Even before the vaccine rollout in the US started, scientists and bioethicists warned that attempts to prioritize those most in need of a vaccine – that is, frontline health-care workers and residents in long-term care facilities, would ultimately prove flawed, as those with money and influence find ways to cut the line.
Though we have yet to hear reports of an actual black market for vaccine doses (perhaps since the supply so far is being controlled pretty tightly) there have been reports of “mistakes” and “errors” that led to high-level doctors and other individuals in positions of influence receiving the vaccine before nurses and doctors.
ProPublica has reported on one example whereby hundreds of residents at Stanford Medicine were passed over despite assignments that required frequent face-to-face contact with people infected with COVID-19.
Instead, “high-ranking doctors who carry a lower risk of patient transmission” received priority treatment, one doctor complained.
“Residents are patient-facing, we’re the ones who have been asked to intubate, yet some attendings who have been face-timing us from home are being vaccinated before us,” said Dr. Sarah Johnson, a third-year OB-GYN resident who has delivered babies from COVID-positive patients during the pandemic. “This is the final straw to say, ‘We don’t actually care about you.'”
Others complained of what appeared to be random errors perpetrated by the algorithms tasked with determining which nurses deserved priority. It all begs the question: why even resort to these algorithms? Why not just let the top managers decide? Well, the funny thing about algorithms and other “quantitative” methodologies is they allow people to distance themselves from outcomes that involve extremely serious consequences.
Additionally, in this time of heightened sensitivity to issues of racial equality and social justice, algorithms have been forced to prioritize elements like race in a way that could skew the results in unanticipated ways.
People’s lives hang in the balance. In one instance, an algorithm assigned a higher priority to an operating room nurse working elective surgeries, over an ER nurse regularly dealing with the infected.
Another resident, who asked not to be named, said a nurse who works in an operating room for elective surgeries has been notified she’ll get the vaccine in the first wave. “We test people for COVID before elective surgeries, so by definition, we will know if those patients have COVID,” he said, so to him, it didn’t make sense that that nurse would be prioritized.
When they asked about the algorithm tasked with determining the first 5K allocations, they were told that, for some obscure bureaucratic reason, they would receive a lower priority.
An algorithm chose who would be the first 5,000 in line. The residents said they were told they were at a disadvantage because they did not have an assigned “location” to plug into the calculation and because they are young, according to an email sent by a chief resident to his peers. Residents are the lowest-ranking doctors in a hospital. Stanford Medicine has about 1,300 across all disciplines.
Ultimately, only 7 of the 1K+ residents made the priority list.
Only seven made the priority vaccination list, despite the fact that this week, residents were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases.
A letter sent by the Stanford leadership explained that the algorithm was meant to “ensure equity and justice”.
In a letter to Stanford leadership sent on Thursday, the chief resident council wrote, “While leadership is pointing to an error in an algorithm meant to ensure equity and justice, our understanding is this error was identified on Tuesday and a decision was made not to revise the vaccine allocation scheme before its release today.” The council asked for a timeline for vaccination of the residents and transparency regarding the algorithm.
Apparently, it accomplished this while also leaving residents and nurses exposed.
In response to the residents’ protests, Dr. Niraj Sehgal, chief medical officer, sent an email saying, “Please know that the perceived lack of priority for residents and fellows was not the intent at all.” He added that with the anticipated authorization of Moderna’s vaccine, “we’re increasingly confident in getting everyone vaccinated, including all of you.” He signed off with “heartfelt apologies.”
Just another reminder that social justice warriors should be careful what they wish for.