Documents Show How Government’s $44M Vaccine Software Was Supposed to Work

The federal government’s $44 million online system for managing the coronavirus vaccine rollout was pitched to states as a free and easy way to book appointments and track shots. 

New documents obtained by VICE News show how the federal government’s optional system, designed by the contractor Deloitte, was supposed to work before the country’s vaccination campaign became plagued by confusion about who’s eligible for vaccination, a patchwork approach to scheduling vaccines, and frequently changing on-the-ground plans.

The U.S. Centers for Disease Control and Prevention’s supposedly simple system, called the Vaccine Administration Management System, or VAMS, has emerged as yet another pain point in the nation’s chaotic public health campaign. Reporting by Bloomberg News and MIT Technology Review shows that some of the people tasked with administering vaccines don't like VAMS. As of Jan. 28, 41 states weren’t using the tool: One of South Carolina’s top health officials had described VAMS as a “cuss word,” according to MIT Technology Review. 

“It is a clunky system. Nobody likes it. The hospitals don’t like it, the providers don’t like it, the users don’t like it, DHEC doesn’t like it,” Marshall Taylor, acting director of South Carolina’s Department of Health and Environmental Control, told state lawmakers last month, according to the Island Packet. “This is not a good system.”

Records obtained by VICE News through public records requests in Nevada and Pennsylvania further detail how VAMS was described to states, underscoring at least some of the confusion associated with it (a portion of these documents is embedded below). 

The documents show that the CDC was demonstrating VAMS to states by at least Sept. 1, and held a series of orientation sessions and town halls before it went live Oct. 26.

The documents detail the federal government’s several different programs to help facilitate vaccine distribution, many of which interact with one another. An email sent from the CDC to state public health officials on December 11, the day the Pfizer-BioNTech vaccine was authorized, titled "Getting Ready for When COVID-19 Vaccine Becomes Available," explains a seven-step process for "successful COVID-19 vaccination program launch." 

These steps included making sure emails from 11 different CDC, Pfizer, and contractor email addresses didn't go to spam and signing up for and making sure different vaccine ordering and tracking software was set up to work together. Vaccines could be ordered through VAMS, but then had to be uploaded to a separate system called VTrckS to actually order them. Daily inventory could be submitted to a program called VaccineFinder, maintained by HealthMap at Boston Children’s Hospital in partnership with the CDC and a company called Castlight Health.

Vaccine administration data could then be tracked in VAMS and submitted to a COVID-19 Data Clearinghouse, where it would then be accessible through "Access Dashboards" on an additional platform, called Tiberius, which was developed by yet another company, Palantir. Adverse reactions from patients were to be tracked on a platform called v-safe.

A "Data Use Agreement" rolled out to states shows just some of the many different systems being used, with one summary reading, "The COVID-19 vaccination administration DUA covers the following tools that will be used to collect and report COVID-19 vaccine data: Immunization Gateway, COVID-19 Clearinghouse, Immunization Data Lake, VaccineFinder, VTrckS, HHS Tiberius, provider systems, and other vaccine sources." 

Presentations obtained by VICE News show that the CDC attempted to explain how some of this works, using infographics like this:

The documents also show that the CDC held a series of "Town Hall Q&A sessions" with state officials to explain how VAMS works. It created seven different user manuals (for different levels of health employees) and had seven different training presentations, according to one September 30 CDC presentation. 

Additionally, the CDC established a team just to support jurisdictions as they planned to go live with VAMS. That team was also set to answer follow-up questions and provide training up until December 31.

Also in the September 30 presentation from the CDC titled “VAMS and Data” was a graphic that seemed to demonstrate VAMS’ utility. The image describes a world in which patients schedule vaccine appointments through an app, check in with a QR code, report any adverse health effects of the vaccine, and receive notifications for their second dose. That data, the graphic seems to explain, would ultimately be de-identified and sent up the chain to state and federal governments to better inform their decisions.

All of that sounds a lot simpler than scheduling appointments through Eventbrite or hunting down spare vaccines at random. But, according to MIT Technology Review, VAMS is sometimes known by providers for randomly canceling patient appointments, among other problems.

Around the time of the demonstration, local health departments were also asking when they’d be able to receive training about VAMS, according to an October 2 “immunization awardee” FAQ that was obtained by VICE News through a public records request in Pennsylvania. And it seemed that, despite being months away from one of the nation’s biggest public health campaigns in recent memory, they’d been offered little access to it. 

“CDC demonstrated VAMS for awardees on Tuesday, September 1, and Wednesday, September 2. Both sessions offered a view of four modules: IIS Jurisdiction, Employer/Organization, Clinic, and Vaccine Recipient,” the FAQ document reads. “There was time for questions and a recording is available on the ISD Awardee SharePoint in the COVID-19 IIS Resources folder or by clicking LINK. User manuals, pocket guides, and training videos will be available prior to launch. Kickoff meetings for jurisdictions that want to use VAMS will begin the week of October 5.”

The Trump administration had pushed the tool, although states largely have their own vaccine information systems, according to Politico. An FAQ document available online from the CDC shows that states had wondered back in June why the system was being built when they had their own tools; the health agency responded they had “modernization needs and inconsistent, disparate capabilities to support vaccination activities.” But weeks before the CDC’s “VAMS and Data” presentation in late September, some states still felt they were expected to essentially choose between upgrading their own systems or opting in to the federal VAMS program without much information, according to Politico.

Kristen Nordlund, a spokesperson for the CDC, said in an email to VICE News that VAMS is currently being used by 10 “jurisdictions.” VAMS is also being used by three federal agencies and one hospital system. 

In highlighting “key areas of VAMS functionality and recent system enhancements,” Nordlund noted VAMS does not require that all of its users have email addresses, it’s able to distinguish between first and second dose appointments, and it “does not directly submit vaccine orders.” The spokesperson also said "there have been no glitches in VAMS resulting in spontaneous appointment cancellations," and that some cancellations were "due to clinic administrator errors (e.g., changing clinic hours after appointments were scheduled). The VAMS system has been enhanced to include additional warnings for clinic administrators."

A spokesperson for Deloitte, meanwhile, said VAMS has been used “to administer more than 1.4 million COVID-19 vaccinations,” and was developed “with input from federal, state and local health officials.” Similar to the CDC’s response, the spokesperson emphasized that random cancellations aren’t VAMS’ fault. 

“We are proud to be supporting the largest public health campaign in our nation’s history to help end the COVID-19 pandemic so that our families and communities can recover and thrive,” the spokesperson said. “Throughout the pandemic, we have harnessed the skills and resources of our organization to respond at every level of this public health emergency.”

Still, some public health officials aren’t pleased with the results.

"The previous administration had plans in place to create just that nationwide unified IT platform that would be available to all states and jurisdictions that would do, among other things, that type of pre-registration. But what ultimately came out—a system called VAMS— didn't meet anyone’s expectations,” Maine Centers for Disease Control and Prevention Director Dr. Nirav Shah said recently, according to WMTW, an ABC affiliate in Poland Springs, Maine.