To vaccinate America, close the digital divide

When a 78-year-old patient sent me an email with the single word “vaccine” in the subject line, I guessed it was going to be good news. Just a few hours earlier, the D.C. Department of Health had announced the release of several thousand vaccine doses designated for any resident over 65 and I had promptly let her know. Now she was writing back, I presumed, to let me know she had successfully signed up for the shot, or maybe even already received it.

Wrong guess.

Her email was a tale of frustration. About the complexity of the online scheduling portal. About finally figuring it out, only to learn that all available appointments had already been claimed in under two hours. About her confusion about when she really would get her turn and how this is all supposed to work.

She is not alone. All over the country people in the over 65-year-old age group are having issues registering to receive the vaccine.

COVID-19 vaccine development has benefited from amazing technological advances: mRNA technology, viral manipulation, vector delivery, immune system bolstering, not to mention the engineering fetes of refrigeration, specialized containers and trucks. The vaccine launch is also an enormous IT challenge in and of itself, considering the need for GPS tracking systems, documentation, database coordination, security and confidentiality enhancements and protection from cyberattacks. 

But as states and municipalities launch rollouts through shiny portals on their websites, it appears that the seemingly mundane issue of basic internet use and access threatens to bring vaccine distribution to a halt in many communities.  

This goes beyond technical bugs, or even the ‘usability’ of the websites. It’s about access — to the hardware, to the software, to the knowledge of how to interact with technology, to a robust internet connection and to WiFi.

The chaotic vaccine rollout exposes yet again the social phenomenon that experts call the ‘digital divide’ — the difficulty certain populations have using the internet. Many people lack access to the hardware required to engage in activities like registering to receive the vaccine. Others don’t have access to technology and infrastructure that enable cyber engagement such as electricity, WiFi and high-speed internet connections.

Studies have shown that the digital divide primarily affects women, the elderly, people with disabilities, poor people, people of color, immigrants, those with low tech literacy, and those who live in rural areas. Many of these are the very same communities that also bear a disproportionate burden of COVID-19 deaths and disease.

This reflects the digital divide of America. Despite significant gains in recent years, in 2019, nearly 40 percent of Americans over 65 didn’t own a smartphone. The same year, the majority of the 10 percent of Americans (roughly 30 million people) who didn’t use the internet were either Black, Latino or over the age of 65. Twenty seven percent of those older than 65 did not use the internet. Nearly 30 percent of Americans with less than a high school education did not use the internet. In 2018, almost a quarter of rural Americans reported problems accessing high-speed internet. 

The digital divide doesn’t just affect our ability to schedule vaccine appointments. In a world dominated by COVID-19 precautions, almost everything depends on knowing how to use and having access to the internet — healthcare via telehealth, education via remote instruction, commerce, food delivery, entertainment. Even our social and religious lives are now conducted in cyberspace. This divide is real and it reinforces existing, long lasting and deep, inequities.

When it comes to vaccine distribution, the elderly parent who is slow in getting to the right website, the immigrant who is confused by the dashboard because he doesn’t read English well, the low-wage worker who can’t afford a computer or smartphone and the farmworker who has no high speed internet connection are all shut out of opportunities to access a vaccine that can literally save their lives.  

Beyond scheduling, COVID vaccine digital documentation (which in the future may be required to enter public spaces, fly or engage in social gatherings), is also very much technology based. Some countries are already asking for vaccination proof via snazzy apps — which, of course, require having a smartphone, knowing how to download an app, having an internet or WiFi connection and possessing overall digital skills.

Given the recent vaccine rollout challenges, experts recommended an overhaul of the IT infrastructure supporting it.  But as big tech companies are discussing bug fixes and sophisticated cloud computing platforms, chatbots and AI schedulers, they must remember technology solutions are great and important, but only as long as the end-user can benefit from them. 

In the end, putting needles into arms — the arms of those who need the vaccine most — will depend on our ability to reach people via low and slow tech solutions such as telephone hotlines. Or deploying an army of tech savvy folks (COVID-19 geek squad anyone?) who can help those who have low tech literacy sign on, schedule appointments and respond to health department follow-ups.

Ultimately, closing the digital divide is about more than COVID-19 — even more than about health. The pandemic has only underscored the urgency and importance of achieving universal internet access, which now impacts access to healthcare, education and employment, among other domains. In this day and age, access to the internet is a human right.

The Biden administration must promote policies that seek to bridge the digital divide. Emergency funding in coronavirus bills should be dedicated to increasing access to hardware needed to connect to the internet, broadband deployment, to ensure information and services are accessible via SMS or mobile-friendly platforms and to support initiatives to develop low-cost or subsidized internet plans. The government should see broadband infrastructure in the same way as other types of public infrastructure which should be supported and developed throughout the country.

Lastly, mandating K-12 digital literacy education is crucial, as well as creating and funding initiatives to offer tech literacy opportunities to older adults and members of underserved communities.  

Whether used to order food online, to check in with family members or schedule a vaccine appointment, closing the digital divide will literally save lives.

Dr. Ranit Mishori is a professor of Family Medicine and interim chief public health officer at Georgetown University and senior medical advisor at Physicians for Human Rights.