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As of Monday, Nick Muerdter had gotten 2.4 million hits on a page he launched two weeks ago to help people find open COVID-19 vaccine appointments at nearby pharmacies.
“I just wanted to simplify it, so you didn’t have to click a dozen times to find out there are no appointments available,” the Colorado programmer said.
The nation’s vaccine appointment system is broken in many places, leading to a race to find appointments that in many places works best for the lucky, the internet-savvy or the mobile.
“I have plenty of neighbors who are driving hours to get to other counties where they can get vaccinated, but not everybody can do that,” said Melissa McPheeters, a professor of health policy and biomedical informatics at Vanderbilt University Medical Center.
Even for those with options, sometimes the system doesn’t work at all.
In Washington, D.C., the city’s vaccination portal was down over the weekend, unable to handle a surge as more than 36,000 people tried to get access to 4,300 appointments, according to a tweet by Lindsey Parker, chief technology officer for the D.C. government.
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Muerdter and others are trying to offer digital help to those without family and friends who can spend hours on the hunt for a shot when the systems function.
Despite the extraordinary success of creating three vaccines to fight COVID-19 in less than a year, America’s fragmented health system meant there was no simple, unified way to sign up to get a shot.
“Appointment scheduling has become a big issue,” said Tinglong Dai, a professor of operations management at the Johns Hopkins University school of business who’s written on the issue. “It’s cruel when people have to suffer through this because the government isn’t doing the hard work.”
In a news conference Monday, White House COVID-19 Response Coordinator Jeff Zients acknowledged the problem.
“We’re also looking at lower-tech solutions that the federal government might be able to provide, whether those are call centers or people to help navigate the system,” he said. “Overall scheduling remains for far too many people, too frustrating. And we need to make it better.”
‘Better luck next time’: ‘SNL’ pokes fun at national vaccination system
Although 15% of Americans have so far received at least one shot, getting them hasn’t been easy. The scramble to find appointments is so common it showed up on Saturday Night Live, which opened this week with a skit featuring Dr. Anthony Fauci, the nation’s leading infectious disease expert, as the host of a satirical game show, “So You Think You Can Get the Vaccine.”
An 85-year-old wins but to get his shot he has to make an appointment online. Unfortunately, he’s got no one with “three straight days to help you click refresh.”
“So close,” one of the judges tells him. “Better luck next time.”
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The skit hits close to home, as thousands of people struggle to navigate appointment systems that favor the computer literate with fast internet access, creating fundamental inequities for those who aren’t tech-savvy.
“It’s a mismatch,” said McPheeters. “We’ve set up a system that’s exceptionally hard to navigate for the target audience of older people.”
To help bridge the gap between the elderly and others without the means to connect online, strangers are stepping in. “Vaccine angels” or “vaccine hunters” have appeared online to help others find spots or simply to share information. Thousands of messages have flooded Facebook groups for people in Chicago, New Jersey, Texas and Washington state. Others have organized on the NextDoor neighborhood site, such as the DC Vaccine Coalition.
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Their posts show the difficulties people face.
“I am trying to help someone who lives in a FEMA designated zip code in Dallas and has severe underlying conditions to get an appointment for a vaccine. I put his name on the Dallas County list. Is there anything else I can do? Should I go ahead and register him everywhere else?” read one from Texas.
A New Jersey vaccine hunter, who lives in a rural area where WiFi is not strong, questioned why a Rite Aid pharmacy appointment site asked users to choose a time when every time she clicked on already was full.
A fellow hunter answered: “They give it to whoever is fastest filling everything out. It’s kind of messed up, but it is what it is.”
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That’s what lead Muerdter, a programmer at the National Renewable Energy Laboratory, to write his code. Colleagues complained two weeks ago they couldn’t make appointments for their parents. So he sat down at night and wrote some quick and dirty computer code to automate looking for open pharmacy vaccination appointments in Colorado.
When it launched, the governor called to congratulate him and asked if the state could use it, too. On Thursday, he created a rough but serviceable national site at vaccinespotter.org, doing the same thing for pharmacy chains whose data he can access.
On Saturday, Arkansas state Sen. Greg Leding tweeted out the address to Muerdter’s site, noting Arkansas had no centralized hub of its own to help connect residents to vaccine.
There are other vaccine finding sites, including one created by the federal government that was started in 2011 during the H1N1 flu pandemic, and has been relaunched to help find COVID-19 vaccine.
The site, vaccinefinder.org, gives users current vaccine eligibility for their ZIP code and what appointments are available at nearby national pharmacy chain stores, said John Brownstein, chief innovation officer at Boston Children’s Hospital and its creator.
For now, the site only has information on health department and other vaccination clinic appointments in a handful of states but more are being added every day. Eventually, Brownstein hopes to add the ability to make appointments nationwide.
Even in its current form, the site’s getting millions of hits and helping people get immunized.
“Even though they still have to register for an appointment, the site told them where there was vaccine near them, which cuts down on frustration,” Brownstein said.
‘Scheduling an appointment for a vaccine should take minutes, not hours’
The difficulties of signing up to be vaccinated are a failure of the system, Dr. Ashish Jha testified before the House Ways and Means Committee on Friday.
“Scheduling an appointment for a vaccine should take minutes, not hours. It should involve a few clicks on a webpage or a quick phone call, not crashing web portals or endless phone calls with five different health care providers,” said Jha, who is dean of the School of Public Health at Brown University.
The ideal is a statewide system with both a functional 1-800 phone line and a solid onlineappointment component. Health officials call this a mosaic approach, accessible to all people regardless of their tech ability.
Systems should also allow residents to preregister for the vaccine and confirm they’ve gotten a place in line.
“Here in Baltimore County (Maryland), we have a preregistration system but there’s no confirmation. You don’t get an email or text message so you’re never sure if you’re application was really registered by the system,” Johns Hopkins professor Dai said.
Users should also be able to cancel if they get an appointment elsewhere, and check their status as they wait. “It’s like being in line at the bank, you want to make sure it’s still moving,” said Dai added.
In Tennessee, counties have complained systems are slowed by waitlists clogged with people who’ve been able to get vaccinated elsewhere.
“If you get a shot here at Vanderbilt University, the county has no way of knowing it,” said McPheeters. “It would be so helpful if we could bump these lists against one and other and share data.”
New Mexico and West Virginia are two states with strong appointment systems that effectively use phone lines and websites. New Mexico has the second-highest rate of COVID-19 vaccination in the country, at 22%. And West Virginia, one of the poorest states in the nation, comes in strong at 18%.
Even the best performing states rely on residents proactively reaching out, what’s known as a “pull system.” But experts say a better approach is a “push system,” where the vaccine comes to the consumer.
That’s how it works in Israel, which had vaccinated 51% of its citizens as of Friday.
Because the country has an electronic national health system, the name, age and contact information of every citizen known is known and people are automatically put on a vaccine priority list. When they become eligible, they get either a call, a text message or an email, and a link that allows them to make an appointment.
That’s impossible in the United States because government and health care company systems are siloed by design due to concerns about privacy, said McPheeters.
But something similar could be done, Dai said.
“When the United States government wants to find you to pay your taxes,” he noted, “they have no problem doing so.”