In the late afternoon on a Wednesday in February, a middle-aged woman wearing a ruffled business top pulled up in her car to the vaccine pre-registration checkpoint at a Los Angeles County mass vaccination site. An older man sat in the passenger seat.
“I’m here to get a second vaccine shot for my father,” she said.
“Great! Does he have his ID and vaccine card? Can I see it? Great. Please have it ready to show the nurse at the checkpoint! Have a nice day!” I said, bending down to talk to her through her window.
I expected the woman to drive ahead, just as most cars had. I was a civilian volunteer at the Six Flags Magic Mountain site that day, and my job was to make sure people had everything they needed before they went to the next step in the process. That way, busy nurses wouldn’t have to wait for people to rummage through their belongings before they could assess their eligibility and keep the vaccination line moving.
But she hesitated. Her mother had an appointment to get her second dose today, too, but she wasn’t able to make it. Would it be possible, the woman wanted to know, to take her mother’s slot?
“I’m an essential worker,” she said. “I work at a bank. I talk to people every day. I have to go to work. Please.”
I advised her to ask the nurse, but it wasn’t likely. The site was only doing second shots that day. The woman deflated as I delivered the news, then drove on with her father. She remained in my mind as, just a couple hours later, I stood in line with a few dozen volunteers — most of whom were white and apparently, based on their clothing and overheard conversations, privileged, just like me — to receive my first dose of the Pfizer vaccine.
In February I donned an orange vest and volunteered at the Los Angeles County mass vaccination site at Six Flags Magic Mountain.
Image: Mario Tama/Getty Images
Although vaccine eligibility remains restricted across the U.S., multiple reports have shown that people outside the proposed tiers have been receiving their shots. People who don’t necessarily qualify for the vaccine based on their age, line of work, or medical conditions have managed to get shots by traveling to places with more relaxed restrictions or jumping at the chance when news of extra doses reach them.
Privilege plays a role even in the less obvious instances when people get a vaccine because of extra doses, or get it through volunteering like I did. Often the people with the connections and resources to hear about vaccine opportunities are the people who are technically literate, or have the means and flexibility to take work off to get a vaccine at a moment’s notice, or both.
A much-criticized program in Massachusetts allowed people who drove the elderly to their vaccine appointments to get the shot. (Had the woman I spoke to been in Massachusetts, not Los Angeles, she would be vaccinated.) Some then paid large sums of money to elderly people for the chance to give them a ride.
There are other above-board civilian volunteer programs in multiple states and counties that may open the door to a vaccine, too. Some explicitly state that volunteers get the shot, some require people to commit to volunteering a certain amount of hours, and some are murky. Recently, California launched a website called MyTurnVolunteer where citizens can sign up for volunteer shifts at sites based on their zip code. If a volunteer works a four-hour shift, the state told SFGate they will receive a vaccine, because you’d be “classified as a community health worker from the California essential workforce list.”
Together, these ways to get a vaccine early — whether through volunteering, intentional manipulation, or happenstance — have led to both public and personal hand-wringing. People who receive extra doses have been told to wait your turn, but if you’re offered a vaccine, take one. At the same time, articles about vaccine tourism and line cutters — some more ridiculous than others — go viral and stoke outrage, because they are such stark examples of the privileged flexing their power, potentially at the mortal expense of others.
On an anecdotal level, since I shared that I received my vaccine, multiple people who are also healthy, 30-something professionals not in the medical field told me “Oh yeah, I’ve been vaccinated too.” But they’ve kept it quiet, out of fear of judgment, and their own guilt.
I understood. Volunteering itself had been extremely rewarding, and I hoped that I had made the job of the nurse I was paired with a little easier. But as I waited in line for my shot and in the immediate days following my vaccination, I felt undeserving, a Mr. Burns-ian shade of manipulative. I felt as if I had disguised a ploy to leapfrog over other people waiting for the vaccine with fake altruism. As I stood in line for my vaccine, some Lululemon-clad women who also volunteered that day joked about how easy it had been to get the vaccine. I judged them, but, in fact, I had worked the system just as they had. I felt dirty. I was so wrecked about it that I decided to write this very article, which would allow me to talk through my issues and guilt with leading medical ethicists — a hilariously over-the-top way to intellectually process my own tsouris.
Just as COVID exposed multiple facets of inequality in America by disproportionately affecting people of color, so too has the vaccine rollout: White people are getting vaccinated at far higher rates than people of color.
Just as COVID exposed multiple facets of inequality in America by disproportionately affecting people of color, so too has the vaccine rollout: White people are getting vaccinated at far higher rates than people of color. So while individuals and tweeters might roil at their personal guilt and/or criticize others, medical experts are not surprised by the phenomenon of people getting vaccines early due to privilege.
“What’s very interesting about Americans, is that they have this myth that everybody in healthcare is treated equally when it comes to life and death,” Dr. Arthur Caplan, a leading vaccine ethics expert who is the founder of the Division of Medical Ethics at NYU, said. “This keeps showing us that they don’t. Money matters. Celebrity matters. Connections matter. Whether you have a car matters. Whether you know somebody matters. Whether you get on the internet matters. And so deep divisions in our society that we don’t like to acknowledge are revealed.”
It’s a problem public health departments and individuals are working to address. California has reserved 40 percent of upcoming vaccine doses for underserved populations. Black doctors and other public figures are doing what Harvard public health Ph.D. student Keona Wynne described as the “heroic” work of sharing their personal vaccination experiences on social media to alleviate the fears of others. Community outreach groups are also working to close the vaccine gap.
Today I vaccinated my mom as part of the @pennmedicine community vaccination initiative.
Alongside some of my favorite colleagues, we vaccinated the black & brown community of Philadelphia.
It was amazing. All of the “God Bless You”, “you so fine” & “go girl, you a doctor!”❤️ pic.twitter.com/IFm4ueVxOV
— Florencia Greer Polite, MD (@FlorenciaPolite) March 6, 2021
For people who get vaccinated early, guilt comes from witnessing those “deep divisions” — and recognizing the way we benefit from this system, in some cases, eagerly. More people may come face to face with vaccine privilege soon, as eligibility broadens, and people with the technical know-how and work flexibility to sign up immediately get to go first. Or as requirements differ from state to state, where, seemingly arbitrarily, two people with the same medical condition are not both able to get the vaccine.
However, there is a gulf between personal experiences and public outrage, and the actual priorities of experts, who take a bird’s eye view to mass vaccination campaigns.
“If we were sorting out vaccine opportunities at a fine grain level, you would probably not be selected,” Dan Wikler, a medical ethicist and vaccine ethics specialist at Harvard’s School of Public Health, said. “But we’re not, and we shouldn’t. You can’t do it. The idea is just get people in there and jab them like crazy. Try to get as many Americans, everyone, as fast as we can. It’s the one ray of hope, it’s our best shot.”
Wikler explained that trying to make vaccine distribution equitable on an individual level is just not a productive use of a public health department’s time. He supports the government’s approach of making broad, categorical distinctions based on risk. And certainly, outreach to underserved communities of color needs to be a priority. However, anything more granular would do more harm than good, Wikler said, so the ethical question of volunteers or other people who receive early vaccinations is just not one to stress out about.
Me and the nurse I was paired with, Cecilia. Without volunteering, we probably would never have gotten to know each other otherwise. I’ll always be grateful for the opportunity to meet the people actually making mass vaccination happen.
Image: rachel kraus / mashable
That doesn’t mean individuals should ignore their discomfort. Caplan points to another problem with line cutters: That it reduces public faith in the vaccine effort as a whole.
“Most of what we’re talking about is marginal, but what happens on the margins directly impacts willingness to support what’s happening in the mainstream,” Caplan said.
Caplan views these “marginal” loopholes as the result of a public health system that has “no policies or guidance about what to do with leftovers, or surplus.” It’s up to counties, cities, even individual clinics, to figure out what to do when a freezer breaks or people don’t show up for appointments. That can undermine faith that a system works for everyone, which could add another layer of mistrust for communities that are already justifiably skeptical of public health campaigns.
“Is that a systemic or an ethical approach to what to do?” Caplan said. “No, it’s just make do.”
Perhaps, this is where people experiencing “vaccine guilt” can actually do something. Sharing their experience, rather than hiding in shame-shrouded shadows while simultaneously benefiting from that privilege, could help shine a light on this issue. It could open you up to criticism, yes, but it could also pressure public figures to produce guidance, informed by both ethics and public health best practices, on a unified plan for distributing leftovers and surplus. The finicky nature of the Pfizer and Moderna vaccines that require cold storage mean emergencies might still arise. But a protocol that takes equity into consideration could be better, and fairer, than wingin’ it, even if at the end of the day, with vaccine expirations nearing, the measured approach transitions to no holds barred.
In a few months, when every American who wants a vaccine will get one, Wikler says that these internal struggles and public shamings of people who get the vaccine before it’s their official “turn” will be forgotten. It won’t matter in the long run.
At the population level, that might be true. But I don’t think that means they’re worth glossing over: It’s rare when the people who benefit from an unequal system are forced to reckon with it. My own vaccine guilt has since abated, but I don’t want to forget how it felt to turn away the woman who worked at the bank. How do we turn shame into change?
I don’t have an answer. I can direct you to ways to help others amid the pandemic and volunteer opportunities that won’t necessarily get you a shot. I can suggest you lobby your elected officials to reduce overcrowding through affordable housing, improve public health care, support essential workers, and work to alleviate the factors that contributed to the unequal impact of COVID on people of color. I can take solace in the fact that, overall, the more people vaccinated, the better.
You might as well take the vaccine you can get, but in the long run, we should all aim to inoculate our healthcare system from the disease of inequality.