On the accessibility of the cantonal vaccination platforms
The availability of recently developed vaccines is a glimmer of hope for many in this pandemic that has already lasted 18 months. To date, over 3 million Swiss residents have been vaccinated against SARS-CoV2. Vaccination registration procedures play a key role in this process: for vaccination to take place, it is necessary to determine whether the person is eligible, what potential risks exist, and time and location need to be matched with local capacity.
In the spirit of Swiss federalism, the cantons themselves are responsible for providing a suitable system for vaccination registration. Those who now expect 26 individually developed solutions will be surprised: The majority of the cantons work with the CovidProtect system from the Swiss companies OneDoc and DrNow. The cantons of Zurich and Bern, on the other hand, use the specially developed platform VacMe, while the canton of Obwalden relies on the existing health care app Misanto. Only the cantons of Neuchâtel, St. Gallen, Vaud, and Jura developed their own solutions.
Accessibility on the Web
For vaccination registration, all cantons rely on a digital solution in the form of a website. However, to ensure equitable access to Covid vaccination, web development must take the accessibility aspect into account. Currently, around 20% of the Swiss population can only use the Internet to a limited extent due to a disability . The federal government and the cantons are required by the Disability Equality Act (BehiG, SR 151.3) to provide services and information in an accessible and comprehensible manner. Discrimination against a person based on physical, mental, or psychological limitations is also prohibited by the Federal Constitution (BV, SR 101). The websites of the cantons for the registration for the Covid vaccination must therefore be usable and comprehensibly prepared for people with disabilities.
To support the cantons in barrier-free digital communication, the Federal Department of Home Affairs (Eidgenössisches Departement des Innern EDI) provides a guideline . This includes various recommendations for making the content accessible to people with visual or hearing impairments, or with a cognitive or motor disability. In particular, the provision of adequate media, e.g. videos with subtitles for people with hearing disabilities, is addressed. Regarding a barrier-free implementation of the website, the EDI refers to the initiative Einfach Surfen , which is supported, among others, by the umbrella organization for people with intellectual disabilities Insieme Switzerland and the Zugang für Alle Foundation. The recommendations of Einfach Surfen are based on and complement the Web Content Accessibility Guideline (WCAG) 2.0 , which is considered the global standard for accessibility on the Internet. The recommendations are based on four fundamental principles:
- Perceptibility: information and components of the user interface must be presented to users in such a way that they can perceive them.
- Usability: components of the user interface and navigation must be operable.
- Comprehensibility: information and operation of the user interface must be understandable.
- Robustness: content must be robust enough to be reliably interpreted by a variety of user agents, including assistive technologies.
To determine whether a website meets accessibility standards, there is an Accessibility Checklist  as well as a range of online tools such as AChecker, WAVE or SortSite, which, among other things, were also used for a similar study of online vaccination registration platforms in the U.S. . The following consideration of the two platforms CovidProtectand VacMe will be made with special attention to accessibility in order to provide possible recommendations for improving the inclusion of these platforms.
CovidProtect: The majority solution
A total of 19 cantons, including Geneva, Basel, Lucerne, Graubünden, or Valais, rely on the CovidProtect system developed by the two Swiss companies DrNow and OneDoc. A closer look at both companies reveals the reason for their collaboration: While DrNow specializes in online questionnaires for medical diagnoses, OneDoc offers a platform that allows users to book appointments with medical professionals in their region. Both, online questionnaires and automated appointment booking, are key components of CovidProtect and enable users to get a SARS-CoV2 vaccination in their canton. Each canton receives its own version of CovidProtect, which is hosted centrally and accessible via a subdomain. For example, the domain bs.impfung-covid.ch (Fig. 1) leads to the registration of the canton of Basel while gl.impfung-covid.ch to the registration of the canton of Glarus.
The first part of the registration includes information about gender and a series of questions about previous illnesses such as cancer. In addition, it is recorded whether the user is a person working in the healthcare sector or whether there is contact with risk groups. These questions automatically determine which vaccination group the user belongs to. Finally, users must identify themselves by name, date of birth, telephone number, and health insurance card number. The system automatically verifies the user’s details and makes it impossible to register under a false name. If there are several vaccination centers to choose from in the canton, the user can select several options. Registration remains possible at any time, even if the user’s group has not yet been approved for vaccination by the federal government. In this case, the user will be placed on a waiting list and informed at the appropriate time.
The website has been implemented in such a way that it meets the requirements of accessibility. It is, for example, possible to operate the website without a mouse, solely using the keyboard. A test of the website with the WAVE Accessibility Checker only pointed out that the use of PDF documents tends to be problematic. PDF documents are usually displayed using a separate application or plug-in, which can lead to confusion and navigation problems. However, the documents themselves were structured in such a way that they withstood an accessibility check and could be read by a screen reader.
After successful registration, all users will be placed on a waiting list without any details about the expected date of the appointment. To confirm the registration, users receive an SMS and a message at regular intervals stating that they are still on the waiting list. As soon as two appointments with an interval of four weeks are available, they are automatically allocated to the users. By SMS users are informed of the time and place of both vaccination appointments. A priority reminder and any changes to the vaccination appointment are also communicated by SMS. The fact that further communication takes place via SMS means that the issue of accessibility is outsourced to the various mobile phone manufacturers. However, this pragmatic decision is justifiable insofar as all common operating systems for mobile phones, such as Google’s Android or Apple’s iOS, have corresponding screen readers and accessibility features.
Bern and Zürich: VacMe
The two populous cantons of Bern and Zurich developed their platform VacMe in collaboration with the IT company DV Bern (Fig. 2). In contrast to CovidProtect, here, users create a profile with a user name and password to have access at a later date. Two-factor authentication via SMS code is used to increase security.
Similar to CovidProtect, VacMe guides users through a questionnaire that evaluates pre-existing conditions and contact with possible risk groups. The review of the website by the WAVE Accessibility Checker yielded a comparable result to that of the CovidProtect platform. Here, too, the use of PDF documents was identified as problematic. In contrast to CovidProtect, however, the accessibility of the PDF documents themselves is not always guaranteed. In particular, the document from the canton of Bern for self-assessment is more difficult to access for people with visual impairments due to its visual layout. The layout distributes the self-assessment questions within a visual grid, which breaks up the linear structure of the content. This may create potential problems when using a screen reader (Fig. 3).
After completing the questionnaire, users are not directly assigned to a vaccination group, nor are appointments automatically allocated. The users themselves must search for and book two suitable appointments at intervals of four weeks. Due to the confusing design, this process became difficult and was criticized by various parties as time-consuming . Users had to constantly check whether new dates were available, either on the vaccination platform itself or, for example, via the cantonal Twitter account (Fig. 4). As soon as the availability of new appointments was announced, users were in a race against time. For example, at the beginning of May, the city canton of Zurich released 180,000 appointments for people aged 16 and older, which were completely booked within a few hours. There were also cases where, after a suitable second appointment was found, the first one was already taken.
Even if the structural design of VacMe fulfills a large part of the requirements for accessibility, the independent search for appointments disadvantages people with disabilities. To be informed about the availability of new vaccination appointments, reading the Twitter feed, for example, must be part of everyday life. As an activity, this requires a great deal of additional time for people with, for example, visual impairments. The fact that the vaccination dates were also made available at intervals, which created a race for free dates, disadvantages people for whom the navigation of a website requires more time.
Since the search for suitable dates was a challenge even for people without disabilities, an anonymous programmer developed his own solution (Fig. 5). On the website, https://rimpfli.web.app/, which has been featured in various daily newspapers , users can get an overview of available appointments in Bernese and Zurich vaccination centers and pharmacies. The rudimentary website provides very basic functionalities: For example, it is possible to hide locations without free appointments or to display only pharmacies. These functionalities are so basic that it is surprising that they are not part of the VacMe platform. Here, too, the website meets the basic requirements of accessibility, but of course, it cannot solve the fundamental problem that registration is still only possible via the VacMe platform.
Self-, or external, determination
In essence, the two solutions CovidProtect and VacMe take different positions on a central question: Are vaccination appointments booked by users, or does the system automatically assign appointments? Taking control of essential processes within a system away from the user is generally considered problematic in user experience design. The CovidProtect system thus takes a unique approach by embodying the attitude that, under current circumstances, it is legitimate to remove some control from users. A decision that, it could be argued, prioritizes efficiency in the sense of rapid progress in the vaccination campaign over personal freedom. Efficiency, however, is difficult to prove. After all, the cantons of Zurich and Bern have recorded a high rate of vaccination progress despite their comparatively cumbersome system.
However, if we look at the two solutions from the perspective of accessibility, CovidProtect is clearly to be preferred. The automatic allocation of appointments replaces the need to search independently for free appointments, which, in turn, does not discriminate against people with disabilities. The same requirements apply to everyone. Nevertheless, there is still room for improvement in terms of accessibility. PDF documents are widely used and are not only part of the vaccination registration, but also an elementary component of many cantonal information platforms. While web pages have a genuine, technically readable structure thanks to the HTML format and can, therefore, be easily processed by screen readers, this is not automatically the case with PDF documents, as the example from Bern shows. Content from proprietary software such as Microsoft Office or Adobe Acrobat is widely used and not designed to be converted into open formats such as HTML. New text formats such as Markdown could help here. Markdown documents always follow a uniform, simple structure. This makes them easy to convert to HTML. At the same time, structure and machine readability remain guaranteed, which can increase accessibility.
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Max Frischknecht is a design researcher, programmer, and graphic designer. Currently, he is a Ph.D. student in Digital Humanities at the University of Bern and part of at the Sinergia research project “Participatory Knowledge Practices in Analog and Digital Image Archives”, funded by the Swiss National Science Foundation (SNSF) from 2021–2025. Max holds an MA in Design from the Bern University of the Arts HKB, where he conducted a research project on the role played by personal data in political communication in Switzerland’s social networks. He studied visual communication at the Academy of Art and Design FHNW in Basel. https://maxfrischknecht.ch/