Online system of booking shots raises questions over accessibility
Ontario is building web portal for mass COVID vaccination. Can we avoid the pitfalls plaguing some parts of U.S.?
On Sunday evening, as millions of Americans watched the Super Bowl, Harriet Diamantidis sat down at her computer to continue her endless search for COVID-19 vaccine slots.
“You’re competing with a lot of people, so you want to try to go online when other people are busy,” she told the Star of her strategy over the phone from Long Island, N.Y., “whether that’s at dinnertime, 5 in the morning, or 2 a.m.”
The 36-year-old has been dubbed a vaccine angel by the U.S. media for helping hundreds of seniors get appointments that are harder to come by than a pair of tickets to a sold-out concert. She does this through a New York City web portal that’s clunky and difficult for older adults to navigate.
Ontario is building its own online booking portal for eventual mass vaccination. The Star has learned it will use the same scheduling software as a system in California, one that’s been criticized as cumbersome, with younger, whiter, wealthier and more techsavvy people often ending up snagging appointments, even though they are the ones who are the least impacted by COVID-19.
The portal, said an Ontario Ministry of Health spokesperson in an email, will be available in both English and French, and “work is underway to incorporate registration and eligibility for the end of February/early March.” That’s when the province should be in “phase 2” of the rollout, where the vaccine will be offered to seniors, starting with those 80 and over, and essential workers.
“There are several parties responsible for building the registration and scheduling ‘portal,’ including the ministry, its agency and vendor partners. The systems integrator is Accenture and the vendor for our scheduling system software that integrates with our Salesforce platform is Skedulo,” the spokesperson said.
Customer service desks will be made available “in parallel” and neighbourhood mobile clinics are being planned by public health units, they added.
California’s My Turn vaccine portal was piloted in Los Angeles and San Diego and is being expanded across the state. But there have been early reports of racial, income and even age disparities in who actually gets the shots, even as they are supposed to go to those over 65 and essential workers.
The Los Angeles Times described “dozens of young, mostly white people in yoga pants and beanies who lounge on beach chairs and blankets on the sidewalk every day … many with MacBooks on their laps, hoping to get leftover doses of the Moderna vaccine,” seniors struggling with online appointments, and determined health workers offering paper forms to lines of older mostly Black and Latino residents in hard-hit neighbourhoods, to input in the data system later.
The same issues have surfaced with the similar online appointment system in New York City, where the New York Times reported clinics full of affluent white people who had travelled to other neighbourhoods for the vaccine, even though lowincome communities of colour have been disproportionately impacted by COVID-19.
A popular SoulCycle instructor there recently apologized following an outcry over a selfie she posted on Instagram, after she drove to a mostly Hispanic neighbourhood and got the vaccine, telling staff there she was an “educator.”
Asked about concerns with equity and seniors, Skedulo’s executive vice-president of marketing, Miles Kelly, said in an email that “in each deployment, we work closely with the state or province’s IT team, Accenture and Salesforce, to address unique accessibility requirements citizens may have. We’re pleased with the progress so far.” The company is based in San Francisco. Media contacts for Accenture and Salesforce did not return requests for comment by deadline.
The “booking experience for Skedulo’s high capacity scheduling for vaccine administration in Ontario will work similarly to California’s myturn.ca.gov site, but of course the user interface and logo will represent Ontario,” he added.
Ontario is not at this phase yet, behind the U.S. and facing a current shortage of vaccine supply.
“You’ll be able to learn from our mistakes,” said Diamantidis, who, with her husband Niko, books appointments for strangers who’ve connected over Facebook and through word of mouth.
The New York City portal has not been reported to use the same software as Ontario will use, but it’s very tough for seniors to manipulate any onlinebased system, she said.
“They didn’t grow up with the internet. If you have to refresh your page a hundred times, that’s really difficult and really time consuming, that’s really frustrating.”
The city’s two-step verification process requires a code sent to an email address, and because appointments are so in-demand, the constant re-entering of information. An executive assistant, Diamantidis knows tricks like the copy and paste function that save time, but said many seniors, and even some millennials trying to book for their parents and grandparents, find the technology a huge hurdle.
She first posted an offer to help in several public Facebook groups in January, after going through the process with her 96-year-old grandmother.
“She can barely use her landline telephone, let alone check email and all of that, so that was what sort of inspired me to do this.” Being able to “reach a human” through a phone line would be hugely helpful, she said.
Some form of that should be available in Ontario through the parallel customer service desk. Mobile vaccine teams will be part of the rollout, said city of Toronto spokesperson Diane Morrison, as well as “smaller community centre immunization clinics” and fixed immunization clinics.
“Using the province’s Ethical Framework, strategies to reach targeted and vulnerable populations are being developed in collaboration with external partners, community leaders and subject matter experts, to not only inform but to address vaccine hesitancy,” she added.
Sabina Vohra-Miller, cofounder of the Toronto-based charity Vohra Miller Foundation, which has donated to health-related causes, and a member of the South Asian Health Network, believes now is the time to be thinking about how to make the wider rollout equitable.
There are “layers” of accessibility around an online component as factors from age to socioeconomic and cultural background all impact digital literacy, she said. Appointments at mass vaccination centres also often require people to have transport.
That’s not to say there shouldn’t be an online aspect, only that there should be an effort to remove as many barriers as possible, said VohraMiller. Mobile vaccine clinics should be “prioritized and it has to be done in a systematic way,” partnering with community health organizations. And the portal should be available in more than just English and French, given how many other languages are spoken here. “Time and time again throughout the pandemic we’ve seen the people who are consistently being left behind are those racialized, vulnerable marginalized populations. We really can’t afford to keep doing this,” she added.
California’s system has seen younger, whiter, wealthier people often snagging appointments