A young man in his 20s who works with computers. A young researcher who studies cancer. Technicians in basic research laboratories.
These are some of the thousands of people who have been immunized against coronavirus in hospitals affiliated with Columbia University, New York University, Harvard and Vanderbilt, even as millions of frontline workers and older Americans await their turn.
The Centers for Disease Control and Prevention issued recommendations aimed at ensuring that vaccines in the country reach the most at-risk people first: health professionals who interact with Covid-19 patients and residents and staff members in nursing homes, followed by 75 years old and older workers and certain essential workers.
Each state has established its own version of the guidelines, but with implementation at a glacial pace, the pressure has grown for a more flexible approach. Officials at the CDC and the Food and Drug Administration recently suggested that it may be wiser to simply loosen the criteria and distribute the vaccine as widely as possible.
Still, these officials did not anticipate that vaccines would be administered to healthy people in their 20s or 30s before older people, essential workers or others at high risk. States should still prioritize groups that “make sense,” Dr. Stephen Hahn, the FDA’s commissioner, told reporters on Friday.
But a handful of the country’s most prestigious academic hospitals have taken the idea much further. Workers who have nothing to do with patient care and who are not 75 years or older received the vaccines. Some of the institutions were the first to receive limited supplies from the United States.
“Clientelism and connections have no place in the launch of this vaccine,” said Ruth Faden, a bioethicist at Johns Hopkins University in Baltimore. “If we don’t do it right, the consequences can be quite catastrophic, so it’s really critical that people are hypersensitive to the rules of the game here.”
The CDC never intended to include workers who do not interact with patients, such as administrators and graduate students, in the first layer of priority vaccinations, said Dr. Stanley Perlman, an immunologist at the University of Iowa and a member of the committee that issued recommendations.
“It all got so messed up,” he said. “In retrospect, I think it was probably necessary to be a little more accurate about what we were thinking, because we never thought about hospital administrators.”
In Nashville, Vanderbilt University Medical Center asked all staff members, whether they were treating patients or not, to register for vaccination. The inoculations started in December, when the Tennessee Hospital Association sanctioned vaccination for all hospital employees, regardless of their duties.
On January 6, the medical center announced plans to start vaccinating its high-risk patients, but only after “administering the initial dose of the vaccine to well over 15,000 people working at the medical center,” according to one and email sent to your patients.
“We continue to follow the guidance we received from the Tennessee Department of Health as we vaccinate the Vanderbilt Health workforce and other priority groups of patients, employees and community health personnel,” John Howser, medical center communications director, said in a statement.
But the Tennessee Department of Health sees it differently. “Hospitals have been encouraged since the beginning of the integration process to use any remaining vaccine to vaccinate high priority populations,” said Bill Christian, a department spokesman.
“Some hospitals interpret their ‘team’ in a broad way,” he added.
The Tennessee department, he said, “continues to applaud hospitals that have prioritized only their high-risk vaccination frontline staff and made any remaining vaccinations available to meet the community’s vaccination needs” from high-priority groups.
“I wish our elderly relatives had received the vaccine before me,” said a young Vanderbilt employee who has no contact with patients and asked not to be identified for fear of reprisals.
In Boston, Brigham and Women’s Hospital and Massachusetts General Hospital, both affiliated with Harvard University, immunized more than 34,000 employees, including those involved in treating patients, researchers who can come in contact with coronavirus samples and those involved in clinical trials , according to Rich Copp, a spokesman for the hospitals.
The reason? Some laboratory scientists may be needed in hospitals as the coronavirus resurfaces. “Our first wave experience has shown that some members of the research community may need to be relocated to support work in patient care settings with Covid,” said Mr. Copp.
Still, medical centers have announced plans to immunize the rest of their staff starting on Monday.
In New York state, only a fraction of the estimated 2.1 million frontline workers have been immunized. Governor Andrew Cuomo has threatened to charge fines of up to $ 100,000 against hospitals that do not vaccinate quickly enough to use their doses.
At Columbia University, the news spread quickly through research labs far from patient care: if you showed up at Milstein Hospital, the university’s main medical center, you could get vaccinated – no matter if your work had anything to do with patients.
Graduate students, postdocs and researchers soon lined up in the hospital auditorium, according to several university officials. Almost everyone at a cancer research center affiliated with the hospital received the vaccine.
Hospital officials said they eventually heard of emails directing people to the auditorium, but that anyone who didn’t need the vaccine was rejected.
“We have worked to vaccinate tens of thousands of employees to date, starting with the team that treats patients, and we are constantly striving to improve our vaccination process,” said Kate Spaziani, vice president of communications for the hospital.
She added: “We will continue to do this until everyone gets the vaccine. We are following all New York State Department of Health guidelines on vaccine priority. ”
But some recipients were upset to learn that they did not qualify under state guidelines.
“My understanding now is that it was not our turn, and I feel terrible for being out of time,” said a young researcher whose work is unrelated to Covid-19. “I’m also frankly a little mad at the hospital and the university for not managing it properly.”
At NYU’s Langone Medical Center, disclosure to team members who have no contact with patients was more deliberate.
“We are currently offering the Covid-19 vaccine only to frontline employees,” says the center’s website. “We will send a message to our patients as soon as we have the vaccine available to patients.”
But in an email to staff members on December 28, Andrew Rubin, senior vice president of the medical center, said the center had finished vaccinating its 15,000 employees who interact with patients and would start vaccinating all other members team’s. There was no mention of older adults or other priority groups specified by the state of New York.
An email on Tuesday to NYU medical center staff members who have not yet applied for vaccination said: “As an employee of a health care institution, you have the opportunity to receive a vaccine that millions across the country wish – and you can receive, right now. “
In a tacit admission that these employees would not otherwise qualify for the vaccine anytime soon, the email warned that, once the state expanded the eligibility criteria, “you may have to wait weeks, if not months, to receive it based on demand and availability. “
State officials were dismayed that NYU and Columbia opened vaccination for low-risk employees, ahead of millions of state residents who needed the vaccines.
On Friday, New York expanded its vaccination guidance to include essential workers and people over 75.
Still, the guidance “does not offer carte blanche to vaccinate all employees at a hospital, regardless of their role,” said Gary Holmes, a spokesman for the state Department of Health. “Although we don’t know all the facts here, if there is a breach, DOH will investigate.”
In particular, some state officials were furious. Instead, the institutions should have asked the state what to do next once they have finished immunizing frontline officials, said an official, speaking on condition of anonymity because he was not authorized to discuss the matter.
“The only reason they have as much vaccine as they do is because they were the guardians of the vaccine – because they have refrigerated storage,” said the official. “It wasn’t NYU vaccine to use at NYU”
The problem is not limited to academic medical centers. Some hospitals have so few controls in place that many people have managed to bypass the line with false vaccine claims.
In Maricopa County, Arizona, for example, an online form recommends that applicants use a personal email address instead of a hospital affiliate and does not require employee identification numbers.
“Yes, we want people vaccinated, but we have to ensure that high-risk groups have access,” said Saskia Popescu, a hospital epidemiologist at the University of Arizona. Having the process so disorganized “undermines confidence in the public health process and I think it is really painful”.
Several university officials, including some who unknowingly accepted the vaccine offline, were also baffled by what they saw as an unfair and unfair process.
“It’s such a bare display of privileges, you know?” said a Columbia faculty member who did not get the vaccine and asked not to be identified for fear of retaliation by administrators. “It is because we are in elite universities and medical centers.”