On October 28, 2021, Emory's Center for the Study of Human Health hosted their very…
By: Zainab Molumo
In the weeks leading up to his inauguration, then President-elect Biden announced what at the time seemed like an ambitious goal: to deliver 100 million vaccines during his first 100 days in office. Having since reached that goal at day 58 in office, however, the Biden administration has surpassed yet another benchmark of over 200 million doses delivered by April’s end. Despite ongoing progress, concerns about vaccine rollout rates, distribution methods, and access persist. Efforts to mass vaccinate in past months, while well articulated at the national level, have looked vastly different across various state and even regional lines. The suspense of waiting and the unremitting fear of becoming infected, or worse, has motivated some in slower-moving areas to travel beyond their district and even state boundaries in search of elusive doses, earning them the distinction of “vaccine hunters.” With this novel practice has emerged a new surge of debate, primarily concerning the ethics of inter-district and state vaccine-seeking, but also about the issues of access and methodology that remain prominent in the face of this crisis.
U.S. Vaccine Distribution
Operation Warp Speed (OWS)—the catchy, cryptic-sounding name given to the nation’s COVID-19 vaccine strategy. As the title implies, swift vaccine uptake was a foremost priority for the plan’s developers, inspiring a four-step distribution model: authorization, prioritization, allocation, and distribution. Actors at the federal level—namely the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC) and U.S. Department of Health and Human Services (HHS)—issued vaccine authorizations and recommendations for vaccine priority criteria, which would be instituted in phases. Authorities at the state and territorial levels were then left to determine their own eligibility criteria, either adopting federal recommendations or formulating their own, and communicate supply needs according to the size of target populations. A seemingly streamlined and straightforward approach, the plan quickly hit logistical hurdles within just weeks of launching.
Initially, strict state guidelines about adherence to eligibility criteria and confusion about storage regulations prompted distribution sites to exercise extra caution when giving out doses. Many only accepted patients by appointment, turning away eligible individuals (or enrolling them on waitlists) despite a reserve of quickly expiring vaccines. As a result, a surplus of unused vials made their way into waste bins instead of arms. Existing supply shortages were exacerbated by wastage, which in turn created a scarcity of appointments as well and further panic. In many states, even those eligible for vaccines during the initial phases found it difficult to secure appointments. Website crashes and vaccination sites underbooking also contributed to the appointment conundrum.
Some states also got a slow start to vaccine distribution, perhaps understandably. In many places, rollout rates were informed by vaccination tracking records, but inefficient tracking meant misrepresentation of supply needs. Georgia is one of the states spotlighted for slow vaccine output. State officials, including Governor Brian Kemp, blamed inaccurate tracking for the slow output of vaccines, yet, reports in recent months talk of “hundreds of thousands of doses” sitting in freezers at Georgia sites. States receive supplies on a weekly basis, as opposed to an as-needed basis, suggesting that unmet demand is likely internal. Frustration with state distribution systems has pushed some to outsource for vaccines, but whether “outsourcing” is justifiable remains a subject of dispute.
Jumping the Line
An air of condemnation and dissent enshrouds the label ‘vaccine hunter,’ the choice of the descriptor ‘hunt’ connoting a predacious and self-serving quality about those who bear the title. Consequently, purported vaccine hunters have been targets of visible public criticism, many being accused of abusing their privilege to jump ahead in line and ‘steal’ doses from the less empowered. There would seem to be more to the story, however.
People “hunt,” or rather seek, for different reasons. Some in search of doses for eligible and high-risk family and community members. During Phase 1, when many states were prioritizing older age groups, eligible individuals experienced difficulty securing appointments, and tracking new openings. For many in this group, younger family members, friends or caregivers often stepped in to help. One Pennsylvania resident, Leslie Price, recalls a two-week (and time and energy-intensive) appointment search for her 67 and 69-year-old parents, a process she knew they would have had difficulty undertaking on their own.
Others, pursue doses for themselves to safeguard the health of loved ones. In the time before Georgia had expanded its vaccine eligibility to post-secondary educators, several Emory professors traveled to neighboring states for their first doses, in many cases hoping to protect their children and other family members ineligible for the vaccine. Dr. Devon Goss, an assistant professor of Sociology at Oxford College, realized she was expecting when she made the decision to travel to Alabama for her doses. She notes that “[the] timeline was compressed regarding the potential to pass antibodies onto my baby,” creating a heightened sense of urgency for her. Similarly, having an immunocompromised family member, Dr. Jennifer Sarrett, a Lecturer in Human Health at Emory College, booked an appointment for her first dose in Alabama after learning about availabilities from other Emory professors. She was, however, able to get her second dose in state.
In both cases, the sites had several unbooked appointments, many of which were going to out-of-state residents anyway. Also, in both (and many) cases, decisions to travel out-of-district or even state were often informed by some familial or even communal consideration. In fact, dedicated circles of vaccine finders now exist across social media platforms and discussion-based forums, many with the goal of connecting high-risk friends and even strangers with appointments. Even a few websites like “Dr. B,” a New York based site designed to help residents secure unclaimed doses, have emerged in recent months. More and more, networks of residential and cross-country community members are coalescing to help curb the waste that marked the early days of rollout.
This isn’t to say that there aren’t individuals who leverage their privilege to acquire doses. According to Washington state officials, vaccination sites in underserved communities saw an influx of residents from wealthier neighborhoods during its Phase 1 rollout, doses that could have gone to more at-risk individuals but that were simply more accessible to those with access to reliable internet, transportation, and more flexible work schedules.
There really is no definitive conclusion to be drawn where an easily polarizing ethical debate such as this one is concerned. Even, Price, the hunter from Pennsylvania, concedes that, “Being a vaccine hunter means possessing an unfair advantage in a very unfair system.” Perhaps it is easier to argue that the perceived need to hunt at all tells of larger structural inequities and systemic inefficiencies, in which case, efforts to reform the system may prove more productive than attempting to assign individual blame.
It goes without saying—particularly with what is now known about disparities in both COVID-19 disease and vaccine uptake—that there are several improvements that could (and should) be made to Operation Warp Speed, especially if we are to mitigate the need to vaccine-seek. According to Dr. Shivani Patel, a social epidemiologist and global health expert at Emory, addressing barriers to access is a key step towards reform. Referring to measures already being taken to boost access, and possibly curb hunting, Patel says, “…there is a lot of hope and interest in using data to guide where we might do things like vaccination camps and mobile sites.”
Concerning the ethics of vaccine hunting, “it’s really an ethically complex question,” says Dr. Patel. “For a lot of the people who are crossing lines [to become vaccinated], I think it’s a variety of things going on. For some, it’s for their own peace of mind, [but] I think that the people who are going to great lengths to make sure that the vaccines don’t get wasted are heroes.”
Vaccine hunting might always remain an issue of contention, and those who engage in it, regardless of motivation, will likely always be criticized for it. Still, I will contend that the debate which surrounds this issue has inspired some good, arguably by pushing us to question inequities in existing health structures and trends, something that will hopefully produce more equity as we push through this crisis.