Hospitals face tensions over who gets the first Covid-19 vaccines

Overall, the initial release of the vaccine has been rocky at some points, with hospital systems in New York and California changing course after workers began immunizing. Mount Sinai Health System in New York said it stopped vaccinations at some clinics included by mistake in its first wave. Three clinic employees received vaccines. Stanford Health Care reworked its list of priorities after Friday protests from doctors in specialized training who said they had been unfairly ignored.

“Our revised approach, driven by the same principles of fairness and ethics, prioritizes health workers in our clinical settings, including residents, fellows, nurses, environmental services, and others, to ensure they are vaccinated first,” Niraj Sehgal said. Stanford Health Care medical chief said Sunday.

The original algorithm took into account age and other criteria to calculate the overall risks of Covid-19, he said.

Doctors in training, known as residents and fellows, at Stanford and the University of California, San Diego Health, said they had little prior explanation of how the first shots were assigned. However, concerns grew amid reports that many of their ranks had not been offered vaccines. “We all had a lot of questions about how this happened, what was done, what was in that algorithm?” said Jessica Buesing, a Stanford resident.

Sean Li, a resident physician and president of the UC San Diego Health Residents and Fellows Union, said doctors at the beginning of their careers have little power in the workplace, but do much of the front-line work in the hospitals. Doctors are looking for a voice in the plan to distribute an additional vaccine allocation, he said.

Private employers cannot publicly disclose details of how they prioritized workers, but they risk undermining trust in a fair trial, law and ethics experts said. “Because they haven’t explained their policy, you can’t give them the edge of the doubt,” said Govind Persad, an assistant professor at the University of Denver Sturm College of Law.

The deployment of the initial Covid-19 vaccine supply is forcing difficult decisions by federal groups and state agencies on which industries will be vaccinated after health care. On Sunday, an advisory committee recommended that the oldest in the country be vaccinated, along with teachers, grocers, police and firefighters and other sectors essential to the economy and at high risk.

The advisory group, which held its meetings publicly and disclosed information on the data and methods used to make its recommendations, stressed the need for transparency in decision-making.

Vaccine supply is expanding, with two authorized this month for emergency use by federal regulators. U.S. hospital officials say they expect to vaccinate all eligible staff quickly and have tried to do so equitably, but vaccinations had to start somewhere.

According to the California Department of Public Health, California hospitals are not required to make vaccine prioritization schedules public or disclose them to the state.

“Because the vaccine is scarce, hospitals and health systems immunizing their healthcare workforce must establish a process to proceed,” the agency said in a statement. “It’s a determination at the hospital or health care system level.”

Hospitals may not be able to avoid stress as they ration the vaccines, said William Parker, a lung and critical care physician who also studies health rationing at the University of Chicago. “There will never be a perfect plan,” he said. But making transparent choices can allow for feedback before release, avoiding the confusion and mistrust created by an uneven release of vaccinations, Dr. Parker.

Doctors gathered at Stanford Medical Center on Friday after discovering by word of mouth that seven of the 1,300 doctors in training had been eligible to receive the first vaccines.

“It is important for us to articulate that at this time, residents are hurt, disappointed, frustrated, angry and feel a deep sense of mistrust towards the hospital administration given the sacrifices we have been making and the promises we have made. they were made to us, ”Stanford residents’ management said in a letter to top health system executives.

In those days, executives said they would review the process to include more residents.

Stanford doctors easily recognized the challenges and speed of vaccine deployment in hospitals and praised the health care system for a quick response. But they also called for transparency about the algorithm used to distribute doses so that others could understand what went wrong and make sure the vaccine gets where it is most needed.

At UC San Diego Health, residents and fellows last week asked to meet with medical leaders after finding many who were not offered early shots despite working with Covid-19 patients, according to an email of the San Diego House Staff Association, a union representing doctors, reviewed by The Wall Street Journal.

In an email response to the union, Christopher Kane, a physician and dean of clinical affairs at UC San Diego School of Medicine, accepted the meeting and said residents and fellows were among the more than 9,000 health workers who were vaccinated within three to four weeks.

According to a separate email, also reviewed by the magazine, residents and colleagues expressed concerns with the union after noticing that they were not offered shots despite working alongside nurses and more senior doctors who were among the first to be immunized.

“There is no transparency in how the risk model was developed,” Dr. Li.

Dr. Kane said some residents and fellows have already been vaccinated and that UC San Diego Health gave priority to all hospital department employees with health care workers caring for Covid-19 patients. “We tried to treat employees with similar risk in a similar way,” he said.

In the week of the launch, UC San Diego Health tried to communicate the broad prioritization plans to workers by email, town halls and through direct communication, he said. Concerns raised by residents point to the need for additional effort, he added.

UC San Diego Health vaccinates about 500 workers a day, Dr. Kane said.

The health system on Sunday evening notified residents by email that it anticipated “significant amounts” of vaccines and would increase vaccination offers. “The current plan is to incorporate most UCSD clinical residents and fellows working in predominantly hospitalized settings into the vaccination program over the next week,” the email said.

Write to Melanie Evans to [email protected]