PROVIDENCE, RI (AP) – The road to a COVID-19 shot often leads through a maze of programming systems: some vaccine seekers spend days or weeks trying to book appointments online. Those who get a coveted slot can still be hampered by form pages or websites that slow down the crawling and blocking speed.
Technological hurdles are familiar to L. Shapley Bassen, a 74-year-old retired English teacher and editor in East Greenwich, Rhode Island. She lost track of the hours she spent making phone calls and browsing websites to get appointments for herself and her husband, Michael, 75.
“A lot of us don’t sleep at night worried about whether or not we’ll be able to get in,” Bassen said.
The technological shortcomings of the nation’s fragmented public health system have frustrated millions of Americans trying to get shot and left officials without a complete picture of who has been vaccinated.
“We are creating an unnecessary amount of human suffering. That could have been avoidable and we could have done better, ”said Tinglong Dai, a professor who studies health operations at Carey Business School at Johns Hopkins University.
The White House promised improvements, pledging to establish a new website and an 800 number on May 1 to help people find nearby places with vaccines.
“You no longer have to look for an appointment day and night for you and your loved ones,” President Joe Biden said Thursday in an early-morning speech to the nation.
The administration also pledged to send technical teams to states that need help to improve their websites.
The bottleneck of vaccine demand appears to be declining in some places and on Friday the US exceeded 100 million doses administered. About 66 million people have received at least one dose. But sometimes vaccine slots are still so hard to get that people turn to Facebook vaccine hunter groups and robots that scan sites for open appointments. Vaccine seekers who are not accustomed to these methods and who have no one to help them are at a significant disadvantage.
Bassen finally landed a slot at a pharmacy near her husband. The website even offered to schedule the second dose, but when I clicked on it nothing happened.
Imagining it was a problem, they printed out the appointment confirmation email. When he arrived, he was turned down. He was told he had to schedule the second shot at the same time as the first.
The rejection caused Bassen to return to the rabbit hole of websites and phone numbers of local governments and pharmacies. He compared it to a set of musical chairs.
“From the point of view of the patient, the consumer, there seems to be no continuity between these three entities,” Bassen said.
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 has fallen by 18%. There was little money left to invest in technology.
To help states prepare for the launch of COVID-19 shots, the Centers for Disease Control and Prevention began building a vaccine management system known as VAMS.
Many states were hesitant to commit because employees need time 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, officials planned to switch to their own program after thousands of people were unable to schedule according to shots within the recommended timeframe. Others canceled their appointments after the system allowed them, by mistake, to reserve spaces for which they were not eligible.
Claire Hannan, executive director of the Association of Immunization Managers, said there would never be a national program that would work well everywhere, especially given the unprecedented magnitude of COVID-19 vaccine monitoring.
Prior to the pandemic, local vaccine records across the country were primarily used to track childhood vaccines. Some are decades old and were never used to schedule appointments.
“A lot of them are kind of like that bowl of spaghetti code, where you don’t stop adding,” said Rebecca Coyle, executive director of the American Immunization Registry Association.
Many vaccine providers, such as smaller pharmacies, were also not connected to pre-pandemic records due to the time and cost of doing so, including the maintenance required, which involves constantly loading data and making sure it is they store and share correctly.
“There’s always been that perception that you build it and that’s it,” Coyle said.
Many states have come to the conclusion that they need a single, easily accessible “front door” to schedule shots, Dr. Deidre Gifford, acting commissioner for the Connecticut health department, said during a recent CDC forum.
The best system, Dai said, would be to send everyone to register at a central location and, depending on the supply, give each person a reasonable estimate to receive a vaccine. It could take a few weeks or months, but managing expectations would alleviate some anxiety.
“The basic idea is to give people confidence, give them peace of mind,” Dai said.
West Virginia has almost done so with a unique statewide pre-enrollment system that uses crisis management programs to collect each person’s demographic and contact information, as well as details such as employment, so they can be targeted certain critical workers. They then receive a text message or a phone call to reserve a slot when vaccine doses are available in their county, said Krista D. Capehart, who coordinates the response from state pharmacies.
Other states have had issues with their vaccine websites or have designed sites that give help, but make people work hard to find the photos available. The Massachusetts site was so overflowing that it crashed. The Washington state site allows people to print a piece of paper saying they are eligible, but finding and booking an appointment is still up to the individual.
Maryland set up a pre-registration portal, but people still have to go to other websites to find a slot. Dai said he has even fought after being eligible and pre-registering for his county. When he was invited to make an appointment, the link did not work.
“By the end of yesterday, I had received five links, but none of them worked,” he said Thursday. He ended up booking alone at Walgreens.
Faced with the confusion, many worry about what will happen when eligibility opens up to an even wider population. It can cost people so much and consume a lot of time to make a shot that they simply give up.
“The situation will be even worse,” Dai said.
Disease detectives controlling the pandemic are also concerned about the lack of consistent data on vaccinations.
“If we don’t have good systems for tracking the number and type of people receiving the vaccine, we may not be as efficient and effective as possible with the limited resource we have,” said Janet Hamilton, executive director of the vaccine. Council of State and Territorial Epidemiologists.
Data on race and ethnicity are only available for just over half of people who have received vaccines so far. This could be because vaccine recipients do not provide the information or because the places where they receive the vaccine do not collect it, do not enter it or enter it too slowly.
In many cases, data was introduced, but errors with different software systems make these fields disappear, said Dr. Marcus Plescia, of the Association of State and Territorial Health Officials.
Dr. Amesh Adalja, a scholar at the Johns Hopkins Center for Health Security, finds the launch of the vaccine embarrassing.
“If we had fought World War II the way we do,” 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 the report.