Five upgrades to make now to COVID vaccine delivery

As of this week, 43 million Americans are fully vaccinated and 40 million have received their first dose. However, the next five weeks will stress our delivery systems even more: 263 million Americans will become eligible for the vaccine and President Biden has moved the goalposts from 100 million to 200 million doses in his first 100 days. 

States, counties and territories have been struggling to pull together the staff, the spaces and the strategies to deliver vaccinations safely and efficiently. They have had little time to change course, to exchange best practices and to improve. 

While we race to vaccinate, to create population protection and reduce the development of variants, opening eligibility does not lead to better access. In fact, the most vulnerable likely become the least able to access current systems. When Alaska opened up to the general public on March 9, there was an immediate surge in demand for vaccines overwhelming clinics and staff. We need to make upgrades to manage such surges. We need to remove barriers in the system. We need to build confidence and trust in people’s ability to access vaccines, to make sure we are setting up the right systems, and ensure we continue to reach the most vulnerable.

We need to prepare for the day when all American adults are eligible for the COVID-19 vaccines now. We suggest several upgrades that leaders should consider making before eligibility opens:

1. Eliminate the requirement to present identification. This is a major barrier to equity and to access. Many people — primarily in the most vulnerable groups such as immigrants and low-income individuals — don’t have a government-issued photo ID, which may discourage them from getting vaccinated where it is required. If individuals do not have an ID, they can self-attest. IDs do not necessarily lead to more accurate population data. Already, more than 20 states do not require ID and in others, only some counties require it.     
2. Simplify appointment scheduling by creating centralized systems and offline options. Finding a vaccine appointment can be frustrating, time-consuming, and discouraging. Long pre-registration questionnaires, location-specific schedules, short-term options that don’t allow for planning and unique registration sites for every provider create a maze that only those with time, technical literacy, patience and steady internet access can navigate. Waiting list options are helpful for sites that cannot predict long-term supply, call-in registration mitigates online challenges and mobile and walk-up registration for future dates all aid in removing bottlenecks. 
3. Allow group registration for families, households or other groups so that members can visit sites together; this reduces transportation burdens and increases the likelihood of participation. The federal government signed a law enabling The Department of Veterans Affairs to vaccinate veterans of all age groups, their spouses and caregivers.  
4. Expand opportunities for users to access vaccination sites. This includes extending the hours and days of existing sites and adding new access points such as mobile vans. Websites such as VaxMap can highlight where new sites need to be. Partner with transportation providers, on demand driver networks like Uber and Lyft to coordinate free rides to vaccination sites.
5. Engage communities, local leaders and employers in communication and outreach. This may include having local groups provide onsite communications support including translators and community health workers. It includes working with minority communities to identify and connect with influential members (e.g., cultural leaders, faith leaders, business owners) who can advocate for the COVID-19 vaccine or conduct outreach. Employers can support policy changes by providing paid time off to get vaccinated and communicate to employees about the importance of vaccinations.

Unlike many countries, the United States will have enough doses for all who want them in the coming months. The more people who are vaccinated, the more protected we all are. Individuals who avoid vaccination centers for fear of being identified or turned away or those who don’t get vaccinated because it is too inconvenient put us all at risk. Before expanding what we are already doing, let’s make sure we are focusing on what counts to accelerate access. 

Rebecca Weintraub, MD, is a member of the faculties of Harvard Medical School and leads the COVID-19 Vaccine Delivery portfolio at Ariadne Labs. Julie Rosenberg, MPH, is assistant director of Better Evidence at Ariadne Labs and serves as deputy director of the Global Health Delivery Project at Harvard. Eric Goralnick, MD, MS serves as medical director, Emergency Preparedness and Access Center, Brigham Health.