Emergency Technological Infrastructure for COVID-19 and Beyond

Throughout the ongoing COVID-19 pandemic in the United States which began in 2020, one of the most urgent priorities for government and medical professionals both here and around the world was the development of a viable vaccine for the virus. As progress was finally being made by pharmaceutical companies such as Moderna and Pfizer, the question of how the vaccines would be administered to the population in a timely manner became a top priority. However, because of ongoing conflicts between President Trump’s administration and State & Local governments, the exact plan for the vaccine rollout remained unclear. With the turnover to the President Biden administration, plans for the rollout finally began to take form. Here in New York City, the logistics of medical facilities receiving vaccine shipments solidified, but the task of developing a way to track and administer vaccine doses to every resident proved to be a daunting task. An emergency web-based appointment tracking system was hastily enacted, but many problems arose during its initial deployment. In reviewing the failures and successes of this online system during an unprecedented emergency, we can better prepare for the next widescale emergency and more effectively leverage information technology assets to meet the challenge.

This review in part comes from my own firsthand experience with helping to operate this system. In early January of 2021, I took a job as an IT support contractor for New York City to help with the COVID-19 vaccine scheduling system. Myself and a number of other support technicians were part of the vaccination hotline, where people needing assistance could call for appointments. Senior citizens and those with certain disabilities were prioritized during the first phase of the vaccine rollout, and we assisted them over the phone by using our individual approved access to the city’s vaccine schedule management SharePoint to search for and confirm appointment times and locations. However, we quickly realized that the appointment website was ill-prepared to handle the sheer volume of requests. Appointment slots would disappear as quickly as they appeared on the scheduler, and whenever the hotline operators or individuals were able to select an appointment slot, there was never a guarantee of locking an appointment even after going through the laborious task of filling out individual personal information.

The process of safeguarding this personal information was actually one of the more successful aspects of the vaccine scheduler system, as individuals who attempted to connect on their own were required to create a “MyChart” individual secure profile managed by the NYC Department of Health. Personally Identifiable Information (PII) was kept to a minimum with only email and phone number contact entry required However, in maintaining this baseline of security, the usability and functionality of creating a profile proved extremely difficult and untenable for some, especially for elder personnel who had difficulty using computers, navigating websites, or those without optimal internet access. Many users found the need to manage multiple profiles or to constantly log in and out for access too untenable for a process that required haste in order to secure an appointment. Although security was achieved, availability and access to the system was intermittent at best.

After several days of speaking on the phone with fellow New Yorkers who were infuriated, panicked, and terrified all in various degrees, I decided to use my social media presence and familiarity with the system to create a hasty tutorial. I created a few minutes of video footage to help guide people through the process, as well as several slide show images for the more complicated inputs. Even now, I am unsure if they were much help, but I knew I has to try something since the situation had become so dire.

This lack of accessibility via technological means manifested a stark disparity of who would have physical access to vaccinations between lower income marginalized communities and well-off residents within in the greater metropolitan area. A report from The City newspaper on January 26th highlighted this disparity by focusing in on the vaccination efforts in Washington Heights area of northern Manhattan. Reporters from the city observed that although Washington Heights was predominately low-income Spanish speaking neighborhood, many of the vaccinations initially taking place in the Washington Heights Armory vaccine hub were administered to wealthy white residents from outside the city. Despite regular press conferences by Mayor Cuomo, there was no concentrated public advertising campaign to inform or assist residents in the neighborhood about the vaccination. Few residents were even aware of the vaccine location, and the support staff at the location had no Spanish speakers to assist those residents who did show up. The lack of internet access by local residents and limitations of the vaccine website to be navigated in other languages proved the most insurmountable obstacle. Soon after the story broke, City officials quickly proclaimed that the Washington Heights armory and other low-income hub locations would only be accepting applicants who lived in the area, the challenges with the website would persist in the weeks to follow.

In the months since the rollout, vaccine administration has become more streamlined. Supply has grown enough to meet the demand, but what lessons can be learned from the problems with the initial rollout. One takeaway is the importance of having an IT infrastructure that is both flexible and powerful enough to meet the requirements of a city-wide emergency. Having dealt with the VaccineFinder SharePoint, it is important that system and network administrators understand all the bugs and glitches that were encountered by support personnel and users. The system overall accomplished the mission, but a more refined software/network package at the ready for the next emergency will only be more helpful in the future. That said, the inverse of this methodology might be the way forward in future pandemics; specifically, cities might be better served with abandoning the need for an appointment system entirely and directing resources required for emergency vaccine distribution IT infrastructure towards other purposes. For example, Philadelphia was among the earliest cities in the U.S. to adopt the walk-in process for all vaccinated personnel as early as March of 2021. An article in the Philadelphia Inquirer noted similar racial and economic disparities regarding vaccinations as in New York, and local health officials adopted the walk-in method to much success. In that case, IT efforts like advertising via social media and demographic data mining might be a more effective way to ensure residents are aware of and have access to resources in future emergencies.

While relief has come after such a long period of despair, the sad truth is that the pandemic still rages. Time will tell what we have learned from this disaster, but there is hope that we can move forward from this and any future pandemics or large scale emergencies if we use the knowledge available to us wisely.