How to make vaccination an efficient and equitable process

The way we’re going about signing up people to get vaccinated is inefficient, unfair, and not scalable. Let’s examine how we’re doing it, and talk about how governments can change course to create a process that improves equity and takes the burden of finding appointments off of individuals.

First, let’s take a look at how we’re currently approaching the process, so we can understand where it falls short. The federal government decided to leave the vaccination process to the states. Each state is handling it differently, but there are some common themes that emerge when you look across the country:

  1. Prioritization — Every state has created a hierarchy of priority groups for getting the vaccine based on recommendations from the Centers for Disease Control. There are exceptions, but for the most part, these prioritization hierarchies put the elderly and frontline medical workers first, followed by those in various essential positions that expose them to greater risk of getting COVID. Those with medical conditions also typically will get prioritization.

  2. Non-centralized distribution — Almost no states are running a centralized vaccination program. In many states, they have delegated the actual delivery of the vaccine to counties, hospitals, pharmacies, and other providers in local communities.

  3. Online signup — As dosages become available, vaccination locations release new appointment availability for online signup.

As a result of this, the process of getting a vaccine is creating a tremendous amount of confusion. As new appointments open up, it’s not clear who is eligible. Appointments go to those who have the ability to sit in front of their computers and react quickly to emails about new appointment availability. The mad rush of a limited number of appointments opening creates a mad rush to sign up, often resulting in websites crashing, further frustrating people with the process.

Instead of this approach, governments should use a process that effectively manages demand and promotes equity by better controlling who gets access to the vaccine. Governments should allow people to sign up to get a vaccination and then tell them when and where they can get it, moving the burden off individuals with limited resources and on to a central authority that can prioritize vaccinations based on user-submitted data.

Here’s an illustration of how this could work.

Governments should create a single page for anyone to sign up to indicate their interest in getting the vaccine. This sign up should collect enough information to identify a person and triage them into a priority group. Once collected, this information is stored in a searchable database. A call center should be used to sign up those that do not have access to a computer.

As new vaccines become available, the government can search through the database and select individuals that meet the current prioritization criteria. For example, a government could filter so that the list is limited to anyone over the age of 65, or anyone with a specific medical condition.

The government can then send a private link to those selected giving them the ability to reserve an appointment. The private link would not require the person to enter information; it simply uses the information they previously entered, so the link can not be shared with others.

If this is done sufficiently in advance, the government can proactively reach out to additional people to ensure that all available vaccination appointments are filled. The government should take over scheduling for all facilities distributing the vaccine in its jurisdiction. For this reason, the best level for this to be applied is at the state level, but this could also work at a more local level as well.

This approach is efficient, in that people are only visiting sites to sign up if there are appointments available. This approach is also equitable, in that the government can decide the criteria by which people are prioritized, and ensure that vaccinations are equitably distributed.

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