Digital COVID-19 Vaccination Certificate Online Proved Impossible

I thought booking a COVID-19 vaccination was difficult, but getting the digital vaccination certificate afterwards is proving more difficult. I had assumed I could simply go to Medicare online. However, that requires a My.Gov account with an exact name match. My medicare card has the name I am usually known by on it, and doesn't match what is on my birth certificate. So I called the Medicare number to have it changed. After 30 minutes on hold I was told that I needed to talk to Medicare (which is who I was calling), and was put on hold again. The automated system said I could change my details online, but I was calling so I can get online, making the messages very annoying.

The recorded message at the start was curious, warning that threats would not be tolerated. That seemed an odd way to treat customers, with a greeting threatening them. But after one hour on hold, I can see how a caller could be irate by the time they get to an operator. As it was, after an hour I gave up.

I would be happy to deal with this matter some other way, but no other option is offered: it is by phone, or nothing. I suggest the system needs to be fixed to overcome this obvious fault. 

Vaccinated at Clinic on the Edge for Many Possible Futures

Today I had my second AstraZeneca COVID-19 vaccination at the

Casey Medical Center in Canberra. I arrived five minutes early and was immediately ushered in for my shot, so that even with the 15 minute period after I was out the door by my original booking time. This was a fast and efficient process. 

To to get to this suburb on the north western edge of Canberra, I had to drive past a major public vaccination center which is much closer to home. Unfortunately when I went to book 12 weeks ago for my first jab the federal and ACT web systems were not working well. As a result I booked at a private clinic, as that was the only place I could get the booking system to work for. As it was sop difficult to get an appointment, I decide not to change my booking for the second dose, which as made 12 weeks ago at the same time as the first (to make it simple I booked both the same day of the week at the same time).

The suburb of Casey reminds me of the dystopian future depicted in the  "Nosedive" episode of the Black Mirror science fiction TV series: rows of neat houses, all built at the same time from the same materials, in the same muted colors. The Casey Medical Center is made of corrugated steel panels and looks like a temporary building quickly erected for a pandemic emergency (or something prefabricated for Antarctica, or Mars). But it is comfortable enough inside.

We have had it easy so far, so get vaccinated now, in case things get worse, a lot worse

For those hesitating about vaccination, please consult your doctor, and if they okay it, go ahead ASAP. Australia has been able to use measures to control the virus under relatively benign national and international conditions, but that may not continue. Natural disasters may require medical and emergency staff currently handling the pandemic to be instead saving lives in floods or fires. Rescue and recovery will then take priority, with hospital beds not available for COVID-19 patients.

It is also possible the Australian Defence Force may be needed in its primary role and so personnel would not be available to aid the civil infrastructure. Also some civilian medical personnel and other specialists are military reserve personnel who would be called to duty, so not available for for pandemic duties.

In addition, there could be cyber attacks on our infrastructure which directly limit medical and vaccination facilities. These could interrupt power supplies long enough for vaccine stocks to be destroyed and stop distribution and booking.

Also it is possible that information warfare could be used to undermine confidence in the authorities and ferment civil unrest. This could see fake information used to discredit officials and the community against each other. This would reduce vaccination rates, and may also case people to stop social distancing, spreading the virus and even attacking the infrastructure used to keep them safe. 

One of Australia's major international customers may decide to limit purchases of Australian goods and services, limiting the nations's ability to pay for imports of essential medical supplies. 

Any or all of these could happen without warning at any time. While these may sound far fetched, would you have believed a warning about a pandemic 19 months ago? In 2009 the assignment I set my web students at the Australian National University was to design a pandemic web site for Australia. Some of my colleagues thought this a little odd: when would those skills ever be needed?

Provide Online Informed Consent for COVID-19 Vaccination

The ABS reports that only 73% of Australians would get a COVID-19 vaccination. Of the others, 52% were worried about side-effects and 15% effectiveness. In response, I suggest that Australia's National Cabinet approve the use of online informed consent using multimedia in multiple languages, to streamline COVID-19 vaccination, using any of the vaccines approved for use in Australia for any adult of any age.

The Australian Technical Advisory Group on Immunisation (ATAGI) has advised: 

"... AstraZeneca vaccine can be used in adults aged under 60 years where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits".

And 

"Noting the current constrained supply of the Pfizer vaccine, ATAGI also recommends adults under the age of 60 who do not have immediate access to the Pfizer vaccine should consider the benefits and risks of earlier protection through the AstraZeneca vaccine. "

However, that advice has been implemented in a way which makes it very difficult for anyone who does not have a GP with supplies of AstraZeneca, from being vaccinated. 

The Australian Government provides a document "Weighing up the potential benefits against risk of harm from COVID-19 Vaccine AstraZeneca" to assist with informed consent. But, this is intended for doctors to help explain to patients. As a result those who don't have a GP to explain it to them cannot give informed consent and so cannot be vaccinated at mass vaccination center. 

I suggest National Cabinet decide that a standard audio-visual package in multiple languages be prepared. This would be added to online booking systems, allowing any adult to give informed consent to an AstraZeneca vaccination online. Any adult should be able to walk into any vaccination center at the booked time, show ID and be vaccinated immediately, without the need to speak to anyone, or fill in any paperwork.

Individuals would still have to option to visit their doctor to discuss vaccination. However, I suggest our leaders now need to ask every Australian to accept that the risk, in the interests of their family and the community to get vaccinated now.

Make Getting a Vaccination Should be as Easy as Ordering a Pizza

It is more than a year since the beginning of the COVID-19 pandemic emergency in Australia. Federal and state governments have spent billions of dollars on health measures, but are still unable to field an easy to use online vaccination booking system. I suggest modelling this on the ease of use, and sophistication, of a pizza ordering system. Some years ago I ordered a pizza online for collection. The system took my details and presented pizza options. It then listed the nearest places I could collect it. What was impressive was the system then asked my means of transport and estimated when I should leave to get there just in time. I left at the time suggested, and as I walked through the door of the pizza parlor, my order popped on an electronic display indicating it was ready. I picked it up and was out the door in under a minute. It should be possible to do something similar for vaccinations.

A responsive online vaccination booking system would instill confidence in the public and increase the efficiency and safety of the vaccination process. Removing long queues at vaccination centers will decrease staffing to manage the crowd and also reduce the risk of spread of infection. All of the information the patient needs should be able to collected online and them arrive with a QR code ready to be scanned and jabbed.

An efficient online vaccination system could prevent tens of thousands of deaths, by speeding up vaccination and preventing mass breakouts of COVID-19. This could also decrease the risk of mental illness and death, due to the suffering brought about by lock-downs and unemployment, particularly of younger people. This places such systems in the category of "safety critical", requiring a higher level of care in design, testing and deployment by computer professionals.

Why Are the Federal & ACT COVID-19 Vaccination Booking Websites So Difficult to Use?

WHO Digital Vaccination Certificate

This is to suggest improvements in the COVID-19 vaccination websites of the Federal and ACT Governments. In contrast to those of a private medial provider, the government sites do not appear to have been designed to prioritize vaccination of the general public. It is suggested a booking link be added to the top of the federal and ACT pages, and the ACT use the same Medicare number format as other providers, and not limit online booking at its clinics to existing patients. This is based on my experience helping design emergency websites and teaching how to do this. 

Below I detail some changes, and why they are needed. Australia's vaccination rate is currently far below that needed to have everyone eligible offered at least one dose buy the end of the year. There are obvious flaws in the federal and ACT vaccination websites, including incorrect, and misleading formation. By making it harder for the public to get vaccinated, are placing lives, and the economy, at risk. It is suggested changing the government sites to make it easier for the bulk of the population to book a vaccination. It would also be useful to offer something tangible, such as a vaccination certificate, with a QR code.

Suggested Changes

1. Booking Link at Top of Page: Both federal and ACT governments should have a line at the top of their main COVID-19 web pages for booking:

• Fifty or over? Book your COVID-19 vaccination now:  50+ Book! 

2. Show online booking sites first: The federal government page should display vaccination centers which have online booking first. Public high capacity clinics should be displayed first, followed by GP clinics, and GPs last.

3. Allow ACT residents to register online with ACT Health: The ACT Government should delete the map from their page until there are more ACT centers for the public to choose from. The Medicare number entry field on the MyDHR registration page should be changed to use the same format as federal government and private medical sites. The restriction that only existing patients can register should be lifted. 

Finding Where to Get Vaccinated

A web search using Google for "covid19 vaccine booking", has as the first four responses:

1. COVID-19 Vaccine Booking - Book An Appointment (Ad) https://www.health.gov.au/
2. COVID-19 vaccinations - Available now in Canberra (Ad) https://www.nhc.coop/
3. How will I get my COVID-19 vaccine? | Australian Government ...www.health.gov.au 
4. Booking your COVID-19 vaccination - COVID-19 - ACT Health www.covid19.act.gov.au

The first two of these are paid advertisements and the next two native responses. The first is to the federal health website, the next a private clinic in Canberra, then a different Federal Government page and lastly the ACT Government. That there are two different federal government pages resulting from the one search is confusing. 

Federal Health Website

The first Federal Government page says "... book an appointment if you are eligible ...", but this is below the fold, below the first screen of information, in the middle of a sentence and thus very difficult to see. 

From: COVID-19 vaccines, Australian Government Department of Health, 17 May 2021 (detail). https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines

The priority in the design of this page appears to be to educate the public as to who is eligible, so as not to overload the system. With the decision to permit all over 50s to book, I suggest this is misplaced. The priority should be on getting people vaccinated and saying "book vaccination".

After three screens the federal system displays the nearest vaccination centers. Here they are for O'Connor, ACT:

Vaccination centers suggested for O'Connor ACT.

The screen is headed with "Please use online appointments where available to reduce call volumes to clinics. If you can’t find an appointment or a clinic in your location, please check back in a week.". However, four of the five entries displays are for phone bookings only. Following the instructions given, the user would select the one and only clinic which takes online bookings.

The only entry which has a link for online booking is to the ACT Government clinic. However, this only accepts online booking from previous patents of ACT Heath (and I was unable to make a booking even though I had been a patient). 

National Health Co-op

National Health Co-op is a non-government, not-for-profit health service. The web link leads to a vaccinations page, with two buttons, for "Covid 19" and "Flu Shot". This then shows the six locations where a shot can be booked. The details of how to registered and book are left until later.

National Health Co-op COVID-19 Booking details

This is a good design, the user gets to see where they could go, without having to enter a lot of personal details first. However, the information presented contradicts that on the Federal Health web site. The Federal site lists the Co-op's ANU clinic as available for phone bookings only. That clinic is not listed by the Co-op's website and all of those listed can be booked online. It appears the Federal government site is incorrect, listing a clinic which is not available and also not listing those which are. 

Second Federal Government Web Page

The second federal government page to appear in the web search results is "How will I get my COVID-19 vaccine?". This has a link for "Book or register for COVID-19 vaccination", but below the fold, so the user has to scroll down to find it. This then links to the COVID-19 Vaccine Eligibility Checker, discussed above. Again the booking link is not prominent, and the page does not appear to be designed to have vaccination booking as a priority.

Federal how will I get my vaccine page.

This is not a good design, as the link for booking a vaccination is not prominent. 

ACT Health

The ACT Health Booking your COVID-19 vaccination page, has the link "How to book your COVID-19 vaccination" above the fold. 

ACT Health Booking your COVID-19 vaccination page

This then displays a map showing the clinics:

ACT clinics map

However, only one of three of the clinics shown are for the general public. As a result showing a map is misleading, not useful. The one clinic shown requires online booking via the ACT Government booking system "MyDHR". This system requires entry of the Medicare number in a format different to that used by the federal government and private providers, and the number is not displayed as it is entered. Also online registration is only available to those who are already patients in the ACT health system (and in some chases even not then). 

MyDHR Registration screen obscuring Medicare number.

Previously I provided some "Suggested Improvements to ACT Health COVID-19 Vaccination Booking System". Unfortunately so far the ACT Government has not made the suggested improvements. The only response received is a Tweet (3:01 PM · May 14, 2021) from ACT Health: 

"Hi, if you have any technical issues when using MyDHR, please call 02 5124 5000 (24 hours a day, 7 days a week). Please refer to our FAQ 'I'm having issues signing up to MyDHR' for other reasons you may be having issues"

While this doesn't address any of the issues, it at least indicates the suggestions have been received by the ACT Government.