Prostock-studio/Shutterstock.com

With Demand Far Exceeding Supply, It Matters That People Are Jumping the Vaccine Line

When hospital administrators and politicians’ spouses get immunized before people more at risk, it undermines confidence in the system.

The Biden administration’s much-needed national strategy to end the covid-19 pandemic includes plans to remedy the chaotic vaccination effort with “more people, more places, more supply.” The Federal Emergency Management Agency will open more vaccination sites, the government will buy more doses, and more people will be immunized. Still, by all estimates, the demand for vaccines will far exceed the supply for months to come.

For weeks, Americans have watched those who are well connected, wealthy or crafty “jump the line” to get a vaccine, while others are stuck, endlessly waiting on hold to get an appointment, watching sign-up websites crash or loitering outside clinics in the often-futile hope of getting a shot.

To eliminate this knock-out-your-neighbor race to score a vaccine, the administration needs to find ways to build trust in the system. It will take more than “more people, more places, more supply” to end the Darwinian competition and restore confidence and order.

That’s in part because, desperate to end their own pandemic nightmare, many of our most respected institutions and politicians have behaved badly. Of course, hospitals have performed heroics during the pandemic — turning orthopedic wards into covid intensive care units, canceling elective surgeries, bringing retired health care workers back to help, all the while losing thousands of staff members to the virus. But some also have behaved selfishly during the vaccine rollout.

When the vaccine was released in December, the Centers for Disease Control and Prevention recommended that health care personnel and nursing home residents receive the first doses. It was pretty clear whom the agency had in mind for “health care personnel”: those who deal directly with patients, including doctors, nurses, technicians, janitors and the people who deliver meals, along with those who might come into contact with the virus, like security guards and laundry staff, as part of their jobs.

But many hospitals interpreted the recommendation broadly, inoculating their entire staff — public relations departments, administrators, programmers, laboratory scientists and, sometimes, their boards. They offered vaccines to psychiatrists who were seeing their patients on Zoom. They vaccinated radiologists who were reading films at home. Some of those immunized were at the upper end of the medical income totem pole, people who had sat out the pandemic at country homes.

Many hospitals pay no taxes because the care they provide benefits their communities. In their vaccine rollout, many of those were not thinking about their communities, only about themselves.

That behavior set a precedent for the national chaos that followed. “From soup to nuts, the whole thing has fallen apart,” said Arthur Caplan, one of the country’s leading medical ethicists. What Caplan called “unfair priority” left him “incredibly irritated”; ethics were often absent from the algorithm. “Once you’ve lost public confidence in the fairness of the process, it undermines willingness to follow the rules,” he said.

Once random people working remotely got shots, those outside medical centers played whatever cards they had, too. Therapists who were teleworking claimed eligibility. Politicians and their spouses — sometimes former spouses — got vaccines.

People offered donations in exchange for vaccinations. Health officials and private doctors tipped off friends about when new vaccine doses would be released. On screening forms, people checked the boxes needed to get a vaccination appointment and in some places were immunized even after their duplicity was discovered.

Pity the rule-followers: Many older Americans who are not tech-savvy or lack internet access have been unable to get slots. It might be theoretically possible to sign up by phone, but by the time you get through, the newly released appointments may be gone. Those without a child or grandchild to help secure an appointment could be out of luck.

Hospitals, clinics and vaccination sites have explained away bad behavior by saying they didn’t want to waste unused vaccines. Many have experienced higher-than-expected refusal rates from those expected to get a shot.

I don’t blame the lucky recipients; after all, hospitals would just offer the unused vaccine to the next person on the list. But I do blame whoever it was in the hospital hierarchy or the health clinic who decided to distribute and redeploy vaccines this way.

If there were unexpected extras, couldn’t hospitals have instead walked those doses to patients in the geriatric, hypertension or diabetes clinics? Or offered them to one of the many nursing homes and assisted living facilities whose workers and residents have still not been vaccinated, though they, like health care personnel, were the Centers for Disease Control and Prevention’s top priority?

Gregg Gonsalves, who is 57, HIV-positive and an epidemiologist at the Yale School of Public Health, said he faced an ethical quandary when he was notified of his eligibility for the vaccine; he was unsure whether to sign up. His 86-year-old mother has not gotten one yet.

“Ethicists are saying, ‘if offered, take it,’ but stepping in line in front of my own mother? I know speed is of the essence in getting shots into arms, but this is entrenching gross inequities,” Gonsalves said. (He declined to say what his decision was.)

The problem is that, often, people are not really being “offered” the vaccine; in some cases, they are grabbing it through position, influence or deceit. They are, in the abstract, taking it from someone perhaps more in need — a subway worker, a high-risk patient, maybe even their own mother.

Now, the new administration is coordinating with states to set up more mass vaccination sites. That’s great. But the United States has allowed its public health system to become a hollowed-out underfunded mess, and many vaccination clinics are being run and staffed by contracted private companies. And the private sector has so far proved too vulnerable to private favoritism.

Until the supply is sufficient, the government needs to give the shots to the people and places that need it most, and find ways to ensure that the plan is followed; the system could prioritize ZIP codes that have high covid-19 infection rates or target low-income populations who might otherwise have a difficult time securing an appointment.

In Britain, citizens are notified, according to risk group, when it is their turn to book an appointment. They don’t have to play knock-out-your-neighbor to score one. We shouldn’t either.

Subscribe to KHN's free Morning Briefing.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.