PROVIDENCE, R.I. -- The road to a COVID-19 shot often leads through a maze of scheduling systems: Some vaccine seekers spend days or weeks trying to book online appointments. Those who get a coveted slot can still be stymied by pages of forms or websites that slow to a crawl and crash.
The technological obstacles are familiar to L. Shapley Bassen, a 74-year-old retired English teacher and editor in East Greenwich, Rhode Island. She lost track of the hours she spent making phone calls and navigating websites to get appointments for herself and her 75-year-old husband, Michael.
“A lot of us don’t sleep at night worrying about whether or not we’ll be able to get in,” Bassen said.
Technological shortcomings across the nation's fragmented public health system have frustrated millions of Americans trying to get shots and left officials without a full picture of who has been vaccinated.
“We’re creating an unnecessary amount of human suffering. This could have been avoidable, and we could have done better,” said Tinglong Dai, a professor who studies health care operations at Johns Hopkins University's Carey Business School.
The White House promised improvements, pledging to establish a new website and an 800-number by May 1 to help people find nearby locations with vaccines.
“No more searching day and night for an appointment for you and your loved ones,” President Joe Biden said Thursday in a prime-time address to the nation.
The administration also promised to send technical teams to states that need help improving their websites.
The bottleneck in vaccine demand seems to be easing in some locations, and on Friday the U.S. surpassed 100 million doses administered. Nearly 66 million people have received at least one dose. But vaccine slots are sometimes still so hard to obtain that people resort to vaccine hunter Facebook groups and bots that scan sites for open appointments. Vaccine seekers who are not accustomed to those methods and don't have anyone to help are at a steep disadvantage.
Bassen finally landed a slot at a pharmacy near home for her husband. The website even offered to schedule the second dose, but when she clicked on it, nothing happened.
Figuring it was a glitch, they printed out the appointment-confirmation email. When he arrived, he was rejected. They told him he had to schedule the second shot at the same time as the first.
The rejection sent Bassen back down into the rabbit hole of state, local government and pharmacy websites and phone numbers. She likened it to a game of musical chairs.
“From the point of view of the patient, the consumer, there seemed to be no continuity amongst these three entities," Bassen said.
The confusion isn’t surprising. An investigation by The Associated Press and Kaiser Health News found that since 2010, spending for state public health departments has dropped by 16% per capita, and spending for local health departments has fallen by 18%. Little money was left for investing in technology.
To help states prepare for the rollout of COVID-19 shots, the Centers for Disease Control and Prevention began building a vaccine-management system known as VAMS.
Many states were hesitant to commit because it takes time for employees to learn new programs, and new systems often have kinks. Few state health departments adopted the CDC program, and at least one has since decided to drop it.
In New Hampshire, officials planned to switch to their own program after thousands of people were unable to schedule second shots within the recommended time frame. Others had their appointments canceled after the system mistakenly allowed them to book slots for which they were not eligible.
Coming up with a national program that worked well everywhere was never likely to happen, especially given the unprecedented scale of tracking COVID-19 vaccinations, said Claire Hannan, executive director of the Association of Immunization Managers.
Prior to the pandemic, local vaccine registries around the country were used mostly to track childhood vaccines. Some are decades old and were never meant to be used to schedule appointments.
“A lot of them are just sort of that spaghetti bowl of code, where you just keep adding on,” said Rebecca Coyle, executive director of the American Immunization Registry Association.
Many vaccine providers such as smaller pharmacies also were not hooked up to the registries before the pandemic because of the time and cost of doing so — including the required maintenance, which involves constantly uploading data and ensuring it’s properly stored and shared.
“There’s always been this perception that you build it and you’re done,” Coyle said.
Many states have concluded that they need a single, easy-to-access “front door” for scheduling shots, Dr. Deidre Gifford, acting commissioner of Connecticut’s health department, noted during a recent CDC forum.
The best system, Dai said, would be to send everyone to register in a central location and, based on supply, give each person a reasonable estimate for receiving a vaccine. That could be a few weeks or months away, but managing expectations would ease some anxiety.
“The core idea is to give people the confidence, give people reassurance," Dai said.
West Virginia has nearly done that with a one-stop statewide preregistration system that uses crisis-management software to collect every person's demographic and contact information, as well as details such as occupation, so certain critical workers can be targeted. Then, they get a text or phone call to book a slot when vaccine doses are available in their county, said Krista D. Capehart, who coordinates the state's pharmacy response.
Other states have struggled with their vaccine websites, or designed sites that give some help, but make people do a lot of work to find available shots. The Massachusetts site was so overwhelmed that it crashed. Washington state's site lets people print a piece of paper saying they are eligible, but finding and booking an appointment is still left to the individual.
Maryland established a preregistration portal, but people still need to go to other websites to find a slot. Dai said even he has struggled after becoming eligible and preregistering with his county. When he was invited to schedule an appointment, the link did not work.
“By the end of yesterday, I had received five links, but none of them worked,” he said Thursday. He ended up booking on his own at Walgreens.
Given the confusion, many worry about what will happen when eligibility opens to an even broader population. People could find it so difficult and time consuming to score a shot that they simply give up.
“The situation will be even worse,” Dai said.
The disease detectives who monitor the pandemic are also concerned about the lack of consistent data on vaccinations.
“If we don’t have good systems to track the number and the type of people that are getting the vaccine, we may not actually be as efficient and effective as possible with the limited resource that we have,” said Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.
Race and ethnicity data is only available for a little over half of the people who have received vaccines so far. That could be because vaccine recipients are not providing the information or because the places where they receive the shot are not collecting it, not entering it or entering it too slowly.
In many cases, the data was entered, but glitches with different software systems cause those fields to disappear, said Dr. Marcus Plescia, of the Association of State and Territorial Health Officials.
Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, calls the vaccine rollout embarrassing.
“If we would have fought World War II the way we’re doing this," he said, "there’s no question that we would have lost.”
Choi reported from New York. Associated Press Writer Carla Johnson in Washington state contributed to this report.