Home Posts I Worked On A Vaccine Hotline, And Here's The Main Issue With The System.
I Worked On A Vaccine Hotline, And Here's The Main Issue With The System.
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I Worked On A Vaccine Hotline, And Here's The Main Issue With The System.


I worked the vaccine registration hotline for a county in suburban Pennsylvania for the past three months or so, and I was struck by the magnitude of a systemic inequity among vaccine recipients and hopefuls from the first day I worked for the hotline: computer access and literacy.

I was relieved to get the job: I was unemployed at the time, applying for any available job, but nobody was hiring in the midst of the winter COVID-19 upswells. The call center was a lucky find: it didn't pay well, but it was well within my skill range, not boring, allowed me to work from home, and actually allowed me to help people.

I couldn't actually register people over the phone, only coach them through the online registration process, so the title "vaccine registration hotline" was a bit misleading.

If a caller had a problem, we could write a report and submit it into the ether (well, to our boss, who then turned it over to the county health department because we worked for a contracted third party and had no way to contact the county or anyone at it directly). I could transfer people to the Health Department's main line (whose unnavigable menu generally kicked people back to us).

In theory, there was some sort of accommodation for those without internet access: the county's senior services program had set up a phone registration line that would register people over the phone if they didn't have a computer; however, we were explicitly told (and sometimes reprimanded) to only transfer people to it if they had no computer or internet, and not if they had a computer and dialysis.

When someone called and said, "I'm on my computer, but I can't figure out how to get to the website and register," my shoulders sagged because I knew I couldn't help them.

I did my best to guide people through the web registration process, and I was pretty good at it, spelling out the web address, talking them through the steps, and explaining what they could expect next; I probably guided about 80% of callers to successfully register.

But some people didn't even have the computer skills to follow directions. They couldn't find the task bar or open a tab. When I asked questions like, "What browser are you using?" many callers had no idea. My only hope was that these callers would call back, claim they didn't have a computer, and be transferred to the phone registration line.

But even that wasn't a solution for many callers because the two registration processes were separate; if a person wasn't registered, they could be registered either way, but if they had been registered over the computer but, for example, lost computer access or weren't sure their registration had gone through correctly, neither we nor the phone registration people had any way of checking the registration.

For the first two months or so that I worked the hotline, the county was vaccinating people in category 1A, which was anyone over 65, people with qualifying medical conditions, and health care workers; however, due to severe vaccine shortages, the county was only vaccinating people who registered on Jan. 13, the first day registrations were open, for more than a month.

That would have been aggravating enough on its own, but communications from the county were sporadic and inconsistent, and the list was frequently shuffled out of order, so that people who registered on subsequent days were sometimes called before the county was finished with the people who registered on the 13th. Oh, and there was one day when the entire web system went down and the clinics went wacky.

All of this confusion is bad enough if you are an internet savvy person who can figure out how to register with multiple providers and constantly check all of their websites for updates, but it was terrifying for seniors who were already overwhelmed by the county's registration system and lacked the web skills to figure out alternatives.

I had callers cry on the phone, and one voice in particular stands out: a hoarse voice repeating, "I think I'm going to die. If I don't get this vaccine, I'm going to die." There was nothing I could do but stay on the phone and try to be sympathetic.

While I would go to the internet to look up how to get vaccinated, many callers had found the hotline number on TV segments or in physical newspapers or paper county newsletters.

Furthermore, we overestimate the availability of support: many of the seniors who called lived alone or with their spouses, with no family members or neighbors nearby to assist them, public libraries were not all open, and many people lacked access to transportation.

Of course, not all seniors lack computer literacy – probably not even the majority anymore – and not everyone who lacks computer literacy is a senior, but that is the general trend. When public health infrastructure seeks to prioritize seniors, making the internet the only means of access is particularly irresponsible.

It's also worth noting that computer literacy wasn't the only issue people had with access; many local public libraries were closed as a result of the pandemic, cutting off reliable computer access for those who are homeless or transient, or who simply can't afford a computer or reliable internet.



The county's website is written in English, so if people didn't know English, they needed someone to translate it for them. On the hotline, I was able to connect to an interpretation relay service, and the interpreters were usually excellent, so we were able to talk people through the website registration process, but they still needed someone to translate the email they received giving them the time.

The county has completed its high-priority list and is now vaccinating people in all categories; it has some walk-in appointments available, which greatly expands access to those without internet access or literacy; and it has a greatly improved web registration system, which was updated about halfway through my time there and is much easier to navigate than the previous one.

Because the hotline was receiving far fewer calls, I was effectively laid off the same week I gave my notice (I am happy to report that I have found a new job that is related to my college degree!)

So, while things are better now, they should have been better from the start. If statewide vaccination registrations were more centralized, if we hotline personnel had the ability to create, access, and edit registrations, and if the entire system wasn't set up exclusively to be accessed via the internet, with the phone as an afterthought, more people would have had access to vaccines much sooner.

Many things have shifted online during the pandemic, and I frequently hear this touted as a win for accessibility, and the internet described as a sort of equalizer. That can be true, but systems set up to be exclusively accessed via internet are not accessible to all people, particularly seniors, and other options must be equally viable and usable, rather than an inaccessible afterthought.

I hope this is a lasting lesson of the pandemic and will inform future public programming, but I doubt it. Internet access is becoming increasingly necessary to participate in society, and those who can't keep up will continue to fall behind.

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