More than half a million people have signed up for a newly launched service called Dr. B in an attempt to obtain a COVID-19 vaccine – and reduce the number of doses that can end up in the trash. Led by the founder of ZocDoc, Cyrus Massoumi, Dr. B is a website that aims to act as a kind of emergency alert system for thawed coronavirus vaccines, which normally need to be injected six hours after thawing.
“This vaccine is now the most scarce resource on the planet,” says Massoumi. “We were concerned that much of the vaccine ends up in this last-minute mess at the end of the day.”
A longstanding obstacle to conventional health care, missed appointments have become a vital issue for the coronavirus vaccine. Massoumi estimates that up to 20-30 percent of vaccination appointments are missed, leaving a defrosted vaccination dose that must be used within six hours or it will be lost forever. State reports suggest that few doses can expire. Instead, vaccination facilities distribute them to employees or anyone outside. But this confusion led to chaotic lines and a random approach to priority lists – something that Massoumi delicately describes as “below ideal”.
Dr. B was designed to serve as a sort of waiting list for these situations, giving providers an easy way to summon willing patients in a matter of hours. More than half a million people in the United States have signed up to be on the waiting list, each providing their home zip code and filling out a complete version of their state’s questionnaire. (Each state has a slightly different list of who is eligible for vaccines first. In New York, the first level, 1st, is people over 65 or with comorbidities. The next level, 1b, includes grocery store employees and others essential workers, and so on.)
When a provider finishes the thawed doses, Dr. B sends texts to participants from nearby postal codes, prioritizing them according to the state health department’s list of levels. After receiving the text message, the participant has fifteen minutes to confirm that he or she can reach the provider and then two hours to reach the location and take the photo. If you say you’re not going to make it, go to the end of the queue (within your priority group).
The system has suppliers to schedule a follow-up injection, which the Moderna and Pfizer / BioNTech vaccines still require – but the hope is that simply bringing patients to the door for the first dose will be a significant improvement.
This is not the first project to create a waiting list for coronavirus vaccines, but it quickly became the largest, absorbing the smallest vaccination waiting project in February. Most impressive is the speed with which the effort has grown. Still limited to America, Dr. B’s waiting list currently has more than half a million people, up from 300,000 just two weeks ago.
Providers are arriving more slowly, as each needs to be examined to ensure it is legitimate, but there are already two sites providing injections through the system – in Little Rock, Arkansas and Queens, New York. The company did not say how many doses were distributed through these sites, but says warnings were sent out each day the two test sites were opened, suggesting that at least a handful were administered through the system. More than 200 other providers are in preparation, covering 30 states.
Massoumi says enrolling these providers is still the biggest bottleneck – but it is an impressive record for what is still mostly a voluntary effort. There is no plan to monetize the system and much of the hosting and other back-end services have been donated by companies like Amazon, Twilio and others. Some employees are loaned to the project for their regular jobs; others are being paid out of Massoumi’s pocket. There is no clear sign of what will happen to the project after COVID-19 is defeated.
“We are just trying to make it happen as quickly as possible,” says Massoumi. “We have patients and vendor sites who want to use this and we just want to make sure that it is ready for prime time.”
As with any vaccination problem, there are concerns about who will have access and who will not. Black and Latino communities lagged behind in vaccination rates, a reminder of longstanding patterns of discrimination in the United States’ healthcare system. The new waiting list is in danger of worsening these inequalities: the nature of the project means that it will only work for patients with phones who can leave what they are doing and go to a vaccination post at any time.
The problem does not go unnoticed by specialists in medical ethics. Gabriel Lázaro-Muñoz, professor at Baylor’s Center for Medical Ethics and Health Policy, said The Verge he applauded the effort behind Dr. B, but feared that the project could deepen the inequality in the way vaccines are distributed.
“If Dr. B sends a text, the majority of people who will be able to drop what they’re doing and get the vaccine will be people who have access to emergency day care, people with cars, people who can probably get out of work with more easier than most underprivileged populations, ”said Lázaro-Muñoz. “So, they are trying to solve the problem, but it also exacerbates the issue of equity.”
Many of the fixes that the team tried to address only in parts of the larger problem. The project has already launched a Spanish version of the site and is in talks with Uber and Lyft to provide free rides in connection with the photos – an effort that would make a significant difference in the transportation problem.
But Massoumi believes that Dr. B’s queuing system will be fundamentally more just than what most states are doing, especially as more layers open up. Most state systems have focused on giving the elderly and vulnerable the first access to the vaccine – but as more people become eligible to receive the vaccine, vulnerable patients will find themselves in an increasingly larger group of people. potential recipients. In the current system, a first-rate patient who waits to receive the injection would have no advantage over anyone in an open layer. Massoumi likens this to a plane boarding call, when a Group 1 passenger who arrives late has to wait in the same queue as all the other groups. But because Dr. B has granular information about each person’s layer, the system can automatically send the most vulnerable patients to the front of the queue – a kind of expressway for late arrivals.
Behind everything, there is a constant march of vaccines. More than 20 percent of the US population has received at least one dose of the vaccine at this time, and President Biden said he hopes the government will have guaranteed sufficient doses for every adult in America by the end of May. Even small gaps in the rate or distribution can worsen in huge gaps in the coming months.
Dr. B’s plans are still limited by providers’ willingness to use the system, which has kept them limited to deployment in the United States and to locations where the scheduling system fails. But, like any founder of startups, Massoumi is not afraid to dream big, noting that nothing prevents the system they have built from being applied to unfrozen doses or in other countries where the launch is taking place more slowly.
“It is not just this country. The whole world will not be vaccinated until 2023 ”, says Massoumi. “It is a global problem, both the pandemic and the scheduling problem, and what we are creating is a global solution.”