vaccine and syringe

Opinion: I Gave up My Spot in the Vaccine Line. Maybe You Should Too.

by Eli Cahan 2.11.2021

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originally published in Undark

On Dec 30th, I received the email nearly everybody on Earth is praying for. The subject line wasn’t exactly scintillating — “Order available for scheduling,” it read. But it could only mean one thing: I, along with other students at my medical school, was getting the Covid-19 vaccine.

As I blanked on my password for the scheduling portal, however, hesitation crept in. Although I’ll return to clinical duties in the coming months, I haven’t served on the front lines during the pandemic. I’m currently on leave, working toward another degree, and reporting for a project memorializing health care workers who have died from Covid-19.

When I haven’t been speaking to families who’ve lost loved ones, I’ve been checking in with friends from medical school who are now resident physicians across the country. Or I’ve been video chatting with my 91-year-old grandmother, my bubbie, who’s been in isolation almost a year now.

So, I turned the vaccine down. Not because I have any doubt it works; the most rigorous science available to us suggests it does. Not because I have any fears about side effects, which appear mild in the sweeping majority of cases and mitigable in the remaining minority. But because for now, “eligible” though I may be, it’s not my turn, morally or epidemiologically.

The major driver behind my decision? The all-too-predictable mess the country has made of delivering vaccinations.

The outgoing administration coordinated with industry partners, including vaccine makers and retail pharmacies, to develop preliminary plans for distribution. But they largely punted implementation to the states. “The federal government has distributed the vaccines to the states,” Donald Trump tweeted on Dec. 30. “Now it is up to the states to administer. Get moving!”

In turn, states have leaned primarily on hospitals to get doses into arms. But these facilities have struggled to decode the complicated prioritization criteria recommended by the Centers for Disease Control and Prevention — guidelines that elevated hospital administrators over first responders, mail carriers over public health workers. Meanwhile, many other categories were left open to wide interpretation. Do migrant farmhands qualify as food and agricultural workers? Do butchers?

Attempts to automate the prioritization process were disastrous; in one notorious case, executives at Stanford Medicine, where I am a student, received shots ahead of resident physicians caring for critically ill patients. And efforts to manually slog through priority lists have left millions of lifesaving doses in storage. Thousands more have been thrown out: Once opened, the drugs have only approximately six hours before they spoil.

Increasingly, public health experts attributed the sluggish pace of U.S. vaccinations to the CDC’s hairy prioritization system.

The major driver behind my decision? The all-too-predictable mess the country has made of delivering vaccinations.

So, on Jan. 12 — in an apparent response to the backlash — the CDC encouraged states to expand access to vaccination to all Americans ages 65 and older. But considerable variability persists between states, whose prioritization protocols are increasingly divergent, both from CDC guidance and from one another. Seniors are eligible here but not there; essential workers there but not here. A mess.

Amid the pandemonium, too often, vaccines are finding their way not into the arms of the elderly, sickly, and vulnerable, but rather into the arms of VIPs and others at low risk for illness.

Covid-denying, line-hopping congressmen aside, even among health care workers the numbers of low-risk individuals receiving vaccines is likely enormous.

For starters, there are the tens of thousands of medical students who, like me, are not currently doing clinical work but will nonetheless likely get vaccinated in the early waves.

Then there are those like a psychiatrist I know well, who is affiliated with an academic medical center. She readily converted her practice to a virtual operation and spent the bulk of the summer in Cape Cod. Yet she received her second dose of the vaccine earlier this month. And there are hundreds of thousands of doctors like her — primary care physicians who work at non-hospital-based clinics and specialists who are unlikely to come in contact with Covid-19 patients — who qualify for priority spots for the vaccine.

For all of Undark’s coverage of the global Covid-19 pandemic, please visit our extensive coronavirus archive.

And then there are hospital staff, like my friend’s husband, a clinical psychologist, who are working remotely during the pandemic. There are more than 4 million others — excluding home health and personal care aides — who work at non-hospital clinics, many of which have shifted to virtual operations. There are the hospital affiliates, including researchers and academics, who don’t provide health care but have jumped the line anyway.

Worse still, there’s the posse of hospital board members, from Washington to New Jersey, who are getting immunized to demonstrate “that it is safe,” in the words of Fred Naranjo, an insurance executive and board member at St. Rose Hospital in Hayward, California. In South Florida, health care systems and nursing homes offered the vaccine to wealthy patrons while the elderly were camping out overnight, draped in quilts and flannels, awaiting their turn.

And then there are the 30 million “front-line” essential workers — including back-office bosses at manufacturing plants and slaughterhouses, remote-working transit authority executives, and so on — who will be entrusted to decide whether they are truly at higher risk than the 54 million Americans 65 or older and the 110 million under 65 with high-risk medical conditions anxiously standing in line behind them.

Following the CDC’s Jan. 12 decision to loosen its guidelines, there is hope that the pace of vaccinations will pick up in the vein of countries like Israel, which has adopted flexible criteria and immunized some five times more people per capita than the U.S. Hope also sits with the Biden administration, which has promised to vaccinate 100 million Americans in its first 100 days.

 


Too often, vaccines are finding their way not into the arms of the elderly, sickly, and vulnerable, but rather into the arms of VIPs and others at low risk for illness.


But even this pledge feels modest: At that rate, only about 13 percent of Americans will be fully immune by May, and only a fraction of the 54 million age 65 or older will be. Immunizing all of the roughly 260 million eligible Americans would take nearly a year and a half. So, we wait.

Fortunately, we are not helpless in this purgatory.

Just as an able-bodied person might give up their seat on the crosstown bus to someone who needs it more, those of us at low risk of severe Covid-19 illness can trade our places in line with those at higher risk. Sure, there’s no way to track a dose from freezer to shoulder. But so long as millions of vulnerable Americans are eligible and eagerly awaiting their chance at immunization, any vaccine deferred by a low-risk person will likely find its way into the arm of someone more in need. A bubbie, perhaps.

This small gesture of solidarity is not merely the morally right thing to do; it’s also the fastest and most effective way to bend the curve, a goal that must remain our top priority as hospitals from coast to coast remain an outbreak away from being overwhelmed by the pandemic.

In other words, now more than ever, solidarity offers our best medicine. Giving up that seat — keeping the most vulnerable safe while the rest of us hunker down for just a bit longer — gives us our best chance at achieving immunity for the whole herd. It’s something we all can contribute to. It’s why I gave up my vaccine. And it’s why I hope others whose name is called before their due will consider doing the same.

You know who you are.


 
Eli Cahan is a masters’ student in health policy at Stanford University as a Knight-Hennessy Scholar, a medical student at New York University School of Medicine, and a freelance journalist.
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