By now, everyone has stories about the Grand Fail of Covid-19 vaccine distribution—especially the inability to even make an appointment for a shot. It has become a process reminiscent of the old Soviet Union: See a line. Get in. There may be something to buy.
This mess is especially hazardous to many older adults, who may not have computer skills—or even the devices or broadband access—to use web-based systems. For those who also may be living with even mild cognitive impairment, signing up for a life-saving vaccine is impossible.
With a few exceptions, government seems incapable of getting the appointment process right. So here’s an idea: Turn over the thing over to firms that know how to allocate scarce resources: entertainment ticket reservation outfits such as StubHub and Ticketmaster.
Not Beyonce tickets
No, I’m not suggesting that they distribute and administer the vaccines. And they can lose the demand pricing or those sky-high fees they charge to score a Beyonce ticket. Neither is appropriate for a public health initiative.
But these outfits do know how to make it easy for lots of people to reserve something that is hard to get. For a modest per-appointment fee paid by government, they ought to be able to do the same thing for vaccines. And likely at a lower cost than government can do it for.
They couldn’t do much worse.
In Maryland, where I live, the state operates under one set of rules. But the state’s counties have their own rules. There is no central appointment process.
The state just opened two mass vaccination sites. Believe it or not, each operates its own— completely different— appointment system (not that it matters, neither works very well).
Residents also can try to get a shot through dozens of private businesses—hospitals, health systems, supermarkets, or drugstores.
Of course, each operates in its own world. Some are web-based only while others also allow you to call. Some take appointments until they run out of slots and make you reapply. Others have waiting lists. Others use a lottery.
Some open for appointments at a fixed time each week. Others make appointments available at seemingly random times. Most will not vaccinate without an appointment, but some will. Some want you to go to their website to try to snag an appointment. Others insist: “Don’t call us, we’ll call you.” Some let you sign up for alerts, some do not. Few are transparent about their processes.
The third-party software used by these providers seems uniformly awful. While each of these sites operates differently, they do seem to have one thing in common: They are impossible to navigate without massive amounts of time, patience, and plain good luck. And for older adults, forget it.
It isn’t community theater
Here was my experience this morning. I went to the CVS website, waited 22 minutes before I could even try to make an appointment. The site finally told me there are vaccines available on Sunday at a store an hour and a half from my home. I clicked through to this store, where I got this message: “There are no more vaccines in stock at this location.” What idiot designed this website?
The Washington Post reports some local governments are in even worse shape: They are repurposing websites they normally use for selling tickets to community theaters.
In theory, government could do this. It works in West Virginia, a rural, poor state that has become a model. There, eligible people sign on to a single, state-wide waiting list. Local clinics work their way down the names of those from their communities. If extra doses are available at a site at the end of the day, the clinics contact people on their stand-by list. And, by the way, all long-term care residents in West Virginia have now been offered the vaccine.
Another success story is Israel, which has vaccinated almost 40 percent of its population. There, nearly everyone is a member of one of four health networks (something like health maintenance organizations in the US, though part of the nation’s national health system). Members get a text from their HMO telling them where and when to go for a shot. They show up at the pointed time and place, register by sliding their national health card into a kiosk, get their shot and an immediate appointment for their next dose.
The Israelis also allow people without appointments to wait in line. At the end of each day, they get any unused doses on a first-come-first-served basis—a bit like scoring standing room tickets at a ball game or the opera.
Both the Israelis and the West Virginians operate on the old KISS model: Keep it simple, stupid.
But many state governments can’t do simple. Torn between achieving multiple goals and satisfying multiple constituencies, they complexify everything. Appointments become a matter of little more than serendipity—just the opposite of what they want to achieve. And they are losing sight of the goal: Maximizing the number of people getting vaccines in the shortest possible time.
In the US, we face three distinct problems: Vaccine production. Vaccine distribution. And vaccine access. Until the supply problem is solved, the US won’t really break the back of the pandemic. But for pity’s sake, we ought to at least make it easy for people to make a simple appointment. If government can’t do, turn it over the businesses that can.