When COVID Vaccine Websites Spring Up, What — and Who — Gets Left Out?

Finding a vaccine appointment can be confusing and complicated — especially if you're not particularly comfortable using the internet.

County public health webpages in the Bay Area have progressively gotten easier to navigate as vaccine information has become more available. But it wasn't so easy a few months ago.

Zoelle Egner was working in the marketing department for a big tech company, from home in Oakland, and was also frantically trying to find vaccine information. Egner said she saw friends doing exactly the same, "calling 20, 30 locations, trying to understand [if they] were eligible for a vaccine, how they get an appointment — and over and over again, really hitting walls."

So, she and her friends decided to do something about it. They created VaccinateCA.com, an aggregator website that compiles data from clinics and pharmacies across the state. After typing in your ZIP code or county name, a list of sites will pop up with vaccination information for eligible people.

"If we call the people who can actually give you a vaccine and we write down what they say — do they have a vaccine, who is eligible and how do you get an appointment — then hopefully, hundreds or even thousands of phone calls don't need to be made [by members of the public," said Egner.

VaccinateCA swiftly expanded as more volunteers signed up to help maintain the site. But Egner and her team weren't the only people using technology to address information gaps around vaccination.

Adam Freemer created VaxxMax, a website that fetches data from pharmacy websites, including Walgreens, CVS and Rite Aid, on the status of vaccination slots at each provider.

"I quickly became frustrated with the process you have to go through on the pharmacy sites," Freemer said. "I brainstormed a bit and thought of a mechanism that could help in the process, originally only for my own personal use." Freemer created a code and built a website that others could use, scraping code for Rite Aid stores. Eventually, the website expanded to other vaccine providers.

VaccinateCA and VaxxMax are just two of many sites that promise a clearer answer to the question on everyone's mind: Where can I find a vaccine?

Some, like VaccineFinder and Vaccine Spotter, scan available appointments at clinics and pharmacies near your ZIP code — essentially aggregating information that's already available online.

Sign-up sites like Dr. B go further, and will put you on a waitlist for a leftover vaccine that could be available near you at a moment's notice.

What — and Who — Gets Left Out?

It's worth clarifying that these kinds of sites aren't run by public health departments, or the state itself. As such, their priorities — including speed and convenience — aren't necessarily those of public health officials.

As a result, public health and internet ethics watchdogs have misgivings about some of these kinds of sites.

Irina Raicu, director of the internet ethics program at Santa Clara University's Markkula Center, worries that while these sites are easy to use for many Bay Area residents, they also require internet access and a fair amount of internet literacy.

"Anytime something is done through the internet, it means that it's leaving some people out," said Raicu.

Her colleague Dr. Charles Binkley, the Markkula Center's director of bioethics, feels that the existence of multiple sites is part of what's confusing the public around vaccines. He also cautions that it's impossible for people using these sites to be completely sure of their accuracy, despite the best efforts of those running them.

Of VaccinateCA's method of volunteers calling vaccination sites to aggregate information, Binkley believes that "it's very unlikely that the person who is answering the phone is going to have this global view of how many doses they have."

"What I'd rather see are these engineers working within the system that's already in place to make it better, rather than trying to duplicate it outside," said Binkley.

Many of these volunteer or pop-up websites were created months ago, back when public health departments were scrambling to handle an influx of traffic from eager residents looking for vaccine information, all as eligibility shifted frequently.

Not only have counties somewhat improved the navigability of their public health websites, but in late January, the California Department of Public Health launched My Turn — a centralized place for Californians to assess their eligibility for a vaccine, and then find an appointment near them as supplies allow. And in light of these developments, Raicu believes privately created sites like VaccinateCA or Dr. B might have outlived their usefulness.

"It may be that this kind of site maybe made every ethical sense in the world for a week, while something better wasn't around," Raicu said. "And maybe it needs, at some point, to just go away — because it's interfering with the efforts."

The Ethics of Hunting Leftover Vaccines

Sites like Dr. B have encouraged people, eager for their vaccine, but not yet eligible, to be on the lookout for a leftover dose. But while some sites will dole out leftover vaccines to ineligible people at the end of the day, other vaccination sites — especially those operated by the Federal Emergency Management Agency — have strict regulations for where leftover vaccines can go.

For example, the RingCentral Coliseum in Oakland is a FEMA-operated site. According to officials from the California Governor's Office of Emergency Services, site operators will call the Alameda Office of Education, the Sheriff's Office and the Transportation Commission to give leftover vaccines to vulnerable individuals in high-risk jobs.

Other sites, like San Francisco's Moscone Center, operated through Kaiser Permanente, have different guidelines that allow them to be more loose with their leftover vaccines.

"Standard practice is that appointments are required at the Moscone vaccination hub," a spokesperson from San Francisco's COVID Command Center said — but "occasionally, when small amounts of unused vaccines are left over at the end of the day, vaccines may be made available to a limited number of people who do not have appointments."

But Binkley is skeptical of this standby-line model for vaccine distribution.

"Is 'first-come, first-served' really a great ethical model? Well, no," he said. "Typically the 'first-comers' are not the most vulnerable, or who need it the most."

Binkley worries that when people wait in line for a leftover vaccine, the people who might need a vaccine, but can't wait in line, aren't able to get that shot. And he worries that sites like Dr. B perpetuate this problem.

If Dr. B prioritized people not by who signed up first, but instead based prioritization on a person's personal information and health circumstances, they could "prioritize you according to the phases and the tiers that have been decided on," Binkley said.

"So, if you have a line forming for leftover doses at the end of the day and you have a healthy 22-year-old at the front of the line and a 89-year-old with diabetes at the end of the line, you would prioritize the 89-year-old over the 22-year-old, just based on phases," he said.

In Binkley's ideal ethical world, Dr. B would morph into a structure of volunteers who would get the vaccine — but who would also bring along people who don't have access to transportation, or who are from more vulnerable populations, to get the vaccine with them.

"What I would love to see is people saying, 'OK, I'm going to get my vaccine, I'm going to reach out to people I know who don't have transportation and see if they want to go with me," Binkley said. "So that we not only think about ourselves, and we think about our neighbor."