Public officials and politicians are among the first in line for vaccines that have yet to reach all health-care workers and will not become available to the public for months. They are showcasing their vaccinations on television and in social media posts to encourage Americans to trust the injections that may spell the end of the pandemic. But some essential workers and other Americans are expressing outrage that they must wait for protection even as leaders who failed to control the pandemic receive shots first.
“Getting your doctors and nurses vaccinated — that would truly build confidence,” said the Georgetown medical resident, who spoke on the condition of anonymity to avoid workplace retaliation. She eventually received a coronavirus vaccine this week.
“We were important enough to work a pandemic but not important enough to be at the front of the line for vaccinations,” the resident said.
Hospital residents and fellows from Palo Alto, Calif., to Denver and D.C. said they had to fight for early doses of the vaccine. Residents at Georgetown University Hospital arrived for the first day of inoculations unclear whether they qualified, a situation that hospital administrators blamed on a glitch in scheduling software. But the confusion caused some residents to seek vaccination at other sites where they provide care and forced hospital leaders to clarify in an email reviewed by The Washington Post that “no resident or fellow has been de-prioritized or overlooked.”
Disputes about vaccine distribution have been playing out nationwide in the week and a half since officials began distributing the Pfizer-BioNTech vaccine after its emergency authorization. Front-line medical workers and the people who live and work in long-term-care facilities are receiving priority for the 11 million doses allocated so far — including the Moderna vaccine, the second to receive federal authorization — but actually getting the shots will take weeks.
Health-care workers at some hospitals rebelled when administrators who do not treat patients received shots ahead of employees who work directly with the ill, most notably at Stanford Medical Center, where hospital leaders apologized and changed how they prioritize vaccines. Fox News founder Rupert Murdoch publicized his vaccination in Britain even as his cable news network promotes vaccine skepticism. And doctors in some of the wealthiest U.S. precincts say their patients are trying to get early doses by making hefty donations to hospitals or, in one case, turning to Russia.
The scramble for the first, limited batch of vaccines portends tensions as the massive distribution effort exposes inequities in the health-care system even as government officials debate who gets priority for lifesaving protection.
“We live in a system structured on power and privilege,” said Glenn Ellis, a visiting scholar at the National Center for Bioethics in Research and Health Care at Tuskegee University. “It’s baked into almost every sector of society. There’s no reason the vaccine will be any different in how it plays out.”
Vaccine for Capitol Hill
The backlash was swift after Sen. Lindsey O. Graham (R-S.C.) tweeted photos of his vaccination Saturday with a thank you for the nurses who administer shots.
In reactions to the tweet, thousands raged on social media that Graham had no business getting an early dose when he refused to get tested for the virus ahead of a debate during his reelection campaign and declined to postpone a confirmation hearing for Supreme Court nominee Amy Coney Barrett despite his exposure to the virus at a committee hearing.
Kelly Bouthillet, the president of the South Carolina Nurses Association, called Graham’s inoculation a “slap in the face” to nurses and other medical professionals still waiting to get their shots.
“This is like liquid gold, and it’s appalling that it’s going to politicians who have not taken the virus seriously, even denying the surges now shooting off the charts, instead of to health and emergency workers,” she said. “It makes me very angry.”
A Graham spokesman said the senator wanted to encourage others to be vaccinated and described the backlash as inevitable.
“Refuse the vaccine and be criticized for encouraging others to get it, yet you won’t go first,” Kevin Bishop, the spokesman, wrote in an email. “Take the vaccine early and face criticism for cutting in line.”
Republican and Democratic lawmakers have been vaccinated, but much of the backlash has targeted high-profile GOP members who did not always take safety precautions and were silent as President Trump spread misinformation about the virus.
Brian P. Monahan, the attending physician to Congress, last week urged every member to be vaccinated without delay, citing a continuity of government policy to ensure smooth government operations during a crisis and stressing that the doses for lawmakers amount to “a fraction of the first tranche of vaccines.”
His office and other federal officials declined to detail how the policy, which is not public, led them to conclude that all lawmakers — regardless of age, health status and risk — should receive priority.
The source of those doses reserved for elected officials and administered at a congressional office building remains unclear. A White House official, speaking on the condition of anonymity to address sensitive matters, said the doses were not being taken from allocations provided to states or five federal entities, including the Defense Department and the Bureau of Prisons, but were their “own separate allocation, details of which are classified.”
Lawmakers publicizing their shots have emphasized they are following the congressional physician’s guidance, an acknowledgment of the political risks that come with the perception of favorable treatment.
At least a quarter of the 100-member Senate has been vaccinated — including Sen. Tim Scott (R-S.C.), who received far less criticism on social media than Graham, and Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.), former Democratic presidential candidates. Other lawmakers announced they would wait and criticized colleagues who did not.
Sen. Rand Paul (R-Ky.), a critic of coronavirus restrictions and the first senator known to become infected, tweeted that it would be inappropriate for him to be vaccinated ahead of older Americans and health-care workers. He said young healthy people such as 31-year-old Rep. Alexandria Ocasio-Cortez (D-N.Y.) “should be among last, not first.”
Ocasio-Cortez, who live-streamed her vaccination on Instagram, fired back, “Gee, maybe if the GOP hadn’t spent so much time undermining public faith in science, masks,& COVID itself, I wouldn’t have to weigh the potential misinfo consequences of what [would] happen if leaders urged [people] to take a new vaccine that we weren’t taking ourselves!”
Their exchange highlights issues being debated by medical ethicists about how decisions on vaccination should be weighed.
There is broad agreement that senior government officials such as House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Mitch McConnell (R-Ky.), as well as figures such as President-elect Joe Biden, should receive protection to reduce the risk of major disruption during a crisis. Building trust in the vaccine also can provide the greatest good for the greatest number of people — a driving principle in medical ethics — if it encourages more people to get the shot, ethicists say.
But that doesn’t necessarily mean rank-and-file lawmakers should receive priority, said Scott D. Halpern, a physician and professor at the University of Pennsylvania School of Medicine who teaches ethics.
“What’s the evidence that vaccinating government officials promotes public trust in the vaccine? I’m really not aware of any,” Halpern said. “Even if it’s true that vaccinating government officials would promote public trust, it does not necessarily follow that they need to be vaccinated now when the majority of the public still won’t have access.”
Governors baring arms
As Texas faces the fourth-largest increase in daily coronavirus cases in the United States and polling suggests more than half of its residents won’t accept the shot, Gov. Greg Abbott (R) on Tuesday became the fourth governor to broadcast his vaccination.
“I want to show my fellow Texans that it’s safe and easy to get a vaccine and also remembering that I will never ask any Texan to do something that I’m not willing to do myself,” the governor said before donning a black mask and rolling up a shirt sleeve for his injection.
Critics found his early dose galling, given his posture during the pandemic. Abbott stopped local Democratic leaders from imposing restrictions to curb the virus’s spread. In May, he became the first governor to reopen his state after lockdowns, contributing to one of the nation’s deadliest outbreaks, which occurred in the Rio Grande Valley of Texas. In the weeks leading up to his vaccination, Abbott repeatedly stressed that inoculation would be “always voluntary, never forced.”
Hours before Abbott’s vaccination, K.P. George, a Democrat and the top elected official in Fort Bend County, Tex., called on politicians to wait until all essential workers had been inoculated.
“Many of these people were not even willing to wear masks. Now, all of a sudden, this vaccine came and they wanted to get it upfront,” George said in an interview, referring to elected officials. “At least for the purpose of decency, and also at least for the purpose of showing we care about everybody, not just us, [Abbott] should have stayed back.”
Others were more circumspect, including the state nurses association, which said it appreciates government leaders showing they trust the vaccine. Abbott spokeswoman Renae Eze said the state’s chief medical officer and federal health officials recommended the governor’s public vaccination to “instill confidence” as residents and medical personnel have “expressed apprehension.”
Abbott follows the Republican governors of West Virginia and Alabama in their public inoculations. In Kentucky, Democratic Gov. Andy Beshear and Republican state legislative leaders received their vaccines together to convey bipartisan confidence.
Leslie Francis, a professor of law and philosophy at the University of Utah who specializes in medical ethics, said she understands why some people wouldn’t want politicians who mishandled the pandemic to receive priority for vaccines. But that loses sight of the benefits of possibly swaying skeptics who trust those politicians.
“On the one hand, you might say they don’t deserve it … or they made things worse, so why don’t we get back at them,” she said. “Another thing we can do is saying, ‘Look, we don’t believe in getting down into the mud. We think the appropriate basis to distribute vaccines is: Are you doing something essential? Can you avoid the risk? Are you at greater risk? Is there any reason in terms of public trust or public taking of vaccines to give it to you?’”
‘Can you make it happen?’
Ethicists are far more critical of the rich and powerful who are calling some doctors and signaling they are willing to go to extraordinary means to get early doses.
“They are asking me, ‘Can you do it? Can you make it happen?’” said Ronny V. Aquinin, who runs a private practice housed at Mount Sinai Medical Center in Miami Beach. “I had one client tell me he can get the Russian vaccine flown in overnight. I said, ‘Good luck to you.’”
Abe Malkin, who operates a concierge medical practice in Los Angeles that charges up to $750 a month for membership, has fielded calls from clients wanting to donate to big-name hospitals to get ahead in line.
“They’re people who have significant means and influence and are used to paying to get the very best care,” Malkin said. “I get them access to the best anti-aging medicine, the best regenerative treatments. But there are guidelines for the vaccine. So it becomes about managing expectations.”
Some experts expect a black market to form even with measures to prevent the diversion of vaccines.
“There’s a lot of gamesmanship out there, people saying this or that to hint they have a way for people to angle to get to the front of the line,” said Terrence L. Bauer, CEO of Specialdocs, a consulting firm for concierge medical practices. “But the doctors we work with are high-integrity folks. You just have to follow the rules.”
A growing body of psychology experiments has tried to untangle how wealth and power can lead to feelings of entitlement and invulnerability.
In one of the more surprising findings, a 2015 paper found that the rich are more likely to take candy from children. In an experiment, subjects compared their finances with others before being told they could take candy from a jar before it is sent to children in a nearby lab. Those who felt richer after seeing the finances of a poorer person took significantly more candy.
“As of now, if the rich and famous have gotten anything, it has been tiny, but they’ve asked,” said Arthur L. Caplan, a professor of bioethics at New York University’s Grossman School of Medicine. “Hospitals have been holding the line, but in the next few weeks, as they expand beyond health-care workers and nursing homes, hospitals will be tempted to give access to big donors and concierge medical operations. … There will definitely be a black market.”
Annie Gowen contributed to this report.