Few guardrails to keep people from cutting in line for Covid shots


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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.

“They’re all bought, paid for, and distributed by the federal government,” said Eric Toner, a senior scientist at Johns Hopkins’ Center for Health Security. “Not only do they want to make sure it’s not wasted or diverted, they need to know exactly who got the first dose so they can follow up with them for the second dose, which requires collecting their identity and contact information.”

The question is what could happen in the coming months, amid uncontrolled spread of the virus. When an FDA expert panel voted Thursday to recommend the agency back a second Covid vaccine from Moderna, one NIH scientist abstained from the vote, saying he wanted federal guidelines to ensure it was “more targeted to people at high risk of more threatening illness and disease.” He also added he was “very uncomfortable” with a blanket authorization that allows states to decide who should get the shots in what order.

Operation Warp Speed, the federal government’s vaccine accelerator, didn’t respond by deadline to questions about whether any measures have been put in place to prevent line-jumping or if the issue has been discussed with states, The CDC did not respond to a request for comment.

Despite the lack of clear federal or state guardrails, there are some mechanisms in place to prevent people from claiming a medical condition they do not have in order to move up in the line.

Community health centers that serve nearly 30 million of the nation’s most vulnerable patients say they plan to use their electronic health record to run reports of which of their existing patients meet certain metrics, like whether they have chronic conditions or are older.

“I think we’ve come from the standpoint that we’re trusting our patients, that the ones that need it, we will know who they are,” said Ron Yee, the chief medical officer for the National Association of Community Health Centers. But he acknowledged it will be more difficult to verify that new patients meet the criteria.

Andie Pivarunas, the director of public affairs at the National Community Pharmacists Association said that her members will be relying on “health records and prescription history” whenever possible when determining who qualifies for early vaccine access, and their “professional judgement” when those records aren’t available.

Officials in many states argue that while this system won’t be perfect, delegating these difficult decisions to health care providers beats any alternative.

“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.”

Brianna Ehley contributed to this report.

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