Amazon can make deliveries in two days. Why can't Big Tech speed up the vaccine rollout?

As the nation takes on one of the largest logistical challenges in history with the rollout of the Covid-19 vaccination program, many Americans have asked why Big Tech can’t run the operation. If Amazon can deliver a phone charger in two days, why can’t it use its logistical prowess to speedily vaccinate a nation? With all of the data that Google collects about its users, why can’t it track down and identify who needs a vaccination?

That’s largely because when it comes to getting a phone charger delivered, a company like Amazon handles every step of the process, from taking the order to delivery. But when it comes to vaccine distribution, tech companies have learned they have far less control. The federal government is paying for the needed medication and is managing the supply to the states. Then, states, counties and corporations take over and figure out how to get vaccines into arms. So while Big Tech is certainly playing a role in the vaccine rollout, it’s not exactly how people may expect.

“We have the scale of this pandemic: you’re trying to vaccinate 300 million-plus people,” said J.T. Lane, the innovation officer for the Association of State and Territorial Health Officials, a professional organization for public health officials. “That’s the biggest effort of our lifetime.”

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Take for example what recently happened in Iowa: It took just one week for the state to cancel its contract with Microsoft to run its vaccination booking system. But officials said it was not because Microsoft’s technology was insufficient. It was too difficult even for a tech giant like Microsoft to combine the patchwork of existing digital infrastructure across 99 counties.

“We understand and support the state of Iowa’s decision to optimize their existing system rather than building a different system across many of their existing platforms,” said Montana MacLachlan, a Microsoft spokesperson.

As Iowa Gov. Kim Reynolds said at a Feb. 17 news conference, “It would not be possible in a timely manner without significant disruption to their current systems, and we did not want to slow down the progress that we’re making.”

Many paths

Tech companies have certainly tried from the start to help with the pandemic response. Nearly a year ago, Google and Apple joined forces to help with contact tracing. But most states ultimately didn’t embrace the technology and it had little substantive impact. Some of Big Tech’s technology that was developed long ago is finally being embraced in the vaccine rollout: the VaccineFinder website that the Centers for Disease Control and Prevention is encouraging the nation to use was started by Google and taken over by Boston Children’s Hospital in 2012.

Other tech companies are carving out their place in the vaccine rollout in entirely different ways. Uber and Lyft have offered free rides to and from vaccination appointments. Google and Verizon are helping pay for advertisements promoting vaccine awareness. Google and Apple have participated in discussions surrounding possible vaccine passports, but have not announced any concrete plans.

Companies like Amazon are circumventing the entire local vaccine rollout by working directly with the White House. On Inauguration Day, Amazon executives offered the Biden administration help in distributing the vaccines, stressing that the company’s own 800,000 U.S. workers should be among the first in line to get it. Biden’s team is currently in talks with Amazon about how the company can assist with the president’s national vaccination program, according to sources at Amazon and the White House who are not authorized to speak publicly.

Mediating battles

But one of the most common ways Big Tech companies like Google, Salesforce and Microsoft are helping is meeting mixed results. That’s because they’re trying to create statewide websites that let people schedule vaccination appointments.

On Feb. 10, New Jersey Gov. Phil Murphy said that Microsoft’s website rollout presented “real challenges” for the state. A senior Murphy administration official who was not authorized to speak on the record described Microsoft’s efforts to help New Jersey as a “subpar experience.” She said that Microsoft’s platform was “misconfigured” and was regularly crashing as recently as this month. There were even instances where vaccine-seekers could sign up for appointments at sites that were inactive or closed.

“When tech companies put up their hands — we as the state and we as representatives of the public are entitled to as good of a service and uptime as a company selling sweaters, and we shouldn’t be having a substandard experience,” she said.

MacLachlan, the Microsoft spokesperson, said in an email that the company was working with New Jersey “to deliver vaccinations as quickly, safely and efficiently as possible, and that includes addressing some technical issues.”

Other states, including California, have also attempted to set up a shared portal for vaccination signups, but those sites reach limited populations. California’s unified site, called MyTurn, is powered by Salesforce and a Bay Area startup called Skedulo.

But for now, MyTurn, which is run by the California Department of Public Health, only offers vaccines to much of the state’s urban area and has left out many suburban counties along with some agricultural and rural areas. That statewide online search tool does not account for CVS and Walgreens, two large retailers that have entirely separate pipelines of vaccines and are not enlisting Silicon Valley for help. It also does not account for major health care providers across the state, like Kaiser Permanente, which are running their own separate signup systems.

But public health experts say that these challenges are not necessarily Big Tech’s fault. Tech companies are caught between how state and county health departments set up vaccination sign-ups. Some systems focus on vaccinating as many people as possible. But other public health departments are focused on vaccinating overlooked elderly, minority and low-income populations who have less reliable internet access.

“Everyone is talking about equity with the vaccine. But given a choice, most people would prefer volume because it would get us out of the pandemic faster,” said Dr. Kim Rhoads, a professor of epidemiology and biostatistics at the University of California, San Francisco, whose recent research examined Covid-19 infection rates in Black communities in the Bay Area. “That’s the thing about website crashes and these tech systems being overwhelmed. We’re going for volume there.”

High price

Still, some Big Tech companies are making inroads with local governments. Salesforce is expected to provide the engine behind Nevada’s forthcoming website. According to Maha Neouchy, a Salesforce spokesperson, the company is providing tech services to “more than 50 federal, state, local and private health organizations” for the purposes of vaccine management. That also includes Lake County, Illinois, among others. She declined to comment on costs. Microsoft has also signed contracts with Oklahoma, Montana and Wisconsin to help provide the states’ online vaccination scheduling portals.

Local governments also seem willing to pay up for these programs. Public records requests revealed that Oklahoma is paying Microsoft nearly $500,000 to run its system from last December through the end of July. That represents nearly 1 percent of the Oklahoma State Department of Health’s $59 million information technology budget.

Similarly, other public records from Lake County, north of Chicago, show that Carahsoft, a Salesforce partner company, told the county it would cost $5.5 million to deliver a “Vaccine Management Solution,” known as AllVax, for work that ran from late October through the end of 2020. The county took over operations for this digital system as of early 2021.

Some local jurisdictions seem pleased with how Big Tech companies have helped them welcome an arguably daunting number of visitors to their sites.

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“Overall I’ve been really proud of the system and that we haven’t had an outage yet — we’ve had 380,000 people registered in the system,” said Jefferson McMillan-Wilhoit, director of health informatics and technology for the Lake County Health Department. He noted that without the $5.5 million deal with Salesforce, which constitutes a notable portion of his department’s $80 million annual budget, it would have been nearly impossible to set up this digital infrastructure so quickly.

North Carolina recently signed a nearly $1.1 million contract with Google to provide services for the next year as a way to create a unified statewide system, rather than having citizens and county public health entities run their own.

“We stood it up and it went live and we pressure-tested it for 1.4 million users [in a four-hour window] and we are getting hundreds of thousands [of hits in that same window of time],” said Sam Gibbs, North Carolina’s deputy secretary for technology and operations, noting that the state’s population is about 10.5 million.

Seeking alternatives

But public health officials note that regardless of how well tech companies create vaccination sign-up websites, there are some crucial populations they will never reach. That’s because there are still millions of Americans who need vaccines but who don’t have access to the internet to even sign up. Rhoads suggests that local health departments find ways to reach out to the populations who do not have the skills, internet access or trust in Big Tech companies to use these sites.

“Bigger is not better. And it just goes back to volume versus equity,” said Rhoads. “If we go big, we’re not going to get equity. With that in mind if we go forward with volume as our priority, we should not be surprised in the end when we don’t get equity.”