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Feb. 25, 2021, 4:26 p.m. EST · CORRECTED

This is the best way to fix the chaos surrounding COVID-19 vaccine appointments

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By Tinglong Dai

Residents of Santa Cruz County in Arizona have struggled with a vaccine preregistration portal. An earlier version of this article misidentified the state.

If you’ve tried to get a COVID-19 vaccine appointment, you know how frustrating the process can be. People are spending hours obsessively refreshing websites, hoping an appointment will open up somewhere. They scan  Facebook groups  for tips and insider information. One writer compared it to  Soviet-style queues for cabbage .

The competition for slots will only worsen when the COVID-19 vaccination priority list opens to the broader public.

It doesn’t have to be this way. Much of this misery comes from  poorly designed vaccine sign-up websites , but the problem is more fundamental.

As an expert in  healthcare operations  and  vaccine supply chains , I have closely followed the difficulties in connecting COVID-19 vaccine doses with people. I believe the best solution to vaccine appointment scheduling lies in building a trustworthy one-stop preregistration system. The U.S. is now near  half a million deaths from COVID-19, and new  fast-spreading variants  of the coronavirus are adding to the urgency. As states scramble to speed up vaccinations and try to prevent their limited doses going to waste, a handful of them are testing this approach.

Why did the traditional model go so wrong?

The traditional vaccine sign-up model does not work when the demand for vaccines far exceeds supply.

Under that model, the only way to get vaccinated is to reserve an appointment slot. Naturally, the  fear of being left out  drives people to attempt to sign up as soon as appointment slots become available. This leads to a rush of people endlessly refreshing the same websites for the few appointments available.

Even if all states had one-stop appointment websites that did not  crash under high volume , the limited vaccine supply would mean most appointment slots would quickly be taken. That could make it even harder for people who aren’t tech-savvy to get the vaccine.

To fix the broken vaccine scheduling system, we need to break this cycle.

What preregistration can solve

Most people have  fairly realistic expectations  about when they will be vaccinated. Their anxiety comes from  the fear of being left out . To address this anxiety, the system must be  designed to reassure  people that they will receive vaccines within a reasonable time frame.

In Israel, which  leads the world  in COVID-19 vaccination, citizens do not need to actively sign up for vaccine appointments. Rather, they are notified when they become eligible via text messages and can then make an appointment.

States can echo this “push” system by creating a one-stop preregistration portal where everyone registers once and is notified to schedule appointments when their turn arrives. The preregistration step helps avoid waves of people trying to get appointments at the same time, which can crash computer systems, as  Massachusetts experienced  on Feb. 18.

A good system will make it easy for people to check their position in the vaccine queue at any time, provide an estimated time to vaccination based on  frequently updated  supply information and then send notifications when their date is getting close. Underlying the system, vaccine doses can be allocated among eligible users on the registry using a lottery system.

A well-designed preregistration system can also help avoid vaccine  doses going to waste  because of no-shows. With an active waitlist, vaccine planners can match supply with demand in an agile manner and offer appointments to people a few days in advance rather than scheduling appointments weeks out when the supply isn’t certain.  Research in appointment scheduling  has shown that  no-shows are more likely  under long lead times.

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