POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”

These are some of the thousands of people who have been immunized against the coronavirus at hospitals affiliated with Columbia University, New York University, Harvard and Vanderbilt, even as millions of frontline workers and older Americans are waiting their turns.

The Centers for Disease Control and Prevention has issued recommendations intended to ensure that the nation’s vaccines first reach those at highest risk: health care workers who interact with Covid-19 patients, and residents and staff members at nursing homes, followed by people age 75 and older and certain essential workers.” (I)

“University of Chicago researcher Sarah Cobey has spent nearly a year studying the spread of COVID-19, but she was still surprised when her employer offered to vaccinate her against the virus.

An associate professor of ecology and evolution, Cobey does not work in a clinical setting and has no exposure to patients. But University of Chicago Medicine has included her and several thousand other remote or off-site employees in its distribution of vaccines intended for health care workers.

“It really makes a difference if you’re giving vaccines to people who are at the greatest risk of severe disease and death, compared to people who aren’t,” Cobey said, noting she’s at low risk. “Who’s getting vaccinated now, it is a matter of life and death.”

Just three weeks into the national vaccination program, the actions by UChicago Medicine add to questions over which people should get vaccinated first, when more groups can start getting shots and exactly who will qualify in each group — with details yet to be fleshed out in a system overseen by already strained state and local health agencies.

Federal guidelines adopted by the state of Illinois say shots for health care workers should go only to people who have direct or indirect contact with patients or infectious material. But in the quick rollout of the vaccine, heavy trust has been placed in health systems to interpret who qualifies.

UChicago Medicine opened up vaccination to all its employees, even those who, like Cobey, work from home. Other local health systems have made different choices. Loyola Medicine, which also has a large academic arm, said it has vaccinated only those workers who have direct contact with patients.

Doctors who helped fashion the U.S. Centers for Disease Control and Prevention’s vaccination guidelines said the goal was to get the shots to all front-line health workers first, regardless of whether they worked in a big city hospital or small rural clinic. It wasn’t for health systems to vaccinate all their own employees, including those working from home, while other clinicians waited.

“I know from talking to colleagues in other states, there are people getting it who don’t fit the strict criteria,” said Florida doctor Jason M. Goldman, who helped shape the guidelines. “I’ve seen it happen. I’ve seen hospital administrators (get it) who don’t necessarily have direct patient care.”

UChicago Medicine, whose vaccination plan was posted online Dec. 18, said the system followed public health guidelines by prioritizing front-line health workers for vaccination before proceeding to other groups who “are critical to supporting patient care and health care operations.” The system also noted in a statement that just 55% of its health care personnel have agreed to be vaccinated…

But — like most things in the pandemic — it’s largely been left to the states to hash out the details, creating different configurations in different places. Illinois’ plan, released this fall, left many late-stage decisions up in the air.

But on the question of vaccinating health care workers, the state’s plan offers specific guidance. Like the Chicago Department of Public Health, which is in charge of vaccine distribution in the city, the state adopted word for word the CDC committee’s definition of who qualifies for an early vaccination: “paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials.”

“The intent really was to address front-line workers … understanding who is exposed because they have to come into work to fulfill their job role,” said Dr. Grace Lee, a Stanford University pediatrics and infectious diseases professor who sits on the committee.

The state’s plan lists about 40 examples of workers who would qualify — from nurses and dentists to morticians and laundry employees in hospitals.

Not mentioned: off-site academic researchers.” (A)

“The nation’s system for distributing coronavirus vaccines lacks safeguards to ensure the next wave of doses reaches the most critical workers and at-risk patients rather than star athletes or the well-connected.

There’s little chance for anyone to jump the line right now while an extremely limited supply of the vaccine is being distributed only in hospitals and nursing homes. But as soon as more doses become available to wider categories of people, much of the immunization program will rely on the honor system, and states will leave it to pharmacies, community health centers and individual employers to verify if someone requesting a shot falls into a priority category.

“I haven’t seen anything that’s going to say, ‘We’re going to stop people from gaming the system,’” said Jen Kates, a senior vice president at the Kaiser Family Foundation, who said the state vaccination plans she’s reviewed have had no language on requiring patients to provide proof of residency, which would prevent people from hopping to another state with more available vaccine to try and get a shot.

The loose controls threaten to continue the pattern of inequities seen throughout the pandemic. In the spring and summer, many waited in line for hours to have their noses swabbed while professional athletes were getting tested multiple times a week and concierge medical practices were supplying tests to celebrities.

For now, vaccines are reserved for front-line health workers and senior citizens in nursing home residents and other communal settings. A panel of Centers for Disease Control advisers on Sunday will recommend the next tiers of recipients, which could include teachers, first responders and other essential workers outside of health care, as well as people with chronic health conditions and people over 65.

But the final decision on who to prioritize rests with states. Some, like Alabama, plan to give some large employers in essential sectors allotments of vaccines, trusting the company to vaccinate its more vulnerable public-facing workers before the CEO.

Hospitals, clinics and pharmacies will play major roles as well. And while they can check electronic health records for their existing patients, and must collect people’s contact information in order to follow up with them for the second dose of the vaccine, people’s medical history can’t always be verified at the point where the vaccination is given.

“If a person presents at one of our health departments and says they have diabetes, we won’t ask for a note from their doctor or a list of their medications,” said Dr. Karen Landers, a medical officer at the Alabama Department of Public Health. “They have a reason for being there, and it’s a matter of trying to get a vaccine out in the most efficient way possible.”…

Unlike coronavirus tests, which the wealthy could purchase direct from an array of companies, Covid vaccines are scarce and tightly controlled.

Hospitals are receiving shipments now and vaccinating their own staffs while the federal government has contracted with major pharmacy chains to send teams of workers into elder care facilities to administer the shots….

“This is a medical operation, not a political operation,” New York Gov. Andrew Cuomo said Wednesday. “If you remember with the Covid testing there was a lot of back and forth, who got it first, and was there favoritism, etcetera. Medical professionals are going to administer Phase 2 [of the vaccine] by state guidelines, but it’s going to be done by medical professionals.”

While rich and famous individuals may not have an obvious advantage, rich and powerful corporations certainly will. As officials continue to hammer out their vaccine distribution plans for essential workers, lobbyists from a swath of industries are pressuring federal and state entities to give groups from pesticide manufacturers to zookeepers priority.

“It’s ultimately about who and what as a society do we value,” said former CDC Director Tom Frieden. “The key is to be completely transparent about the decision-making progress, because you aren’t going to maintain the public’s trust if it looks like people are jumping the line. When you’re in a situation of shortage like we’re in right now, you want to make sure that you don’t create even the appearance of impropriety.”

Others worry that if states define “essential workers” too broadly, it could mean months of delays for other priority groups, such as people with diabetes and other comorbidities.

“You risk not getting to people with bad health outcomes for a very long time,” Toner warned. “A lot of people with high risk could die while we’re vaccinating people who are lower risk.” (B)

“With vaccinations against the coronavirus now underway, at least one prominent individual has said he won’t jump the queue to procure a dose for himself — the CEO of Pfizer, the giant pharmaceutical company that is helping to manufacture and distribute the Pfizer-BioNTech vaccine.

“None of the executives and board members will cut the line,'” Albert Bourla recently said on CNBC’s Squawk Box.

With a limited supply of doses, government officials around the world have prioritized who gets the vaccine first. That means front-line health-care workers, people living and working in long-term care facilities and the elderly are generally first in line….

In the United States, Dr. Eric Toner, a senior scientist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said he believes it would still be difficult for the wealthy to get priority access, considering the registration process of getting the vaccine.

“Nothing’s impossible, but it’ll be pretty tough to game that system,” he said. “I suppose one could, and there are ways you could cheat.

“But I don’t think there are a lot of ways for a wealthy person to cheat any more effectively than somebody who wasn’t wealthy.”

The issue of queue-jumping was raised just last week following a report that the National Hockey League was looking into the private purchase of the COVID-19 vaccine.

That professional athletes might be able to receive the vaccine ahead of others sparked a social media backlash and prompted a clarification from the league that it would only consider purchasing any excess doses…

Currently, the ability to jump to the front of the line may also be made more challenging by the requirements of storing the Pfizer-BioNTech  vaccine — it must be kept at temperatures between –80 C and –60 C.

“It’s possible that a wealthy organization like the Toronto Maple Leafs or the NHL could do a deal directly with Pfizer and procure the refrigeration units necessary to just store it,” said Dr. Joel Lexchin, an emergency physician and an associate professor of family and community medicine at the University of Toronto.

“For individuals, I don’t think that’s realistic.”

So far, however, Pfizer has been adamant that during the pandemic, it will not be making private sales.

“Our COVID-19 vaccine contract is only with the federal government, and we’ll be providing doses according to the designated vaccination locations,” Christina Antoniou, a spokesperson for Pfizer Canada, said in an email…

Following a report the NHL is interested in purchasing COVID-19 vaccinations for their players, Prime Minister Justin Trudeau told the media on Friday there is nothing any private company can do to “slow down the delivery of [free] vaccines to Canadians.”…

“At any time, if there’s a company willing to sell something and someone willing to buy it, that is a risk.”…Arthur Caplan, a professor of bioethics at New York University, said that certainly in the U.S., the potential that celebrities or persons of wealth might jump the queue to get a vaccine is “very real.”

“It’s definitely the case that there are clinics, hospitals, concierge practices, private companies that can throw money and try to divert some amount of supply either to an individual or to a group,” he said.

He acknowledged that with the supply currently controlled by government, it would make it more difficult to divert vaccines.

“But nonetheless, if you send your supply to Hospital X and CEO is there and somebody calls him up and says, ‘We need to get this,’ that’s where you might see some diversion.”

Caplan said he doesn’t believe queue-jumping would result in a major shift in resources, but even a small degree of diversion undermines trust and support for the rules.

However, Toner, of the Johns Hopkins Bloomberg School of Public Health, said what will likely be a bigger issue is the debate over who should be declared an essential worker in order to move ahead in line to get a shot.

“I’m already seeing lots of it here, that everybody, every group that has a national association, that national association is advocating for them to be a priority group.”

Naylor, of Canada’s immunity task force, suggested there could be some “gaming later on,” when the priority groups are larger and the delivery is highly decentralized.

“At that point, I doubt it will be only the wealthy and powerful.” (C)

“Hospitals and health care systems are taking unprecedented steps to safeguard the limited supplies of coronavirus vaccines amid concerns over security and the potential for black markets to emerge across the globe.

Operation Warp Speed, the government drive to develop and distribute the vaccines, requires medical facilities to develop a security plan. Every dose of vaccine shipped from manufacturing centers in Michigan and Belgium is tracked from the warehouse to hospitals where they are injected in staffers, medical officials said.

Extra security personnel and constantly running cameras watch over storage units, where the locks have been upgraded.

“We’ve known from the start that this was going to be a vaccine that’s going to be rationed, so we’ve been thinking all along about how to secure it in a couple of different ways,” said Melanie Swift, a physician leading the vaccine rollout at the Mayo Clinic. “That’s making sure none of it goes missing.”

Some doctors and medical officials said they were concerned about rumors of illicit markets for vaccines, in which wealthy individuals might be able to secure a dose for themselves before their turn in line. At least one hospital, Mount Sinai in New York, has hired an external auditor to oversee its vaccine distribution plan.

Law enforcement agencies have warned that criminal syndicates may target vaccine supply chains, either to steal doses or to run scams meant to steal money. Earlier this month, Interpol’s secretary general warned member nations to identify potential criminal activity around the vaccine…

Early on, scarcity helps. The front-line health care workers who are first in line for a vaccine are known to the hospitals that will distribute it,  and alerting them that they are eligible is as simple as sending an email. Some hospitals can simply scan badges of those workers in line for a vaccine and check their names off a list.

Those next in line to receive a vaccine are similarly likely to be easily identified: First responders like police, fire fighters and emergency medical technicians will have government-issued identifications, and those who live in long-term care facilities will be easy enough to identify.

But as the vaccine becomes more widely available, the prospects for line-jumping will become more prevalent. National vaccine registries exist, but they have never been tested under such immediate and critical conditions.

“We’ve had to build new systems in the midst of a pandemic,” said Rebecca Weintraub, a vaccine distribution expert in the division of Global Health Equity at Brigham and Women’s Hospital in Boston. “They have not been tested in the midst of a global pandemic.”” (D)

“Health care workers have been getting their COVID-19 vaccines for the past few weeks. However, we’ve learned people outside of that group have been able to cut in line and also get the vaccine.

KRQE News 13 learned health care workers shared their so-called “special event codes” with family and friends, who shared them with more people, allowing them to get the vaccine, no matter their age, occupation, or health. Wednesday afternoon, News 13 asked the NMDOH why they’re getting to jump the line.

“Yes, we are aware of surrounding reports of people jumping the line by sharing codes,” said Dr. Tracie Collins, Secretary-Designate of the NMDOH. “What we’ve done immediately is implement a technical fix to try and prevent this from happening.”

A viewer tipped News 13 off to the confirmation code “BYE2020” being used to make appointments for the COVID vaccine at EXPO New Mexico; News 13 confirmed it worked. We were shown the appointment confirmation by someone who used the code and was able to get an appointment for the vaccine this week.

The code was originally given out by hospital employees who started circulating the limited-supply code which allowed hundreds to get the vaccine who were not in the high-risk categories like the elderly and chronically ill — which were next in line to get the shot. Some locals we’ve spoken to say they’re not happy others are taking the vaccine before those who need it most.” (G)

“New York Gov. Andrew Cuomo said Monday he intends to make it a crime in the state to administer a COVID-19 vaccine to anyone trying to skip their place in line, or to sell them the vaccine.

He also said anyone who misrepresents who they are, or administers the drug to an ineligible person, should lose their license as well as face criminal charges, CNN reported.

“This vaccine can be like gold to some people,” Cuomo said. “And if there’s any fraud in the distribution — you’re letting people get ahead of other people, or friends, or family, or they’re selling the vaccine — you’ll lose your license. But I do believe it should be criminal and I’m going to propose a law to that effect.”

Last week, New York-based ParCare Community Health Network was accused by State Health Commissioner Howard Zucker of acting “contrary to the state’s plan to administer it first to frontline healthcare workers, as well as nursing home residents and staffers.”

ParCare said it followed state guidelines and will cooperate with a state investigation.” (E)

“The Medical Board of California has released guidance for licensed physicians on COVID-19 vaccine distribution, noting that they are subject to discipline if they don’t comply with the phase structure in federal and state guidelines… 

If licensed providers stray from the phases in their administration of vaccines, they face disciplinary actions, up to and including the revocation of their license and disenrollment from the COVID-19 Vaccination Program.

The guidance follows remarks from California Gov. Gavin Newsom, who on Dec. 28 warned of penalties that healthcare providers would face if they violate vaccine priority guidelines. Mr. Newsom said enforcement is needed at the state, county, local and clinic levels to ensure “someone’s not passing a few vials over to their cousin or aunt or uncle, or God forbid, making a buck or two on the backs of a vaccine that should be distributed to someone who is at high risk or at higher need.” (F)

“Concierge medical practices are fielding inquiries from their wealthy patients wondering when the COVID-19 vaccine will be available. Dr. Bill Lang of the WorldClinic was even fielding texts from patients on Thanksgiving day, according to the health publication Stat. The rules around who gets a vaccine when will shift from state to state, but the ethics and scrutiny around who will receive a vaccine first remain immutable. And they don’t require any late-night texts to answer….

There are already rumors of executives seeking special dispensation to have their workers newly designated “essential” in order to cut in line. Any new designations should be carefully examined, and governmental agencies should sequester their decision-making processes from undue political influence. The lives of those who have been risking theirs to care for our sick, work in our drive-thrus and stock our grocery stores and drugstore shelves should come first.   

The optics of jumping the COVID-19 vaccine line will be terrible and should be damaging. Anyone who has the means to finagle access to a vaccination before essential workers who have no option to work from home should think twice. Media and political scrutiny of those who leverage connections and money for early access will be intense. Conveniently timed claims of fresh diagnoses of chronic asthma or sudden onset diabetes in order to engineer admission to the “at risk” group will — and should — be met with deep suspicion…  

For those leaders who are healthy and still wealthy in the midst of the global health and economic meltdown, and whose employees have largely been able to work effectively from home, patience will be the name of the game and the path toward lasting trust with customers, global policymakers and the public. The ongoing inconvenience of remote work and more frequent testing — until those most at risk are protected first — could be preferable to the societal and media condemnation of those who don’t wait their turn.   

Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others. 

No one should want to be the metaphorical man in the fur coat elbowing his way through women and children to secure a seat in the lifeboat. Elites must think carefully about the collective social opprobrium bound to rain down before seeking a shortcut.” (H)

(A)Some early doses of COVID-19 vaccine meant for health care workers go to researchers working from home, By JOE MAHR, https://www.chicagotribune.com/coronavirus/ct-coronavirus-vaccine-health-worker-debate-20210106-etrwbtjbbvc2db3cocvm66xyua-story.html?int=lat_digitaladshouse_bx-modal_acquisition-subscriber_ngux_display-ad-interstitial_bx-bonus-stor

(B) Few guardrails to keep people from cutting in line for Covid shots, By ALICE MIRANDA OLLSTEIN and RACHEL ROUBEIN, https://www.politico.com/news/2020/12/18/cutting-in-line-covid-vaccine-448048

(C)Tight controls on COVID-19 vaccine may limit queue-jumping for the well connected, by Mark Gollom, https://www.cbc.ca/news/health/covid-19-vaccine-queue-jumping-1.5842061

(D) Hospitals boost security, seek to stop vaccine ‘line-jumping’, BY REID WILSON, https://thehill.com/policy/healthcare/530658-hospitals-boost-security-seek-to-stop-vaccine-line-jumping

(E) Gov. Cuomo: Make It Criminal to Sell, Administer Vaccine to Line Jumpers, https://www.usatoday.com/story/opinion/2020/12/20/covid-vaccine-name-shame-elites-who-jump-the-line-column/3920917001/

(F) California outlines penalties for providers giving COVID-19 vaccines out of order, by Molly Gamble, https://www.beckershospitalreview.com/hospital-physician-relationships/california-outlines-penalties-for-providers-giving-covid-19-vaccines-out-of-order.html

(G) “Line jumpers” reportedly used shared code to get New Mexico COVID vaccine early, by: Jami Seymore, Jackie Kent, https://www.krqe.com/health/coronavirus-new-mexico/reported-special-event-codes-allowed-people-to-access-covid-vaccine-early-in-new-mexico/

(H) Don’t cut in line for the COVID vaccine. Elites who do will be named and shamed., by Juleanna Glover, https://www.usatoday.com/story/opinion/2020/12/20/covid-vaccine-name-shame-elites-who-jump-the-line-column/3920917001/

(I) At Elite Medical Centers, Even Workers Who Don’t Qualify Are Vaccinated, By Apoorva Mandavilli, https://www.nytimes.com/2021/01/10/health/coronavirus-hospitals-vaccinations.html?referringSource=articleShare

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