Appointments for vaccinations – restoring fairness and avoiding black markets

By Dorothea Kübler and Rustamdjan Hakimov

Booking an appointment for a Covid vaccination is tedious. It can mean being on hold for hours when calling up hotlines, trying to access a website that breaks down regularly, or getting up early to make sure to be among the first. It’s like getting a ticket for Wimbledon, the Olympic Games, a Lady Gaga concert, or the Berlin Philharmonic Orchestra. But those who currently hunt for appointments are 80 years and older. 

Access to the vaccine depends on the speed of booking, and many people waste a lot of time on the phone or at the computer. Both features are problematic. In the coming months, many more appointments will have to be scheduled. Thus, it seems worthwhile to spend some thoughts on how to improve the systems – and to see what science can contribute.

Bookings via the phone or a website that depend on speed raise fairness concerns. Some elderly get assistance, e.g., from their children or grandchildren – who can dial the phone multiple times per minute or click repeatedly on the right buttons for online bookings. These persons have a much higher chance of receiving an appointment than others who do not get help. Apart from the fairness issue, the current booking system wastes a lot of time for those trying to make a booking, and leads to frustrations among those who remain unsuccessful but have tried for hours. Additionally, the attempts to be the fastest cause regular server break-downs.

While booking via the phone seems well suited for the group of the elderly, it is the first-come-first-served rule that makes it as problematic as online bookings based on the same principle. Moreover, the current first-come-first-served systems can even create greater problems than the ones already observed. It will most likely lead to a black market for vaccination slots. Firms will use software, or bots, to book all slots and sell them to those who need an appointment. Such black markets for free appointments are observed worldwide, e.g., for visa appointments at German and US consulates, at public agencies that give out residence permits in France and Ireland, and many more.

In the black markets that are observed, there are many no-shows such that appointment slots are wasted. This is due to the firm not selling all booked slots to keep the prices up. In the case of slots for vaccinations, this would be very costly, since no-shows can lead to the vaccine  – an expensive and highly overdemanded resource  – being wasted.

One could think that a proper verification of the identity when booking a slot can help overcome the problem, but this is not the case. Despite ID verifications, the firms that book and sell slots can make bookings on fictitious names and passport numbers. Once a customer is found, the firm can cancel a slot and immediately rebook it in the customer's name, including pin numbers etc. required for the booking. There is no risk in this operation: despite competition from many people who continuously try to book a slot, no one can compete with the software regarding speed. Bots can book any available slot within a fraction of a second – too fast for any human.

Even if cancellations are not possible, people who want to get the vaccination can hire the firm and ask it to book a slot with their credentials. We have seen this for example with sales of exclusive sneakers or train tickets in India.

Thus, the system of allocating slots can significantly impact the success or failure of the vaccination campaign. When designing it, we should draw lessons from similar booking systems. If something that is scarce and valuable is allocated for free (or at a low price that leads to excess demand), it creates possibilities for scalping, just like a Lady Gaga concert or tickets to the Champions League final would. One can auction off the slots to the highest bidder to solve the problem, but this is unlikely to be accepted and lacks fairness.  Luckily, unlike with concert tickets, the identity of the person to be vaccinated can be verified easily when she appears for the vaccination. This allows the problem to be solved without an auction.

What can be done? The solution is simple and has been proposed by Rustamdjan Hakimov et al. 2020. Instead of relying on speed, the online booking system should collect applications for slots and preferred times continuously. Whenever a new batch of slots becomes available, the system randomly determines which applicants get a slot. Instead of a completely random allocation, the system can also use priorities based on the applicants' attributes. In this way, there is no time pressure when applying for a slot, websites will not break down any more, and fairness can be restored by making sure that the desired priorities are followed. Importantly, this system is immune to black market activities, as shown by the authors.

What are the disadvantages of the proposed system? The only disadvantage is that applicants will need to wait for some time until they learn whether they received a slot. The allocation of a batch can, for instance, be determined every other day, offering new slots a week later. In this case, a person will receive the result of the allocation every two days, without any time-consuming activity in between. Waiting for feedback seems like a small price to pay for a fair and stress-free system lacking a black market.

Work cited:

How to Avoid Black Markets for Appointments with Online Booking Systems by Rustamdjan Hakimov, C.-Philipp Heller, Dorothea Kübler and Morimitsu Kurino, WZB Discussion Paper, SP II 2019-210.
Conditionally accepted at American Economic Review.

28.1.2021