The government's $44 million vaccine rollout website was a predictable mess – here’s how to fix the broken process behind it
- Written by Tinglong Dai, Associate Professor of Operations Management & Business Analytics, Johns Hopkins Carey Business School, Johns Hopkins University School of Nursing
The COVID-19 vaccine rollout has been a nightmare[1] for many Americans as they struggle through multi-step registration and appointment systems[2].
The federal government had envisioned states using one national vaccine scheduling system, and it offered a contractor US$44 million to develop it. But that system turned out to be so poorly designed that all but nine states[3] opted out before even trying to adopt it, even though it was being offered by the government for free.
The few states[4] that do use the Vaccine Administration Management System, or VAMS, have reported random appointment cancellations and unreliable registrations[5]. Some vaccinators have had to resort to creating records on paper[6] because of system glitches, slowing down the pace of getting shots into people’s arms.
As troubled as the VAMS website may be, it is also a predictable result. We’ve seen this movie before.
HealthCare.gov, the federal healthcare exchange website that was launched to implement the Affordable Care Act, also known as Obamacare, cost taxpayers nearly $1 billion[7]. When HealthCare.gov was launched on Oct. 1, 2013, only six people[8] were able to sign up for health care on the first day. The Obama administration ended up having to enlist a team of engineers from Google, Amazon and Facebook[9] to fix it.
The U.S. is among the most technologically advanced nation in the world, with some of the most powerful technology giants and the largest talent pool[10]. So, why has the federal government repeatedly failed to deliver a functioning website essential to public health?
As an expert in health care operations management[11] and contracting[12], I believe the complex federal contracting process bears much of the blame. The Biden administration has the power to fix it.
Three big problems with federal contracting
The U.S. government is the largest buyer on Earth[13]. It spends more than half a trillion[14] dollars a year procuring a wide range of goods and services from the private sector.
While private buyers may have their own rules governing purchasing, the U.S. government has to follow a set of procurement regulations. These regulations are known as the Federal Acquisition Regulations[15], or FAR, and they have been in place since 1983[16]. The rules dictate all aspects of the federal purchasing process, including the contracting process for building websites such as HealthCare.gov and VAMS.
The Federal Acquisition Regulations were created to uphold the federal government and taxpayers’ interests through a uniform set of rules. Despite its good intention, this process has three key problems.
First, with thousands of clauses[17] that are difficult to navigate, the Federal Acquisition Regulations have created a complicated and time-consuming contracting process, and many of those clauses are nearly impossible to implement in practice[18]. That restricts the government to using a small group of vendors who are experienced in the game of contracting but are not necessarily the best choices for delivering products.
When the government announced the HealthCare.gov project, the tech giants that were eventually called in to fix it did not even participate in the bidding process, because the process favors past vendors such as CGI Federal, which specialized in federal contracting[19].
Second, in many cases, the complicated nature of the rules enables vendors to be selected without competition. In choosing a vendor for developing VAMS, the Centers for Disease Control and Prevention determined that Deloitte was the only contractor[20] that met the project requirements. The reason: The CDC believed VAMS required GovConnect, which is Deloitte’s propriety platform. The GovConnect platform was launched in June 2020[21] and has had some problems[22]. It is not clear why a vaccine rollout platform had to be built on GovConnect.
Third, the contracting process discourages communications and interactions[23] between vendors and contracting officers. For websites like HealthCare.gov and VAMS that have many stakeholders, the needs of those stakeholders typically evolve during the development process. Companies such as Google, Amazon and Facebook use an “agile[24]” method designed for changes during development. The current federal acquisition process naturally supports a traditional “waterfall[25]” model that largely specifies all requirements at the beginning and allows little room for change.
Fixing the federal contracting process
How can the federal contracting process be fixed? Repealing the Federal Acquisition Regulations[26] would likely cause chaos, but fixing it is doable. The executive branch[27] of the U.S. government can modify the Federal Acquisition Regulations on its own, so it is up to the Biden administration to make changes.
Next, the federal contracting process must value results, not only the process itself or the vendors’ history of winning federal contracts. Deloitte[28] and CGI Federal[29] both continue to win federal contracts worth billions of dollars despite past failures[30].
VAMS has sparked far less public outcry than HealthCare.gov, but its failure is no less consequential, because a rapid vaccine rollout is the key to ending the ongoing COVID-19 pandemic. Deloitte spokesman Austin Price told Bloomberg News[31] the company “continues to enhance the system based on feedback and priorities of VAMS users.”
The Obama administration started some reforms[32] of the federal contracting system, particularly moving it away from the “waterfall” approach to allow more changes during development. The Biden administration could continue that work as it rethinks the tangle of federal contracting rules.
Unless it fixes the outdated federal contracting process, the U.S. will almost certainly repeat the same disaster again and again.
[Get our best science, health and technology stories. Sign up for The Conversation’s science newsletter[33].]
References
- ^ nightmare (www.concordmonitor.com)
- ^ registration and appointment systems (www.wsj.com)
- ^ all but nine states (www.bloomberg.com)
- ^ few states (www.beckershospitalreview.com)
- ^ random appointment cancellations and unreliable registrations (www.technologyreview.com)
- ^ records on paper (www.technologyreview.com)
- ^ $1 billion (www.zdnet.com)
- ^ only six people (www.nbcnews.com)
- ^ Google, Amazon and Facebook (hbswk.hbs.edu)
- ^ largest talent pool (www.geekwire.com)
- ^ health care operations management (scholar.google.com)
- ^ contracting (tinglongdai.com)
- ^ largest buyer on Earth (fas.org)
- ^ half a trillion (www.govexec.com)
- ^ Federal Acquisition Regulations (www.acquisition.gov)
- ^ in place since 1983 (fas.org)
- ^ thousands of clauses (www.acquisition.gov)
- ^ impossible to implement in practice (www.federaltimes.com)
- ^ specialized in federal contracting (www.washingtonpost.com)
- ^ the only contractor (beta.sam.gov)
- ^ June 2020 (www.executivegov.com)
- ^ problems (www.wdrb.com)
- ^ discourages communications and interactions (www.jdsupra.com)
- ^ agile (www.amazon.com)
- ^ waterfall (www.geeksforgeeks.org)
- ^ Repealing the Federal Acquisition Regulations (defense360.csis.org)
- ^ executive branch (fas.org)
- ^ Deloitte (www.technologyreview.com)
- ^ CGI Federal (www.usaspending.gov)
- ^ past failures (www.technologyreview.com)
- ^ told Bloomberg News (www.bloomberg.com)
- ^ Obama administration started some reforms (www.theatlantic.com)
- ^ Sign up for The Conversation’s science newsletter (theconversation.com)
Authors: Tinglong Dai, Associate Professor of Operations Management & Business Analytics, Johns Hopkins Carey Business School, Johns Hopkins University School of Nursing
