Why are we making it this hard to get in line for a COVID-19 vaccine?

It looks like the COVID-19 vaccine distribution is becoming an unfair, chaotic mess. In New York City, where I live, it is at this moment a train wreck, with many of my fellow New Yorkers venting about the hassle and roadblocks that government officials have put in their way. The goal of herd immunity with 70% or 80% of the country’s population inoculated seems like a distant goal, a failure made all the more unbearable by a nationwide death count on the cusp of 400,000.

On Sunday, former FDA Commissioner Scott Gottlieb tweeted: “47 million doses of COVID vaccine have been ‘allocated’ to the government, less than 7 million used. We’re in a race against new COVID variants gaining foothold in U.S. There are 50 million seniors over age 65. We have the tools to protect many of them. We should give them access.”

Were it that simple. Access has been a challenge for many who have tried to sign up for vaccinations in New York City, with a confusing array of glitchy websites making matters worse. I’m wagering that New York isn’t the only place where seniors, in particular, are having trouble. Sarah-Karlin Smith, who covers the pharmaceutical industry from Washington, D.C. for the Pink Sheet, a trade publication, noted in a tweet Monday: “from neighborhood listserv: it looks like seniors having a lot of trouble actually getting vaccine appointments — which DC just opened up to them today. One person sent out a tip to try sites far away from our neighborhood.” At the same time, medical providers have been forced to throw out vaccine doses because New York State’s requirements on who should get them proved too stringent.

In New York City, Comptroller Scott Stringer tweeted there were more than 200 vaccine slots available on the nycHealthy website late Sunday evening when his tweet went out. Apparently, these were unclaimed doses, prompting Stringer, who is also running for mayor next year, to voice concern over the “failures of outrage and technology by the city.” A New Yorker who replied observed that “Signing up is complex, burdensome and buggy,” and “a major problem,” adding the process is “An obstacle for too many people, particularly seniors.”

Mark D. Levine, who chairs the New York City Council health committee and is running for Manhattan borough president, let New Yorkers know the task of signing up is daunting. His tweet noted on January 9 there are multiple websites people are asked to use to sign up — one from the city’s Health and Hospitals site; one from the City Department of Health and Mental Hygiene; another from Costco.  “For community clinics, 7 have their own different websites, 4 require calling, and 1 is by email.”  We need a unified scheduling system for all of NYC,” Levine said in the same tweet. 

The nycHealthy site requires people to go through a multi-step verification process just to set up an account and a six-step process to set up an appointment. Along the way, there are as many as 51 questions or fields to fill in along with uploading images of your insurance card, Stringer tweeted. Why your insurance card? Aren’t these injections supposed to be paid by taxpayer funds and distributed free to Americans by the federal government? There are about one million uninsured New Yorkers who are uninsured, according to Elisabeth Benjamin, vice president at the Community Service Society in New York City. Those people have no insurance card. Does that mean they can’t get vaccinated through this system?

It’s not like state officials didn’t know mass vaccinations were coming. We’ve known for months people would eventually get their shots and would need guidance on how they would do that. 

New Yorkers have also shared their frustrations with Stringer on Twitter. One woman named Miriam explained that she was trying to sign up her 75-year-old plus father and called one site “a nightmare to navigate.” Specifically, she pointed out some places have phone numbers only, no online registration. Some sites said they weren’t taking people eligible in phase 1b, which includes those over age 75, teachers, and other essential workers like fire fighters and transit personnel.

Miriam posed another question: How do such sites as she described “help a population with those less comfortable with technology or those who don’t speak English?” I’m not sure the city has an answer, but I do know many seniors are not computer savvy. One woman tried to log in to a vaccine site but could not because of a “session error.” She gave up. Another person on the thread suggested clearing “cookies” from her browser. He added, “Can’t expect the average person to do this though.”

Laura Nahmias, a member of the editorial board at the New York Daily News, tweeted about an 89-year-old legally blind New York woman who called into the Brian Lehrer Show to ask how she and her husband could get vaccinated. She said she tried to find out by searching the web, but her vision problems have made it difficult. “Heartbreaking to listen to,” Nahmias said in a tweet.

Residents in other states are having troubles too. "Thousands of calls have poured into the newsroom" of WEAR ABC 3, a TV outlet in Pensacola, Florida. The station reported that the Department of Health in Escambia County distributed more than 1,400 doses of the Moderna vaccine to those 65 and older but only at specific events where vouchers were handed out beforehand. When the station requested an interview, the health department declined to speak on camera and said appointments were fully booked for the doses they had on hand. Residents were encouraged to fill out an online vaccination form, which turned out to be a form to notify the county they were interested in getting the vaccine. Station reporters wanted to know if the county planned to implement a phone line or website to book appointments; county officials said they didn’t yet have answers to that.

There are plenty of other stories like this one. You get the picture. Getting vaccinated is not a walk in the park. It’s not like state officials didn’t know mass vaccinations were coming. We’ve known for months people would eventually get their shots and would need guidance on how they would do that. But a lack of a coherent and detailed strategy from the federal government has left states and over-burdened local governments to their own devices, with predictable results.

It’s not only the process that seems inscrutable and complicated. The eligibility requirements vary widely from state to state and seem to shift daily. A few days ago, I saw a tweet from Tara Haelle, who is the Medical Studies Core Topic Leader for the Association of Health Care Journalists. Haelle, 42, announced she had received the vaccine. I knew she was rather young and so I asked her how she had moved up in the queue. She said she has had significant health problems since she was a teenager, when she had a massive pulmonary embolism, and is at extreme risk for serious disease.

Luckily, her home state of Texas is allowing people like her to move up the line faster. That, of course, made me wonder why 74-year-olds or 68-year-olds, many with similar underlying health conditions, who live in other states like New York still had to wait. “I know I was following what Texas and the county laid out as requirements,” Haelle told me, “but I don’t think I should have gotten access any earlier than others in my situation in other states nor do I think I should have gotten it before public school teachers when I have the ability to continue to work from home.”

“I expected inequities, but I think it’s actually worse than I anticipated based just on my own observations,” Haelle added.

Haelle’s observations were in my mind when I read the story New York Times reporter Apoorva Mandavilli told about inequitable vaccine distribution at some of the country’s most prestigious medical centers. The story, one of the most interesting, freshest, and revealing COVID-19 stories I’ve read in a long while, tells of “thousands of people who have been immunized against the coronavirus at hospitals affiliated with Columbia University, New York University, Harvard, and Vanderbilt, even as millions of frontline workers and older Americans are waiting their turns.” “I wish our elderly relatives had received the vaccine before me,” said a young Vanderbilt employee. A Columbia faculty member who has no contact with patients and who did not get the vaccine, told the Times, “It’s such a naked display of privilege. It’s because we’re at elite universities and medical centers.”

On Tuesday, the Trump administration told all states to immediately vaccinate Americans 65 and older. It’s part of a broader strategy to accelerate vaccinations, as Politico Pulse reported Wednesday. “The new approach – which would punish states that don’t vaccinate fast enough and prioritize shots for older and high-risk Americans – aims to jumpstart a sluggish and uneven inoculation campaign,” the outlet reported. “But it must now balance speed with equity, or risk leaving underprivileged and hard-to-reach communities behind.” 

If ever there was a time for good ethical behavior on the part of everyone desperate to get a scarce resource like the vaccine, this is it. That requires some modicum of solidarity, but then solidarity when it comes to health care is something Americans, unlike our counterparts in other countries, have never embraced.

As I was writing this post, New York Gov. Andrew Cuomo announced that people 65 and older will now be eligible for the vaccine, as well as younger people who have compromised immune systems. Before I had a chance to see firsthand what a bear the New York experience is, a relative signed me up on the third website he checked.  The first two had no appointments. Were the websites as complex as I found in my reporting? I asked him.  Yes, he said, the process would’ve much too difficult for me and my husband. He should know: He teaches computer science for a living.