Tuesday, January 5, 2021

Damned If You Vaccine, Damned If You Don’t

Dr. SJ and I aren’t kids anymore. She’s a health care provider. We’ve waited patiently to learn when and where we should get our vaccines. The silence has been disappointing, if not deafening. Nobody seems to know, and our primary care docs are getting annoyed with people asking because they have no answers.

It’s easy to blame Trump, because that’s both the cool thing to do and everybody does it, but when it comes to the actual distribution of vaccines, it’s local politics. The states get their vaccine and then are left to move it from vial to arm. This raised the usual problem, Governor Andy caught between getting on TV to spew empty platitudes for his next book about what a great job he did to knee-jerk punitive fixes to the ordinary combination of people being people and people still being people.

New York Gov. Andrew Cuomo has given hospitals a conundrum. Fail to use all of your COVID-19 vaccines within seven days of receipt? That’ll be a $100,000 fine. Vaccinate someone out of the state-designated order? That’ll be a $1 million fine.

Damned if you let your vaccines expire, damned if you don’t let your vaccines expire—by using them on anyone outside of the approved hierarchy.

The hierarchy, or as it’s officially called, the distribution plan, is a product of politically correct fear.

The state’s distribution plan mandated that a slew of people receive the vaccine before the elderly, including health care workers, patient-facing employees at long-term care facilities, first responders, teachers, public health workers, grocery store workers, pharmacists, transit employees, those who uphold “critical infrastructure,” and individuals with significant co-morbidities. Such a plan is common across the U.S., and it requires a robust logistical framework to execute properly.

Which group are you in*? When is it your turn? Do you show up (and if so, where and when) or await notification? The plan isn’t really a plan at all, as much as a lot of words that provide the most vague and generic descriptions of “priorities” and not much else, Some want to cut into line. Some want to wait their turn.

The former gave rise to the $1 Million fine because they used their “privilege” to violate the state-mandated equity. The latter left vaccines expiring in the freezer because nobody told them to come get their shot, a mere $100,000 fine plus loss of future vaccines, which will certainly save those who will need to be vaccined but won’t get it because their provider is now on the naughty list.

In New York, most individuals over 65 were not eligible to receive the vaccine until recently—when the state graduated to Phase Three of its plan—which partially explains the sluggish rollout. That prioritization, or lack thereof, inspired backlash from politicians and armchair pundits alike, many of whom argued that the elderly should have been first in line to receive the vaccine.

Talk is cheap. And yet, there is almost no talk about coming in next Tuesday to get the vaccine. The argument about who should be prioritized is one thing. The lack of any discussion about why no one is being told that it’s their turn, come on down, is another. It makes little difference if your third or fifth in line if no one tells you when to show up for your shot. We’re just sitting here, waiting, to hear something, anything, about when our turn rolls around, and what we hear is that if we appear too soon, there’s a million dollar fine, and if we don’t appear, there’s a hundred thousand dollar fine as the vaccine expires.

Of the nearly 900,000 vaccinations sent to New York, only about 275,000 first doses have been administered. That’s 30 percent. Some states lag even farther behind: North Carolina clocks in at around 26 percent, California at 24 percent, Florida at 23 percent. Kansas is at 15 percent.

But New York leads the way in filling the process with fear and red tape. In Washington, D.C., by contrast, the Department of Health is reportedly encouraging health care providers to administer surplus vaccines nearing expiration to any willing recipient.

Instead of putting his bureaucracy into motion to get information out, to let people know when to get on line, get the shot, and get on with it. It’s not that communication isn’t possible, as Governor Andy has made sure that everybody knows how has unilaterally come up with fines to make it financially dangerous to show up out of turn or let expiring vaccines expire. So what about letting people know when and how they should get those glorious vaccine shots?

In MacMillan’s case, he lucked out when two people didn’t show up for their scheduled appointments—something that is bound to happen and is out of health care workers’ control. The pharmacist “turned to us and was like, ‘Hey, I’ve got two doses of the vaccine and I’m going to have to throw them away if I don’t give them to somebody,” MacMillan said on TikTok. “‘We close in 10 minutes. Do you want the Moderna vaccine?'” In D.C., that’s one more person who’s been vaccinated against COVID-19 and one tiny step closer to herd immunity.

Had that happened in New York, the pharmacist might be out of a job.

Damn that Trump.

*To be clear, Dr. SJ should be in the Priority One group. Is she? Nobody knows, and nobody will tell her if she can get her shot.

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