Fix the Appointment System
Most states have a much better system that is not only less complex but more equitable than the ADHS’ convoluted appointment system. For example, in Minnesota, folks can register on the state health department website any time, any day. This levels the playing field for persons with jobs that require them to be at their post during the few minutes when appointments become available.
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 us to ensure we are allocating vaccine with a lens to health equity.
One could even look at the vaccination trends geographically. When you see that certain low-income parts of the state (or city) have been under-served you could proactively make statistical adjustments to improve their chances of being selected.
A letter to the editor in the Arizona Republic this week 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.
Equitably Allocate Vaccine
Arizona’s original vaccination system plan hinged on leveraging county health departments to execute their vaccination plans. A core element of all those plans include prioritizing hard to reach and under-served areas by making vaccine available at Federally Qualified Health Centers, mobile clinics and the like.
Those plans were jettisoned in early January when Director Christ began prioritizing “state run” sites over the needs and plans that the county health departments have.
Note: While the State Farm is branded as a ‘state run’ site, the vast majority of the coordination work is being done by Blue Cross Blue Shield of Arizona.
ADHS is prioritizing “their” PODs for each week’s supply at the expense of the county health departments. In addition, weekly county allocation is highly erratic making planning at the county level next to impossible.
It also makes it impossible for the county health departments to implement their plans to reach into underserved areas.
For additional background on how the decisions that are being made by Director Christ and the ADHS are impairing county health departments ability to roll out vaccine equitably read this piece by Stephanie Innes and Alison Steinbeck in the Arizona Republic: Rollout of the COVID-19 vaccine differs along rural-urban lines.
Editorial Note: I write this with a sense of resignation. I realize at this point that Director Christ and Governor Ducey are going to do whatever they want to do regardless of the needs and interests of stakeholders like county health departments and their community vaccinator partners. Nevertheless, we will continue to expose what we see are unjust decisions if for no other reason than to document their actions and the impacts that their decisions are having on ordinary Arizonans.
