Feb. 8, 2021 -- While federal guidelines say only certain segments of the population are the current priorities for COVID-19 vaccinations, many outside those groups are doing whatever they can to get shots of their own.
Right now, the CDC recommends that the COVID-19 vaccine go to people in three priority groups: essential workers, people over 65, and people 16-64 with underlying health conditions. All told, that’s more than 200 million people, but individual states are making their own decisions as to who gets priority.
As of Friday, 57.5 million doses of the vaccine have been delivered around the country, falling far short of demand. And while some Americans are volunteering to help in any way they can, the urge to jump the line is strong for many.
And that is a problem, Daniel J. Hurst, PhD, and Matthew Arbo, PhD, wrote in the American Journal of Bioethics.
“When demand for a healthcare resources outpaces its supply, it is imperative to allocate resources in an equitable manner. Doing so respects the basic principle of justice,” they wrote.
The available data on the racial makeup of vaccine recipients paints an unpleasant picture. Among the 23 states that report those details, Black and Latino people received far smaller shares of the vaccine than their share of cases and deaths, and compared to their share of the states’ populations. For instance, in Mississippi, Black people make up 38% of the population and 41% of the deaths due to COVID-19, but they’ve received just 17% of the vaccinations.
“The burden of COVID infection and severe illness and death has been very unequal,” says Muriel Jean-Jacques, MD, who co-wrote an editorial in the Journal of the American Medical Association called “Vaccine Distribution -- Equity Left Behind?”
“So it makes sense that when you have a limited supply commodity, like a vaccine in the middle of a pandemic, that you would try to get it to those who are most likely to die, or to get severely ill first. It's also not surprising that a limited commodity may not actually go to those who need it most. Especially if those who need it most have borne the brunt of structural racism and classism.”
For example, a vaccine site opened in a Latino community in New York City saw its appointments snapped up by white people from elsewhere. Glitches in the system let people outside priority groups in Washington state, Tennessee, and Missouri make appointments. Some counties in Michigan are allowing local elected officials to get shots.
Among the country’s rich and powerful, many are scheming to find a vaccine before their turn. In Hollywood, entertainment-world heavyweights have been working their networks, offering bribes and flying by private jet to get shots when they can find them. In New York, a celebrity SoulCycle instructor nabbed an appointment by deeming herself an “educator.” Before the state clamped down, Florida’s priority list didn’t require recipients to live in the state, so wealthy “vaccine tourists” flew in to get a shot. And some Seattle-area hospitals offered “invitation-only” vaccinations to hospital foundation board members and major donors.
“In this country, we’re used to prioritization and timeliness being determined by power, privilege, and money,” says Jean-Jacques. “I understand they’re equally scared, but they need to wait.” (Not all celebrities are taking advantage: 75-year-old Dolly Parton, who donated money to help vaccine research, has announced she’ll hold off on getting the vaccine.)
“Allowing the ultra-rich to buy their way to the front of a line, much like a Disney FastPass that allows guests to pay an added fee to avoid long lines at attractions, is uncertain to maximize benefits and minimize risks,” Hurst and Arbo wrote in the American Journal of Bioethics.
While these examples are clearly unethical, the decision whether or not to jump the line isn’t always so clear-cut. Because a vial of vaccine must be used in its entirety within 6 hours after opening, facilities sometimes wind up with extra doses at the end of the day. Those would have to be thrown away if the provider couldn’t find anyone to receive them. Knowing this, some people will sometimes wait in line, just in case. Freezer breakdowns have also led to facilities throwing open the doors, rushing to administer the vaccines before they were no longer viable. Caught up in snarled traffic during a snowstorm, health care workers in Oregon went from car to car, looking for takers.
“If you truly have vaccine that's about to be thrown out, of course, you should get it into any safe arm that you can,” says Jean-Jacques. “Everybody in this country is at risk for COVID-19, illness, and death.”
But just because you can get a vaccine, should you? “It's understandable that people want to do everything they can to get a dose as quickly as possible. But we know that people with certain characteristics are more likely to die,” says Jean-Jacques. “That means people who don’t have those characteristics, even if they’re equally scared about getting COVID, need to wait.”