I Worked A Vaccine Hotline. Here’s The Big Problem With The System.

"I had callers cry on the phone. There was nothing I could do but stay on the line and try to be empathetic."
"When someone started their call by saying, 'I’m on my computer but I can’t figure out how to get to the website and register,' I knew it was likely I couldn’t help them."
"When someone started their call by saying, 'I’m on my computer but I can’t figure out how to get to the website and register,' I knew it was likely I couldn’t help them."
PeopleImages via Getty Images

For the past three months or so, I worked the vaccine registration hotline for a county in suburban Pennsylvania. From the very first day I worked for the hotline, I was struck by the magnitude of a systemic inequity among vaccine recipients and hopefuls: computer access and literacy.

I was happy to get the job: I was unemployed at the time, applying for any available job, but in the throes of the winter COVID-19 upswells, nobody was hiring. The call center was a lucky find: It didn’t pay great, but it was well within my skill range, not boring, allowed me to work from home, and actually allowed me to help people. I bought a $30 headset from Target, underwent one day of training, and then I was ready to work.

The title “vaccine registration hotline” ended up being something of a misnomer ― I couldn’t actually register people over the phone, only coach them through the online registration process.

If a caller had a problem, we could write a report and submit it into the ether (well, to our boss who turned it over to the county health department ― we worked for a contracted third party and had no way to contact the county or anyone at it directly). I could transfer people to the Health Department’s main line (whose unnavigable menu generally kicked people back to us). I could answer questions about vaccine locations, timetables and schedules. Or I could transfer people to the phone registration line.

In theory, there was some kind of accommodation for those without internet access. The county’s senior services program had set up a phone registration line that would register people over the phone if they had no computer. However, we were explicitly told (and sometimes reprimanded) to only transfer people to it if they had absolutely no computer or internet, and not if they had a computer and didn’t know how to use it. We couldn’t break protocol because our calls were listened to by administrators.

So when someone started their call by saying, “I’m on my computer but I can’t figure out how to get to the website and register,” my shoulders would sag, because I knew it was likely I couldn’t help them.

I tried my best to talk people through the web registration process, and I was pretty good at it ― spelling out the web address, talking though the steps, explaining what they could expect next. I probably guided about 80% of callers to register successfully.

But some people lacked even the computer skills to follow directions. Some people couldn’t figure out where the task bar was, or how to open a tab. When I asked questions like, “What browser are you using?” many callers had no idea. My only hope was that these callers would call back again, claim they had no computer, and be transferred to the phone registration line.

But even that was not a solution for many callers ― the two registration processes were separate. So if a person wasn’t registered, they could be registered either way, but if they had been registered over the computer but, for instance, lost computer access, or weren’t sure their registration had gone through correctly, then neither we nor the phone registration people had any way of checking their status for them.

For the first two months or so I worked the hotline, the county was vaccinating people in category 1A, which was anybody over 65, people with qualifying medical conditions, and health care workers. The county had drastic vaccine shortages, meaning for over a month of that time it said it was vaccinating people who had registered on Jan. 13, the first day that registrations were open.

That would have been exasperating enough on its own, but communications from the county were spotty and inconsistent, and the list frequently got shuffled out of order such that people who registered on subsequent days were sometimes called before the county was through with the people who registered on the 13th. Oh, and there was one day that the entire web system shut down and the clinics went walk-in.

All of this chaos is bad enough if you are an internet savvy person who can figure out how to register with multiple providers and constantly check all of their websites for updates. But for seniors who were already overwhelmed by the county’s registration system and lacked the web skills to figure out alternatives, it was dread-inducing.

I had callers cry on the phone. There’s one voice I remember in particular, a hoarse voice repeating, “I think I’m gonna die. If I don’t get this vaccine, I’m gonna die.” There was nothing I could do but stay on the phone and try to be empathetic.

People middle aged and younger vastly overestimate the ubiquity of computer literacy. While I would go to the internet to look up how to get vaccinated, many callers had found the hotline number on TV segments or in physical newspapers or paper county newsletters.

Furthermore, we also overestimate the access to support. Many of the seniors who called lived alone or with their spouses, without family members or neighbors nearby to help them. Public libraries were not all open, and many people did not have access to transportation.

Of course, not all seniors lack computer literacy ― probably not even the majority anymore ― and not everyone who lacks computer literacy is a senior, but that’s the general trend. When public health infrastructure seeks to prioritize seniors, it is particularly irresponsible to make the only means of access be the internet.

It’s also worth mentioning that computer literacy wasn’t the only access problem people encountered. Many local public libraries have been closed due to the pandemic, cutting off reliable computer access for those who are homeless or transient, or who simply can’t afford a computer or reliable internet.

The county’s website is written in English, and so if people didn’t know English they needed someone to translate it for them. On the hotline, I was able to connect to an interpretation relay service. The interpreters were usually excellent, so we were able to talk people through the website registration process, but they would still need someone to translate the email they got giving them the time and day of their appointment.

Things are better now. The county got through its high-priority list and is now vaccinating people in all categories. It has some walk-in appointments available, which greatly expands access to those without internet access or literacy. It has a greatly improved web registration system, which was updated about halfway through my time there and is much easier to navigate than the old one.

I was effectively laid off the same week I’d given my notice (I am happy to report, I have found a new job that relates to my college degree!) because the hotline was receiving far fewer calls.

So while things are better, they should have been better from the beginning. If statewide vaccination registrations were more centralized, if we hotline personnel had the ability to create, access and edit registrations ― if, generally, the whole system wasn’t set up exclusively to be accessed via the internet, with the phone an afterthought, more people would have had access to vaccines far sooner.

Many things have shifted online during the pandemic, I frequently hear this touted as a win for accessibility, and the internet described as a sort of equalizer. That can be the case. But systems set up to be exclusively accessed via internet are not accessible to all people, particularly to seniors. Other options need to be equally viable and usable, and not an inaccessible afterthought.

I hope this will be a lasting lesson of the pandemic and will inform future public programming. I don’t think it will be, though. Internet access is becoming increasingly necessary to participate in society, and those who can’t keep up will continue to be left behind.

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