An old man getting computer help help (Photo by Unkel/ullstein bild via Getty Images)
Access to Covid vaccines has highlighted the disparities in our society more than anything recently. If you are educated, wealthy, and tech savvy, you are far more likely to obtain a vaccination appointment than otherwise.
Why is this? What can we do to help?
The first problem is the “digital divide,” because most appointments are made online. Many people in rural areas, like mine, do not have computer or internet access. Others are limited by poverty or by age.
Even if you have internet access, the hoops are daunting. You might have to register on multiple sites, for example, and be knowledgeable about navigating the internet. For example, many hospitals have patient portals to access health information. Those with household income less than $60,000 per year were much less likely to have access to their own medical information this way. Similarly, being older than 65 was a barrier as was having less than a high school education.
You also have to have agile fingers and good eyesight to fill out the online forms quickly, before someone else snags the spot.
Screen shot of screening questions on Walgreen’s website 2/8/21
Some turn to friends and neighbors for help registering for an appointment. Increasingly, there are crowdsourcing options such as PA CoVID Vaccine Match Maker. One of the more innovative programs was the 24-hour vaccine clinic run by the Black Doctors COVID-19 Consortium (BDCC).
Other tech-savvy kind souls wrote programs. Their bots find open vaccine slots by scouring the web more efficiently than a person could, a process known as “scraping.”
In other areas, cadres of volunteers make appointments for those who are not able to. Some of them learn when vaccine appointments are likely to become available for a given site, and are ready to leap into action then. Altruistic volunteers are trying to focus on people with particular needs for help and on low-income areas, rather than facilitating vaccines for wealthier suburbanites.
A case study – struggle to get a vax for my aunt
I spent 12 full days trying to obtain a Covid vaccine appointment for my 96-year old aunt, a Holocaust survivor, in Iowa.
Criteria kept changing—before 2/1, Kitty was not eligible under state guidelines because she lived independently. Almost all the sites initially listed by Iowa’s government were dead links or had not yet been allocated vaccine. Walgreen’s site, the only semi-functional one, was difficult to access. Sometimes it would show an occasional slot for a first dose, but the site would not let you complete registration because an appointment for a second dose was not available.
By Feb. 10, I again received a message that she was no longer eligible under Iowa guidelines, above. This was not true.
At the same time, the Des Moines register wrote that Iowa was sitting on 180,000 doses. Despite that, and the state ranking near the bottom of vaccine administration, Governor Kim Reynolds lifted the state’s mask mandate.
I was so frustrated and angry that I tweeted a photo of Kitty in the Holocaust Survivor and Liberator’s gallery at IHENE, with the caption: High risk conditions and age no longer qualify for Covid Vax in Iowa.
Auschwitz didn’t kill Kitty; now Iowa Gov Reynolds might w 180k unused doses. She (Kitty) was an avid Holocaust educator pre-Covid.
Screen shot of tweet of photo of Kitty in Survivor’s Gallery at IHENE in Omaha
Walgreen’s response left something to be desired. First, via email, they said the problem was related to a “temporary glitch” with scheduling. They did not explain the error message that I repeatedly received saying that this senior did not qualify BASED on STATE Eligibility Requirements.
Screen shot Walgreen’s website form 2-10-21 by Judy Stone
Screen shot of tweets between Walgreen’s and Judy Stone
You can see my rising anxiety, desperation, and anger as I, a computer savvy individual, tried to navigate scheduling.
My search led me to calls and messages to Walgreens, the Governor’s office, KETV, the local health department, numerous pharmacies, and even Holocaust centers in other states. The saving grace was that I met several kind, helpful people along the way.
One of the most disturbing things I learned (from the Gov’s office) was that pharmacies have the discretion to make their own criteria within a given tier (e.g., in 1B, they could choose not to vaccinate the elderly, but prioritize teachers). There is zero transparency.
This story has a happy ending in regards to vaccination. With multiple people trying sites at all hours, we finally scored an appointment for Kitty through the health department and Hyvee’s.
Walgreens was never satisfyingly responsive. Citing the slow rollout, the Federal “Partnership has been a fiasco”, according to Kaiser Health News. They note that “CVS and Walgreens stand to make a lot of money: Medicare is reimbursing $16.94 for the first shot and $28.39 for the second.” One ongoing question for me is how national pharmacies got the government contracts and is there any oversight? I’ve not yet found it.
Another Iowan shared a similar story of a senior being well enough to live independently having that used to exclude them from vaccination. In her town, discretion as to who to prioritize was given to a public health nurse, rather than a pharmacy. While there was a waiting list available, no one was told where they were on that list.
In my own county in Maryland, the lack of accessibility is also a huge issue. Some people have tried to call for appointments—one woman said she tried 200 times before getting through, only to find no appointments were available. After months, the health department and hospital have made a waiting list. No one knows how they rank people on the list nor where they stand. Vaccines are now available at some local pharmacies, but there is no communication between the health department and the chains to prioritize immunization. For the commercial pharmacies, each has its own site and it again comes down to persistent technical skills and living on the company’s website, day after day, hitting refresh. We need a heavily advertised (posters, newspaper) public call enter for the people who do not use computers.
Poor communication is the norm, both between local institutions and with the community. Also, in this poor county, the lack of public transportation is a huge barrier, since the primary vaccination site is about 12 miles outside of town. County health department Covid testing is also at a relatively inaccessible fairground.
Our local Women’s Action Coalition has raised these concerns with Governor Larry Hogan and the county health department, and has offered to staff a central call center to schedule appointments. We were told that Senior Centers are assisting with scheduling and transportation, but this information is not being adequately publicized in the community.
Register on every site and waiting list in your community. Some have snagged a vaccine by being available on short notice to go to a site with an unexpected leftover dose.
Have a team trying at different times of day. Have all the information you will need for the person you are trying to help at your finger tips. Some recommend skipping any essential questions. Sadly, some pharmacy sites want you to upload Medicare information or some other information you might not readily have. One wanted a photo of cards uploaded—how many seniors can do that? Be prepared with this information before you start on the site.
Some people set alerts to notify them if a web site changes (e.g., Distill.io) or if the health department tweets.
Mostly, success requires a team of people willing to help you and remarkable persistence. My aunt was lucky to have such a team of friends and family all over the country. It still took us 12 days. What about the millions of others who don’t have such support? There is no excuse for such an inequitable system in a country with so many other great technological achievements. The way we have treated the elderly, poor and vulnerable will be a lasting shame.
I am an Infectious Disease specialist and author of Resilience: One Family’s Story of Hope and Triumph over Evil and of Conducting Clinical Research, the essential guide