PROVIDENCE, RI (AP) – The road to a COVID-19 admission often leads through a maze of scheduling systems: some vaccine seekers spend days or weeks making online appointments. Those getting a coveted slot machine can still be hindered by pages of forms or websites slowly crawling and crashing.
The technological obstacles are known to L. Shapley Bassen, a 74-year-old retired English teacher and editor in East Greenwich, Rhode Island. She lost the hours she spent making phone calls and navigating websites to book appointments for herself and her 75-year-old husband, Michael.
“Many of us don’t sleep at night and worry whether or not we can get in,” said Bassen.
Technological flaws in the country’s fragmented public health system have frustrated millions of Americans who tried to shoot and left officials without a full picture of who was vaccinated.
“We create unnecessary human suffering. This could have been avoided, and we could have done it better, ”said Tinglong Dai, a professor of health care at Johns Hopkins University’s Carey Business School.
The White House promised improvements and promised to set up a new website and 800 number before May 1 to help people find nearby locations with vaccines.
“You no longer have to search day and night for an appointment for you and your loved ones,” President Joe Biden said in a primetime address to the nation on Thursday.
The administration also pledged to send technical teams to states that need help improving their websites.
The bottleneck in vaccine demand appears to be diminishing in some locations, and on Friday the US exceeded 100 million doses administered. Nearly 66 million people have received at least one doseBut vaccine slots are sometimes so hard to come by that people are turning to Facebook groups that hunt vaccines and bots that scan sites for open appointments. Vaccine seekers who are not used to those methods and have no one to help are at a major disadvantage.
Bassen finally got a spot at a pharmacy close to home for her husband. The website even offered to schedule the second dose, but when she clicked on it, nothing happened.
Thinking it was a glitch, they printed out the appointment confirmation email. When he arrived, he was rejected. They told him to schedule the second shot at the same time as the first.
The rejection sent Bassen back down the rabbit hole of state, local government, and pharmacy websites and phone numbers. She compared it to a game of musical chairs.
“From the patient, consumer point of view, 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 public health departments has fallen by 16% per capita, and spending on local health departments is down 18%. Little money was left to invest in technology.
To help states prepare for the rollout of COVID-19 shots, the Centers for Disease Control and Prevention have begun to build a vaccine management system known as VAMS.
Many states were hesitant to commit, as it takes time for employees to learn new programs, and new systems often have kinks. Few state health departments have taken over the CDC program, and at least one has since decided to drop it.
In New Hampshire, officials planned to switch to their own program after thousands of people were unable to schedule second shots within the recommended timeframe. Others had canceled their appointments after the system falsely allowed them to book slots for which they were not eligible.
Coming up with a national program that worked well everywhere would probably never happen, especially given the unprecedented scope of tracking COVID-19 vaccinations, said Claire Hannan, executive director of the Association of Immunization Managers.
Prior to the pandemic, local vaccine registries across the country were mainly used to track down vaccines for children. Some are decades old and were never intended for scheduling appointments.
“A lot of them are just some kind of spaghetti bowl with code, you just add to it,” said Rebecca Coyle, executive director of the American Immunization Registry Association.
Many vaccine providers, such as smaller pharmacies, were also not connected to the pre-pandemic registries due to the time and cost to do so – including the maintenance required, which involves constantly uploading data and ensuring it is properly stored and shared .
“There’s always been a perception that you’re building it and you’re done,” Coyle said.
Many states have concluded that they need a single, easily accessible “front door” for shooting scheduling, noted Dr. Deidre Gifford, acting commissioner of the Connecticut health department, at a recent CDC forum.
The best system, Dai said, would be to have everyone registered in a central location and, based on the offer, give each person a reasonable estimate for receiving a vaccine. That could take a few more weeks or months, but managing expectations would ease some anxiety.
“The core idea is to give people the confidence, to reassure people,” said Dai.
West Virginia has almost done that with a comprehensive statewide pre-registration system that uses crisis management software to collect each person’s demographics and contact information, as well as details such as occupation, so that certain critical employees can be targeted. They then get a text or phone call to book a slot when vaccine doses are available in their country, said Krista D. Capehart, who is coordinating the state’s response at the pharmacy.
Other states have struggled with their vaccine websites or have designed sites that offer some help but make people do a lot of work to find available shots. The Massachusetts site was so overwhelmed that it crashed. The Washington State site allows people to print a sheet of paper stating that they are eligible, but finding and booking an appointment is still left to the individual.
Maryland has set up a pre-registration portal, but people still have to go to other websites to find a lock. Dai said even he has struggled to qualify and pre-register with his county. When he was invited to make an appointment, the link did not work.
“At the end of yesterday, I had received five links, but none of them worked,” he said on Thursday. He ended up only booking with Walgreens.
Given the confusion, many are concerned about what will happen if an even wider population is eligible. People might find it so difficult and time consuming to score a shot that they just give up.
“The situation will get worse,” said Dai.
The disease detectives monitoring the pandemic are also concerned about the lack of consistent data on vaccinations.
“If we don’t have proper systems to track the number and type of people 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 Territorial Epidemiologists.
Data on race and ethnicity is only slightly more than half available of people who have received vaccines so far. That could be because the recipients of the vaccine do not provide the information or because the places where they receive the shot do not collect it, enter it, or enter it too slowly.
In many cases, the data has been entered, but glitches with different software systems are causing those fields to disappear, said Dr. Marcus Plescia of the Association of State and Territorial Health Officials.
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, calls the introduction of the vaccine shameful.
“If we had fought World War II the way we do this,” he said, “there is no doubt we would have lost.”
Choi reported from New York. Associated Press writer Carla Johnson in Washington State contributed to this report.