Buggy websites and complex online tools are used to schedule appointments for the COVID-19 vaccine across the United States. The systems are difficult to navigate for many people, but they are particularly inaccessible to older people. People aged 65 to 75 are a priority for the first waves of immunizations and are most at risk from COVID-19 – but they are also often uncomfortable and unfamiliar with the technology.
“The most vulnerable people are even more left behind than if we hadn’t used a technology-driven solution more,” says Ethan Basch, medical oncologist at the University of North Carolina at Chapel Hill and chief medical officer at the North Carolina Cancer Hospital.
Across the country, registration websites for vaccine appointments were criticized by demand upon launch, filling up in minutes. Many Florida County health departments have turned to the Eventbrite event management platform to schedule appointments. New York City has several registration websites, some of which have dozens of fields to fill out and ask people to download attachments. Navigating these platforms fast enough to secure a dating slot can be difficult for anyone who is not comfortable with computers or the Internet, and impossible for someone who does not have access to these tools.
Only about half of people over 75 use the Internet at all, says Susan Nash, a visiting researcher at the Stanford Center on Longevity, who studies digital literacy options for seniors. “The great irony of this problem is that the people we need to reach with the vaccine and get information are the ones who are least likely to be online,” she says.
During the pandemic, gaps in internet access and digital literacy have made other aspects of healthcare delivery difficult for people who struggle to use technology. Many physicians have made the switch to telehealth, but people without Internet access – who tend to be older, non-white, and low-income – are less likely to make telehealth appointments and are at risk of not having any. care. They were also excluded from other services: A person without internet access would not have been able to order groceries through an online service, for example, Nash says.
“There have been these equity issues all along with seniors. While we have lived through the pandemic, some of the easiest solutions have been to go online, which leaves this whole population behind, ”she said.
As the vaccine rolled out, the need for speed and scale pushed managers towards digital planning tools. But local health services in the United States have been underfunded for the past decade, and they haven’t received funding in recent months to create vaccine delivery systems. When injections became available, many rushed to set up platforms to allocate doses to eligible people.
Many small departments, especially in rural areas, are overwhelmed, says Charles Wallace, associate professor of computer science at Michigan Technological University who runs digital literacy programs. “Some poor people have had to take time out of what must be an incredibly busy schedule to put this information on the web, and designing a good interface takes time,” he says.
The rapidly developed and jury-rigged digital recording platforms are likely to have elements that are difficult or stressful for those less familiar with the technology, Wallace says. A local Michigan Department of Health, for example, sent people to a second web page via a pop-up warning users that they were leaving the Department of Health’s website. “These pop-ups and warnings are exactly the sort of thing that annoys people when dealing with newcomers,” he says.
Many check-in sites in Florida and New York forced people to travel as quickly as possible to enter their information, otherwise they would lose a selected appointment slot.
“We can easily lose sight of how poor people’s skills are,” Wallace says. “There is a false sense of accomplishment. We put everything on the website and can say, great, we’re done. For a lot of people, the assumptions that people are willing to add attachments and things like that are completely wrong. ”
Asking people to use these complex systems to schedule something as important as a COVID-19 vaccination appointment worsens anxiety, Nash says. “There’s more to worry about, and there’s more reason for someone to talk to a human to know, ‘Do I really have a date? Tell me about the side effects, ”she says.
Basch and his colleagues recognized this problem for their patients at North Carolina Cancer Hospital – a public facility that serves a rural population and groups with low health education and literacy levels. The state has just opened up vaccination to people over 75, and their cancer patients in this age group are in particular need of vaccination.
The hospital planned to contact patients through their electronic health records and patient portals, but many patients do not use this system to communicate with their doctors. “We realized we would leave people behind,” he says. They have started compiling a list of all patients over the age of 75 who do not use the portal and plan to call them by phone to schedule immunization appointments.
Outsourcing doctors to contact patients directly is one way around the digital divide, Nash says. But it puts the burden on already overtaxed health care providers. “It’s another thing to attribute to them, but it works,” she says.
Older people also look to children or grandchildren to browse web pages or make appointments on their behalf. This is another temporary fix, says Nash – but it only fixes the problem for people who have parents who can access the Internet.
In the chaos and inconsistency of the initial vaccine rollout, there is no defined group taking responsibility for connecting people to vaccine resources. Guidelines change quickly and there is no clear communication to support those who need help. Instead, many of the people who would benefit the most from the vaccine are left with the question of how to get one on their own.
“Is it up to the patient to realize and connect? Or is it the health system or the state? Basch said. “There is a lack of clarity as to who is responsible.”