PROVIDENCE, RI (AP) – The path to a COVID-19 injection usually goes through a maze of scheduling systems: some vaccine candidates spend days or weeks trying to schedule appointments online. Those who get a coveted place can still be stopped by pages of forms or websites that take time to crawl and crash.
The technological hurdles are familiar to L. Shapley Bassen, a 74-year-old retired English teacher and editor from East Greenwich, Rhode Island. She lost track of the hours she spent making calls and surfing websites to get appointments for her and her husband, Michael, 75.
“Many of us don’t sleep at night worrying about whether or not we will be able to get in,” said Bassen.
Technological deficiencies across the country’s fragmented public health system have frustrated millions of Americans who were trying to get vaccines and left the authorities without a complete picture of who was vaccinated.
“We are creating an unnecessary amount of human suffering. That could have been preventable and we could have done better, ”said Tinglong Dai, a professor who studies health operations at the Carey Business School at Johns Hopkins University.
The White House has promised improvements, promising to establish a new website and an 800 number until May 1 to help people find nearby locations with vaccines.
“No more looking around day and night for a date for you and your loved ones,” said President Joe Biden on Thursday in a prime-time speech to the nation.
The government has also promised to send technical teams to states that need help improving their sites.
The bottleneck in demand for vaccines appears to be easing in some places, and on Friday, the US surpassed 100 million doses administered. Almost 66 million people received at least one dose. But vaccine vacancies are sometimes still so difficult to obtain that people turn to groups of vaccine hunters on Facebook and bots that scan websites for compromises. Vaccine candidates who are not used to these methods and have no one to help are at a great disadvantage.
Bassen finally got a job at a pharmacy close to home for her husband. The site even offered to book the second dose, but when she clicked, nothing happened.
Assuming it was a failure, they printed out the appointment confirmation email. When he arrived, he was rejected. They said he needed to schedule the second shot at the same time as the first.
The rejection sent Bassen back to the rabbit hole of the state, local government and drugstore websites and phone numbers. She compared this to a set of musical chairs.
“From the point of view of the patient, the consumer, there seemed to be no continuity between these three entities,” said Bassen.
The confusion is not surprising. An investigation by The Associated Press and Kaiser Health News found that, since 2010, spending on state public health departments has dropped 16% per capita, and spending on local health departments dropped 18%. Little money was left to invest in technology.
To help states prepare for the implementation of COVID-19 vaccines, the Centers for Disease Control and Prevention began building a vaccine management system known as VAMS.
Many states were hesitant to commit because it takes time for employees to learn new programs and new systems often have problems. Few state health departments have adopted the CDC program, and at least one has decided to abandon it.
In New Hampshire, authorities planned to switch to their own program after thousands of people failed to schedule a second dose. within the recommended timeframe. Others had their appointments canceled after the system mistakenly allowed them to reserve places for which they were not eligible.
A national program that works well everywhere is unlikely to happen, especially due to the unprecedented scale of screening for COVID-19 vaccines, said Claire Hannan, executive director of the Association of Immunization Managers.
Before the pandemic, local vaccine records across the country were used primarily to track childhood vaccines. Some are decades old and were never meant to be used to schedule appointments.
“Many of them are just a kind of bowl of code, where you keep adding,” said Rebecca Coyle, executive director of the American Immunization Registry Association.
Many vaccine suppliers, like smaller pharmacies, were also not tied to pre-pandemic records because of the time and cost of this – including the necessary maintenance, which involves constantly uploading data and ensuring they are stored and shared in a proper.
“There has always been this perception that you build and are ready,” said Coyle.
Many states have concluded that they need a single, easy-to-access “front door” for scheduling injections, noted Dr. Deidre Gifford, acting commissioner for the Connecticut department of health, during a recent CDC forum.
The best system, Dai said, would be to send everyone to register at a central location and, based on the supply, give each person a reasonable estimate to receive the vaccine. This may take a few weeks or months, but managing expectations would ease some of the anxiety.
“The central idea is to give people confidence, to give guarantees to people,” said Dai.
West Virginia almost did this with a single statewide pre-registration system that uses crisis management software to collect demographic and contact information from each person, as well as details such as occupation, so that certain critical workers can be targeted. They then receive a text message or phone call to book a place when doses of the vaccine are available in their county, said Krista D. Capehart, who coordinates the response to state pharmacies.
Other states have struggled with their vaccine websites, or designed websites that provide some help, but make people work hard to find available vaccines. The Massachusetts website was so overloaded that it crashed. The Washington state website allows people to print a piece of paper saying they are eligible, but finding and making an appointment is still up to the individual.
Maryland has established a pre-registration portal, but people still need to access other sites to find a vacancy. Dai said that even he has struggled to become eligible and previously registered in his county. When he was asked to schedule an appointment, the link did not work.
“At the end of yesterday, I received five links, but none of them worked,” he said on Thursday. He ended up making his own reservation at Walgreens.
Given the confusion, many worry about what will happen when eligibility is open to an even broader population. People may find it so difficult and time-consuming to bid that they simply give up.
“The situation will be even worse,” said Dai.
Disease detectives who monitor the pandemic are also concerned about the lack of consistent data on vaccinations.
“If we don’t have good systems to track the number and type of people who are getting the vaccine, we may not be as efficient and effective as possible with the limited resources we have,” said Janet Hamilton, executive director of the Council of State and Epidemiologists Territorial.
Race and ethnicity data are available for just over half of people who have received vaccines so far. This may be because the recipients of the vaccine are not providing the information, or because the locations where they receive the injection are not collecting, entering, or entering too slowly.
In many cases, data has been entered, but flaws in different software systems make these fields disappear, said Dr. Marcus Plescia, of the Association of Territorial and State Health Officials.
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Safety, finds the launch of the vaccine embarrassing.
“If we had fought in World War II the way we are doing it,” he said, “there is no doubt that we would have lost.”
——
Choi reported from New York. Associated Press editor Carla Johnson of Washington State contributed to this report.