3 Ways to Be a More Ethical Designer During a Pandemic

Create vaccine management programs that serve everyone.

This article is based on Integrating Ethics Into Vaccine Management Software — Lessons From the Field by Rob Katz and Yoav Schlesinger on the Salesforce 360 Blog.

The age of designing for a pandemic is not going away anytime soon, which is why designers need to start developing their ethical muscle memory now. I sat down with the intrepid team behind the end-to-end vaccine management platform, Vaccine Cloud, to hear how they’re navigating big ethical questions and doing their best to create a better future for all of us.

Vaccine management technology can help businesses and schools reopen safely and provide a path toward the new normal. However, there are also ethical concerns to consider as we design this technology — for instance, we need to be cautious about collecting and using sensitive, personal health information. Bringing an ethical lens to the design and implementation process for these tools prompts us to pause and ask questions about the intended — and unintended — consequences of our choices.

When we were putting together the fields for information or coming up with the language to include in Vaccine Cloud, I often thought of that scene in Jurassic Park where Jeff Goldblum’s character says, “Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.” It was crucial to keep inclusion and ethics top-of-mind with every detail and feature we designed. — Mike Cain, Product Manager of Salesforce’s Vaccine Cloud

Four designers and thinkers behind Vaccine Cloud — Rob Katz, Senior Director of Ethical and Humane Use; Yoav Schlesinger, Principal of Ethical AI Practice; Mike Cain, Product Management Director of Vaccine Cloud; and Gerard Iervolino, Senior Product Manager — share their best practices and tangible tips for adding an ethical lens to any design process.

Mobilize and scale vaccine administration programs.

Whether you’re working on a vaccine management solution or curious about how to design more ethical systems more generally, here are some good design patterns to think about:

Make things easy

“We need to accommodate everyone and every use case. Just because I can use a certain technology doesn’t mean it comes easy to everyone. And, some people need to access their digital health credentials more often than others. Someone may show their vaccination records a few times a year when they fly, but a college student will show their records multiple times a day. We have to make it easy for everyone.” — Gerard Iervolino, Senior Product Manager

Thoughtful design is critical because if users become overwhelmed or confused when trying to book an appointment, they may quit or give up out of frustration. Ultimately this could put them and others at risk of infection. It’s important to make the sign-up process easy and then scale your approach as you continue to design other user experiences, like digital health credential technologies.

To make things easy for users registering for a vaccination appointment:

• Ensure multi-channel access. Solutions should be screen-reader compatible and work on all phones. They should be available via SMS and on legacy browser technology.
• Have a call center set up. This is an essential step for serving rural, underserved, underrepresented minority populations and older communities.
• Enable individuals to schedule appointments for themselves or others. More specifically, an individual should be able to sign multiple people up. For example, the manager of a homeless shelter should be able to book appointments on behalf of their residents. A child under the age of 18 should be able to schedule an appointment on behalf of an aging parent.
• To prevent “gaming” the system, we recommend using two-factor authentication or reCaptcha in the background and implementing de-duplicating processes to identify someone with multiple sign-ups (as in the case where an older adult has scheduled themselves and, at the same time, been scheduled by their well-meaning adult children).
• Include stock text about the vaccination process in the registration flow. These will help create more clarity in periods of great uncertainty.

Vaccine administrators should provide two short paragraphs including:

• One paragraph that explains how vaccination eligibility decisions are made and how prioritization and allocation work (with links to the appropriate, local guidance).
• A second paragraph that includes information on the safety and efficacy of vaccines (with citations or links to public health guidance, scientific studies, and other materials).

Design for the edge cases (it’s better for everyone)

“My advice would be, identify the most vulnerable parts of the population and design your products around them because if it works for them, it should work for everyone.” — Mike Cain, Product Management Director of Vaccine Cloud

Typically, you solve challenges for a finite number of users, but it’s now about creating a solution that applies to everyone. As of May 6, 2021, 32.6% of the U.S. population is fully vaccinated, and some offices are aiming to reopen (at limited capacity).

Therefore, addressing inclusion and equity includes answering questions like: what if the person doesn’t have a phone, email address, or access to the internet? And what about people with disabilities? What part of the global population are you leaving out as part of the design?

Yoav Schlesinger, Principal of Ethical AI Practice, shared, “If sign-ups can only be performed online or via smartphone, and are only available in English, there is a serious risk of marginalizing those without access to technology, those who are less digitally literate, non-English speaking populations, and those who are only able to use lower-tech options.”

To avoid marginalizing communities, consider:

• Using inclusive language. For instance, use “residents” instead of “citizens,” because permanent residents and undocumented populations are all eligible for vaccination programs in the United States.
• Not everyone has health insurance. Making it a required field might exclude those without it or could lead to collecting more personal health data than needed. Furthermore, many countries do not have private health insurance, so this field may not be relevant in certain contexts.
• Unhoused and undocumented populations may not have a government-issued ID, so proof of identity should be considered a flexible field in the set-up flow. If a vaccine administrator needs proof of local residence, anything from a driver’s license to a utility bill should suffice.
• Accessibility is key. A key element of our ethics-by-design approach is to make sure everyone has access to technology, including those who are blind/low-vision or deaf/hard-of-hearing, as well as those with older technology or without access to a computer or smartphone at all.

Empower users

“Privacy-preservation is my number one best practice because it’s all based on trust,” according to Gerard Iervolino. “We need to allow the end-user to share what they want, how they want. I’ve talked to some people setting up Vaccine Cloud for their organization, and they want to track everything, which is not only unethical but can lead to morally questionable consequences down the line.”

In the past (and still today, for the most part), vaccination records were stored on paper, which meant the person holding the form had the power to share it with whomever they wanted, whenever they wanted. Today, we’re creating a hybrid world where we need to enable both paper-based and digital solutions, which creates an additional layer of responsibility for data security and privacy. To preserve individual privacy, we need to be mindful to collect minimal amounts of data, and we need to store it for the least amount of time required to deliver the solution. And, although health records may be digital, the power to share this data should remain in the user’s hands.

Here’s an example of how companies can preserve privacy:

• Administrators who have access to data for sales, customer service, or pricing don’t need to have access to sensitive vaccine or health information — and vice versa.
• For example, in Work.com (Salesforce’s pandemic-response product), shift managers do not see the details of a person’s “wellness status” — they only see if someone is available to work or not, protecting employees’ privacy while also helping managers schedule appropriately.

This may be only the beginning of designing vaccine management systems, especially as solutions move into the private sector. Starting to develop your ethical muscle memory now will help create a better future for all of us. I’ll leave you with a bit of advice from Rob Katz, Senior Director of Ethical and Humane Use at Salesforce, “If there’s one thing I would love for designers who are going to be designing solutions for the pandemic to think about, it’s this — just because you can do it, doesn’t mean you should.”

Ready for more? Take the Ethics by Design Module to learn how Salesforce thinks about Ethical & Humane Use as we create technology that drives our customers’ success and upholds the basic human rights of every individual.

Thank you to the wonderful thought leaders and designers who helped bring this article to fruition: Madeline Davis, Crystal Garrett, Yoav Schlesinger, Rob Katz, Mike Cain, Gerard Iervolino, Christina Zhang, Anna Kowalczyk, and Paula Goldman.

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