Vaccination Frustration: Interview with Signetic Co-Founder Chris Sprague

SPRAGUE SAYS THE COVID VACCINATION EFFORT NEEDS SYSTEMS THAT ARE FLEXIBLE, TRANSPARENT, AND EASY TO NAVIGATE.

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• The following is part one of a two-part series. It’s been edited and condensed for clarity. See part two here. •

We've all heard stories about challenges with vaccine rollouts across the country. What are some of the top frustrations people face when trying to register for a COVID vaccine? How can a vaccine management solution alleviate those frustrations?

I think the biggest frustration is just being able to get an appointment, and the hoops that many people have to go through, and the frustration of repeatedly failing to get an appointment. People rightly believe that getting a vaccine for them or on the behalf of their loved ones is a life or death event.

For example, when my parents were trying to get their vaccine, my mom had to wake up at 8 am every morning and check every single website she knew of. They live in Georgia, so she’d go one by one through the directory of people giving vaccines, madly clicking buttons, trying to get one of the few appointments that had been released for that day. And she was unsuccessful for five days in a row before she finally, at 8:01 am on a Friday, was able to get an appointment for my dad. And then she joined more of a wait list system, and got notified the following Monday that it was her turn.

It’s unnerving being just one of the many people in this kind of land rush or gold rush. I was reading in Florida that people described trying to get a vaccine appointment is like trying to get Springsteen tickets.

And it makes sense, because this is so important for everyone, and everyone's been waiting so long. One of the big issues is just confusion. It's still unclear because it's inconsistent. Even within states, it's inconsistent around counties, municipalities. And there's phase guidelines and state phase guidelines? But the truth is, it's really hard to read that criteria.


Vaccine management solutions like Signetic are the last piece in the journey of the vaccine. What can they do to alleviate the hodgepodge nature of how the vaccines are rolling out?

One is making it easy to understand in context—whether it’s your turn, and detail the vaccine policies in your jurisdiction. So when people inevitably have those questions coming to your site, it's right there for them. Don't shy away from educating people about different phases of the vaccine.

We may be used to doing things like ordering from Amazon or ordering food online. But everything with this feels different. Even if we're clicking the same buttons, going through similar flows, everything feels different with the gravity of what we're dealing with.

So just make using the software easy to understand; be transparent and descriptive about how the process will work. Make it easy to use in terms of clarity and steps and fewer things to click on to get through the process. Make it lightweight.

If someone is just trying to get their name on the list as soon as possible, they shouldn't have to check 100 boxes to get there. Take the minimum: name, contact info, age—determine if they're eligible. Just try and reduce that friction at every step.

This stuff is definitely new for a lot of the older and more vulnerable populations. But even if you are familiar with technology and user interfaces, the motivation, importance, and fear of doing it wrong are so different, that it all feels new. And there's this higher implicit perceived cost of doing it wrong. So whatever your process is, and whatever your software provides you, it's important to guide people step by step into doing the right thing, and clearly confirming that they are.


Can you speak to how Signetic is making the process more user friendly?

We've done remote usability tests with older populations, specifically, just trying to validate some of the assumptions and best practices that we have.

With this new audience, for example, my grandma had never used any kind of computer until we got her an iPad for Christmas, because she was isolated. She's 99, and we weren't able to speak with her. For these older populations, it's not even just that they've never signed up for a vaccine themselves online; it's that they don't do anything online.

So accessibility can't go by the wayside. Older populations, for example, might have low vision or other challenges. So you need these higher contrast, you need larger fonts, you need more space between things, you need instructions at every single step.

And if those are the easiest kinds of corners to cut when you're trying to move really quickly, but it’s too important here, so you build it in from the get-go.


What about people who simply just don't have access to the internet? What can solutions like ours do to alleviate that problem?

We need to enable people who can bring the vaccine registration to those that don't have access to the internet. We have a registration app in our suite of tools. That’s just for people that are going out in the field. They're going into older communities, they're going around trying to find vulnerable populations, like those without shelter and food.

As a vaccination management solution, we’re giving them the tools to do that—to mobilize themselves—and just really easily help those populations without internet access. It’s about enabling volunteers and community-based organizations to take the internet to them and take that barrier out of the equation.


We hear from many providers that their hands are tied in predictably offering scheduling and administering vaccines at scale. What are some of those logistical challenges? Is there anything a vaccine management solution can do to help providers navigate those challenges?

I think on the provider side, on the patient side, on the software vendor side, this is all an entirely new problem that we're dealing with. And one of the big ones is just this demand versus supply. Quite simply, more people want the vaccines and there are vaccines available.

And compounding that problem is that supply is unpredictable. The combination of huge demand and unpredictable supply, and the need to connect that supply to the demand as quickly as possible.

“AS MIKE TYSON SAID, FAMOUSLY, EVERYONE HAS A PLAN UNTIL THEY GET PUNCHED IN THE FACE.”

So as Mike Tyson said, famously, everyone has a plan until they get punched in the face. And I think providers and pop up clinics, everyone is getting punched in the face, repeatedly. And honestly, pre-existing software systems were just not meant for this.

Existing software systems are built around having predictable inventory, predictable demand. But what do you do when you have 5000 people signed up to receive a vaccine, and then you find out a few days before that you’ll only receive 2500 doses.

What do you do? Do you move everyone to a different day? And if you move people to a different day? What do you do with the people that already have appointments on that day?

And then there's this kind of multiple doses and different policies of doses and ticking clocks between vaccines. So you need to get the Pfizer vaccine 21 days roughly after the first dose. The recommendation from a Moderna is 28 days, and now Johnson & Johnson is being administered, and it's a single dose. Software systems weren't meant to have all of these different options for a particular condition like COVID-19.

Another way software systems weren't meant for this is showing in their performance.


How do we see poor performance playing out in the vaccination effort?

In Portland, Oregon, where I live, people tried to sign up 400,000 times to try to get something like 3000 slots, and the system was slow. And it was contentious. Some people spent up to three hours trying to get an appointment for themselves or likely their loved ones, with just seemingly endless load times. And then if they were lucky enough to be able to schedule an appointment, by the time they actually click Submit, that appointment may be gone. And that's happening over and over. And demand is so high.

And then of course, as someone who cares about my family members receiving that link, the first thing I want to do is share it with my loved ones and say ‘Hey, can we all get the vaccine now?’ And consequently, when certain municipalities thought they were inviting 1000 people to schedule their appointments, in reality, they're inviting 10,000 people didn't didn't qualify for the vaccine.

Performance is an issue simply in terms of scale too. We need a lot of people administering vaccines that don't normally do that. There are also location challenges: We don't want people overloading our health facilities. Yet for this new theme, we don't want vulnerable populations all gathering in the same closed space in the midst of a pandemic.

And that spurred this incredible new need that you mentioned for distributed vaccinations and bringing the vaccine to people rather than asking everyone to come get it in the way that they normally do. So it's a different mode of operation and new categories of software challenges.


Sounds like flexibility is pretty crucial here.

Yes, when you're looking for a vaccination management system, make sure that it's flexible.

Because you're going to almost certainly need the tools to adapt and reason around things like dynamic inventory. You're going to need tools that allow different modes of operation, for example, right now, there's by far more people that need the vaccine than there are vaccines, is that always going to be the case?

And there are different eligibility phases. What happens when instead of targeting just subsets of our population, the vaccine opens to everyone? Does that open up this new need for a new mode of operation, like ‘show up on the day with proof of identity with who you are and get a shot in the arm? We don't know.

So again, if you want to use a software system to manage this, make sure it's flexible, and that it can adapt—not just to what you think you're going out the door with, as a best practice at the time—but to best practices over time, as that environment inevitably changes.