When the Food and Drug Administration approved the Pfizer vaccine, pure bliss exploded in hospitals around the nation. My eyes welled up reading my fellow front-line workers’ proclamations of joy on social media upon receiving the first doses of the coronavirus vaccine.
For many, however, that feeling was quickly replaced by shame and guilt. This week the tension between the haves and have-nots of health care workers finally reached a flashpoint. Our primal fears manifested in a systemic breakdown reminiscent of “The Lord of the Flies.”
With the vaccine in limited supply, hospitals have handled the distribution of their first Phase 1a batches very differently. While no hospital can allocate vaccines based on “role,” prioritizing factors like age or location is allowed ― such as anyone over 65 or working in the intensive care unit.
Now imagine that there are still not enough vaccines for everyone who fits the prioritized categories.
Some hospitals therefore utilized a lottery system, hoping to ensure equitable access. But immediately there were divisions between people who had tirelessly worked together toward a common goal all year.
The pandemic, in some ways, brought out the very best of our profession. This week also saw the worst, as complaints against one another mounted on social media or in hallway whispers. Those deemed less worthy to be the “first” among the first were shamed. Protests against Stanford Medicine’s allocation algorithm, which grossly overlooked doctors in training, sparked a staged protest and a formal apology.
Triaging a limited resource highlights the bioethical conflicts between achieving the greatest good for the greatest number of people, ensuring justice and equity (particularly as it pertains to marginalized groups), and, of course, doing no harm.
I remember a class debate in middle school on who should have been allowed into the lifeboats of the Titanic. We all agreed that giving unilateral access to first-class passengers was wrong. But we couldn’t agree on almost any point thereafter.
I argued that families should board first as intact units. I was ultimately beaten by another student who argued that weak swimmers should have first access. I tried to point out that this was a false choice: Whether or not you were a strong swimmer, without the lifeboat you would likely die when the ship went down.
And that is precisely what being a front-line worker in 2020 has felt like: being aboard a slowly sinking ship. We all want to escape. Now.
So seeing friends at other institutions get vaccinated is the worst kind of FOMO imaginable. The news of millions of doses of Pfizer’s vaccine sitting in a warehouse was insufferable. At its core is our most primal fear: death. And yet, bafflingly, it is our recognition that there is something worth more than this fear that also brought us to work every day.
So when my name made it through the lottery qualifying me to sign up for a vaccination appointment last week, I hesitated. Do I deserve this?
In March, when the first wave hit Boston, I volunteered to work the COVID-19 floor’s night shifts for weeks. Next month, I will again be working in inpatient units frequently exposed to COVID-19 patients.
Technically, according to my hospital administration, yes, I qualify for the first batch of vaccines.
But in this ethical tug-of-war, I found myself asking not whether I qualify, but whether I deserve the vaccine. As a fellow in the department of medicine, I am still considered a “trainee” on the front lines, but do I deserve the chance to get into a lifeboat more than an intern burning through 24-hour ICU shifts?
I remember what that felt like, exhausted from always standing in the line of fire. Do I deserve immunity more than elderly sub-specialty attending physicians? Statistically speaking, infection with COVID-19 would harm them more, even if their exposure risk is less.
If we’re talking about justice, what about hospital housekeepers (who rarely get the same applause or advocacy) commuting from higher-risk communities? Or my colleagues with children? Do their lives offer more value than mine because I have no dependents? All of these groups have compelling cases to make.
More pragmatically, abstaining from the lottery wouldn’t guarantee that my vaccine would reach a “worthier” soul of my choosing — it would simply go to someone who didn’t have my existential crisis.
It’s a dystopian cliché for us to feel pitted against each other for a limited resource due to powers beyond our control. We should learn from our mistakes and make adjustments when our algorithms fail entire groups of vulnerable people.
Be warned: This is merely a microcosm of the arguments to come when the next waves of vaccines roll out to the public. Even now, debates are bitterly raging about politicians receiving the vaccine ahead of front-line health care workers. Before long, grocery store employees, teachers, transportation workers and other groups critical to our society will join the fray.
Unless we keep the process and expectations transparent, it’s going to get ugly. Still, I am grateful to even be talking about vaccination now while some health care workers in this country continue to scrounge for personal protective equipment.
In the outside world, some are questioning whether they should get the vaccine at all. This special medical edition of “The Hunger Games” should make that answer obvious, as doctors (ultimately including me) take the shots. Hopefully, in the next few weeks, we’ll once again remember that it’s COVID-19 we resent, not one another. After all, in “The Lord of the Flies,” we all want to believe we would be Piggy, the one who saw the humanity in others and clung to the conventions of civilization.
Piggy, as you’ll recall, does not meet with a happy ending.