On Monday, California began a new phase of the launch of the COVID-19 vaccine, making almost half of all residents eligible for an injection – and relying more than ever on the public’s trust and honesty to ensure that the doses reach those who need it most.
The changes add more than 4 million people to the eligibility list, mainly those aged 16 and over who have underlying disabilities and health problems.
Previous eligibility layers focused on certain jobs and age groups – factors that are easily verifiable to determine whether those who seek the vaccine are entitled to it under state guidelines.
But there will be a much more flexible verification system for this new group due to privacy and access issues. And despite the eligibility lists provided by the state, there is still confusion about which health conditions are covered, so the true size of the new group is unclear.
Ambiguities raise new ethical and logistical challenges.
“I think we saw during the launch that there is a great need to vaccinate people,” said Dr. Kirsten Bibbins-Domingo, head of the department of epidemiology and biostatistics at the UC San Francisco School of Medicine. “What I hope is that we trust our Californian colleagues to rely primarily on the honor system.”
There is certainly potential for fraud, as people are being asked to attest to their eligibility. Cutting lines has been a major problem in California, especially in cases where access codes for members of underrepresented communities have fallen into the hands of wealthier residents.
But advocates, health experts and public health officials are optimistic that most residents will not take advantage of a system that depends on trust, although they admit that it would not be difficult to do so.
A more immediate concern is that the supply of the vaccine is still limited. This puts this new group in direct competition for nominations with previously qualified groups, including residents aged 65 and over, health professionals and a variety of essential professionals.
As more people compete for the vaccine, advocates have advocated a system that would not create unnecessary barriers to obtaining vaccines, following situations where people have forged documents and abused access codes intended for high-risk communities. Public health officials begged people not to take advantage of negligent regulations.
Dr. Aaron Kheriaty, director of the UC Irvine medical ethics program and a member of the vaccine task force in Orange County, said implementing more stringent requirements, such as medical certificates, would overburden doctors’ offices and, more significantly, leave large numbers of people outside in the cold.
“The challenge is that if we make the verification criteria too strict, they will become too costly and complicated to actually implement them on the spot, and people will be really stuck in all kinds of bureaucracy,” he said.
For example, a person with a cell phone and a medical concierge service can easily obtain a medical certificate within a day, while an uninsured or underinsured person, or does not have a regular health care provider, may be left without documentation. needed.
Tory Cross, a 27-year-old with severe asthma and Ehlers-Danlos syndrome, said the lack of verification requirements is indeed crucial to California’s commitment to vaccine equality.
“It is very important that people can self-certify,” she said, noting that many lost health care during the pandemic and may not have easy access to a doctor. “In addition, I know so many people with disabilities who have disabilities that are invisible [like asthma] we were really concerned that we would have to argue with vaccine providers to make them believe that we are at high risk ”.
When Cross secured an appointment at Safeway, she “cried like a baby” in relief, she said on Monday.
Others were not so lucky. Some people, including asthmatics, have already expressed confusion on social media about whether they qualify for vaccination according to the most recent expansion. Some complained that consultations were already scheduled when they tried to get a place and wished the state had opened the process earlier.
Under current guidelines, Californians do not need to disclose their condition, only that they are eligible – a decision that experts have attributed to health privacy laws, noting that not everyone involved in vaccine administration, including volunteers at county, are bound by doctor-patient confidentiality.
In Los Angeles County, public health officials estimate that 1.5 million to 2 million residents qualify under the new eligibility list and have reserved about 19% of the 181,560 first doses of vaccine this week for those with underlying diseases.
“We don’t have a definitive number … of how many people are eligible under the current new eligibility guidelines that were issued by the state,” said LA County Director of Public Health, Barbara Ferrer, on Monday. “The biggest unknown is how many people have a disability, or a condition that puts them at serious risk, that was not on the list.”
The state offers a list of 10 general conditions that qualify one for vaccination, but it also includes a nonspecific category of “individuals likely to develop serious life-threatening illness due to COVID”, which is intended to allow healthcare providers use their clinical judgment.
Some people may suffer from illnesses that they consider to be high risk; others have rare conditions for which little or no state data exist. Ferrer said people who are unsure about their eligibility should check with their doctor or provider.
In the guidance released on Thursday, the state offered examples of who might qualify for the vaccine in categories not clearly listed, including those who receive services at home or receive care from an independent living center.
“California has moved from being a middle ground in terms of priority vaccine eligibility to being the best in the country,” said Andy Imparato, executive director of Disability Rights California and a member of the COVID-19 health equality task force. president Biden.
Other states have also implemented an honor system by not requiring extensive verification. The belief is that removing obstacles to obtaining the vaccine will benefit those most at risk and will help ensure equity.
“Some may argue, ‘[California] opened the floodgates, aren’t you worried? My answer is unequivocally no. I think anything the state has done to try no opening the floodgates would have created barriers, ”said Imparato.
Some jurisdictions may implement a more stringent verification process in addition to state guidance. But for now, experts are optimistic that the implementation will not be hindered by fraudulent behavior.
“I think most of society in a situation like this is interested in fair play,” said Dr. Jeffrey Luther, a member of the state’s vaccine advisory committee and board member of the California Academy of Family Physicians. “You start to think that there is a crazy race for vaccines and nobody is to be trusted – I don’t think that’s true.”
Luther had already answered questions from patients about when they would qualify and how they could get an injection. Over the weekend, he said, questions were asked by people asking whether their condition meets eligibility requirements.
While vaccinations are increasing, the state still has a long way to go. With the reopening of businesses and schools, many Californians are still waiting for their turn to be vaccinated. And all the time, coronavirus variants have increased.
But the latest expansion of the vaccine is a notable sign of progress, said Bibbins-Domingo. “I think things are going in the right direction,” she said.
Although the system allows for some scams, many accept this if it means that more high-risk people can get the doses.
“I prefer to know that someone lied to be vaccinated than to know that they are not being vaccinated,” said Emma Alvarez-Gibson, 45, who is diabetic and has been quarantined for a year. “The goal is for everyone to be vaccinated.”
Experts have said that to a certain extent whether fraud is inevitable when you are dealing with a state of nearly 40 million people.
“Public policy cannot force people to be good,” said Kheriaty, noting that the system can only “nudge or dissuade” people from making the wrong choices.
“For society to function, especially in circumstances like this,” he added, “you have to try to trust that most people, most of the time, will behave reliably and correctly.”