsh, a pharmacy owner in Little Rock, Arkansas, figuring out what to do with the remaining doses was a daily headache.
She said the number of no-shows increased as vaccines became more available, and others had to cancel at the last minute because they developed Covid-19 or were exposed to someone who did. Although people sometimes call, she said, “most of the time, we just don’t show up.”
Ms. Marsh has been testing Dr. B’s service for a few weeks and said it saved her employees the trouble of calling a waiting list of other customers to fill vacancies quickly. With Dr. B, she said, “I know they are calling at least what we think is the right group of people to come and get these injections, so that we never have to waste them.”
Dr. B has revealed few details about which providers have expressed interest in using his platform, as well as saying that the providers are based in 30 states and include doctor’s offices, pharmacies and medical departments at major academic institutions.
The company collects confidential personal information that it promises to protect closely, although, as the company itself is not a medical provider, the data is not protected by the federal health privacy law known as HIPAA.
When asked about his long-term plans for the company, Mr. Massoumi objected, noting that the race for vaccination would not end anytime soon.
“At the moment, we just want to distribute the vaccines in the best possible way,” he said. “I can’t think of a better use of money to help resolve the pandemic, so we are with our heads down, focused on that.”