The frustrating experiences of many older adults trying to enroll and register for COVID-19 vaccinations highlights a technological barrier to mitigating the pandemic. The Centers for Disease Control and Prevention’s (CDC) Vaccine Administration and Management System (VAMS) is a system that was poorly designed for end users.
In the race to get vaccines into arms — and particularly into the arms of the most vulnerable populations — the technologically complex enrollment and registration process in VAMS is a barrier to access. As death rates from COVID-19 are on the downslide, U.S individuals ages 75 and older are still at the highest risk for contracting COVID-19, being hospitalized and dying from the virus. These same individuals are least likely to have the necessary computer literacy skills to navigate VAMS. When older adults forego vaccinations due to technology barriers, systems must change.
The mantra of public health is to make the healthy choice the easy choice. Why, then, did the CDC roll out a public-facing system that appears to have been developed for research data collection requiring multiple steps, multiple days and complex data entry skills? Who was the system built for? Considering the vulnerable populations to be served, the VAMS process does not align with the urgency of the pandemic and the needs of end-users with low computer literacy skills, some of whom have no Internet availability. The healthy choice is now the hard choice.
Firsthand experiences with the frustrations encountered by older adults attempting to use VAMS include the requirement for a unique email address for each individual. Many older couples share an email address if they have one at all. Setting up a new email account is burdensome. VAMS is not optimized for smartphone use. Users who rely on smartphones rather than computers or tablets are at a distinct disadvantage.
VAMS instructs users to seek help with enrollment and registration from a son, daughter or friend. These instructions are a poor excuse for a system that does not meet the needs of intended users. Many older individuals do not have access to social support systems with the necessary skills to navigate VAMS. It would make more sense for the CDC to employ user-centered design principles to develop and offer a system that maximizes the likelihood of successful enrollment and registration for a vaccine that saves lives. Instead, users are sent into a maze of dead ends and cryptic messages. The easy solution for many individuals is to simply give up.
Fortunately, some states and health systems implemented processes that circumvent VAMS. Unfortunately, this strategy is not widely available. The interface between the CDC’s VAMS and state health departments is not uniform; however, adding further confusion to the process that already takes multiple days to complete. Access to vaccines varies across state lines — the downside of a federalist approach during a pandemic.
We urge the CDC to redesign VAMS with end-users in mind. The Biden administration is coordinating efforts to beat the pandemic and save as many lives as possible. Scientists have made the enormous lift to develop safe and effective vaccines to combat COVID-19 with critical funding from multiple streams including taxpayer dollars. Revising the VAMS website and user interface to improve usability should be a high priority task. While we wait for a better VAMS process, we can all unite by assisting those in need, especially older adults and underserved populations to enroll and register for COVID-19 vaccinations.
Lisa J. Sundean, PhD, is an assistant professor at the University of Massachusetts Boston. Ellen M. McCabe, PhD, is an assistant professor at Hunter College at the Hunter-Bellevue School of Nursing. Kathleen Nokes, PhD, is professor emerita at City University of New York. Priscilla L. Sagar, EdD, is professor emerita of nursing at Mount Saint Mary College. The authors are Fellows of the New York Academy of Medicine.