The Arizona Republic Editorial Board was right on the mark today that we need detailed demographic data so that the public can have a clear eye into the equity and effectiveness of Arizona’s vaccine distribution system. Such detailed demographic information, including age distribution, zip code and even income data (via insurance information), already exists. It’s just that the ADHS is not disclosing the information.
When people try to get one of the coveted vaccine appointments in Arizona, they input their date of birth (age), race and ethnicity, and address, complete with a Zip Code into the state’s appointment system. Because the appointment site also captures insurance information, the ADHS even has some information about what percentage of folks are insured through AHCCCS (Medicaid) or private insurance.
Arizona remains one of the very few states that still doesn’t disclose this important information- info that the people can use to hold the state agency and the governor accountable for their decisions. They are collecting important demographic fields, but they aren’t using the data to inform their vaccine allocation and policy decisions. Why? Perhaps it’s because they don’t want to admit that the current appointment system favors the wealthy.
To get one of the coveted appointments in AZ, you need to have a flexible job so you can be ready to hit their server in the few minutes when appointments become available. You need good Wi-Fi, a new computer, and enough technology skills to navigate their convoluted system. If you don’t have a rapid digital connection, time to repeatedly refresh the site or sit on hold for hours, and don’t have the ability to travel to a vaccination site, you’re far less likely to obtain a COVID-19 vaccine. Many who are at highest risk also face language and cultural barriers, or simply distrust the process and the vaccine.
Is the state avoiding transparency because we will see that the current system gives an advantage to wealthy (and overwhelmingly white) Arizonans? Is ADHS unwilling to take responsibility for the unfair playing field created by the flawed appointment registration system?
You might ask what would work better and be more equitable?
Most states have a much better system that is not only less complex but more equitable. For example, in Minnesota, folks can register on the state health department website any time any day.
As vaccines become available, (about once a week) the health department randomly selects qualified registrants from the list. People that are selected are given a password that ensures them an appointment that week. Folks without an email address or internet access are called to let them know they have an appointment, and they schedule it with them. Simple decisions could be made to make an allowance for a guest or two that is in a qualifying category (e.g. a spouse).
Such a system would allow you to ensure you were allocating vaccine with a lens to health equity. For example, build a selection algorithm to ensure that folks over 75 are given a higher chance of being selected. You could even look at the vaccination trends geographically. If you were to see that certain low-income parts of the state (or city) you could make it more likely that registrants from that part of the state or city are selected the next week.
A letter to the editor in the Arizona Republic today by Kirk Kobert today said it well:
“Whose idea was this Lord of the Flies method for choosing who gets shots and who doesn’t? My old algebra teacher said, ‘Work smart, not hard’. Time to use technology and our God-given reason to do this better”.
Building a better system for allocating and distributing vaccine isn’t rocket science, but it does require some strategic thinking and a tad bit of creativity.