‘Like gold’: Hunt for leftover doses in area takes strategy, ethics and luck
Five doses.
That’s all that remains by 6:47 p.m. at the CVS on Harrisburg in Houston’s East End following a long day of COVID-19 vaccinations. Five people scheduled to receive their shot — for whatever reason — were unable to make it to their appointments on this recent Wednesday in early March.
Now pharmacy staff are tasked with deciding who should receive their thawed-out doses before the precious supplies go to waste.
By 7 p.m. the phones are ringing off the hook. The parking lot is crowding with cars filled with vaccine-hunting Houstonians hopeful to get lucky and receive a “leftover dose” — despite many being ineligible under current state guidelines, which prioritize Texans who are over the age of 50, teachers, or those with underlying conditions.
The pharmacy technicians meet in a huddle, their eyes darting back and forth at one another as they discuss their game plan. They ask those waiting in their cars and the few hovering inside the
store: How old are you? Do you have any chronic health conditions?
Maria Gomez, 48, is one of the lucky ones. It took her four attempts in total, including visiting CVS three times that Wednesday, but she finally secures a vaccination for her son.
She breathes a sigh of relief as she watches her 24-year-old son, Javier, receive his shot. He is not yet eligible for the vaccine, but his chronic asthma easily flares up, leading him to get sick often.
“I thought OK, he’s not taking the place of anyone else. If there are extra vaccines and they are going to be thrown away, it’s no problem,” Gomez says. “[Now] there’s one less person to be vaccinated.”
Houstonians are hunting doses at pharmacies, hospitals and city and county-run sites in a desperate chase for a scarce, coveted resource. For the frontline workers administering the vaccines, deciding who should receive the extra doses before time runs out is a daily challenge — and some are using the chance to offer the vaccine to friends and family, creating an ethical dilemma that exacerbates vaccine inequity.
‘Who is close?’
When the first batch of COVID-19 vaccines arrived at Houston Methodist in December, Executive Vice President Roberta Schwartz found herself running at full speed through the hospital hallways trying to find someone to take a leftover dose before it expired.
Vaccines come in vials that offer up to 10 doses and must be kept at below or near freezing temperatures, depending on the maker. Once thawed and reconstituted, the vaccines expire in six hours or less unless they are administered.
“When your motto is don’t waste a dose, you will do whatever it takes to not waste a dose,” Schwartz said.
The first few weeks of January, people often gathered outside, waiting without appointments, but with high hopes. The crowds sometimes grew to upward of 20 people, which staff had to mine through to decide who gets a dose.
“It was almost a terrible feeling: First of all, which people do you pick?” Schwartz said. “It wasn’t always organized and you didn’t always get it to the right people.”
As vaccine demand grew by the day, the hospital system scrambled to create what Schwartz calls “funky” policies for addressing leftover doses. Methodist has a very low no-show rate, Schwartz said, at less than 3 percent on average. But every dose is precious. So they made some changes. People are no longer allowed to wait outside. Now, a few hours before they close every day, staff start drawing up one vial at a time, counting patients in line to ensure extra vials are not opened.
They now have a priority list of eligible patients, law enforcement and 1B people for determining who should receive extra doses. Hospital officials said in the past, they prioritized finding patients who live nearby and could make it to the center at a moment’s notice. But they stopped that practice and now only does so for “extreme exceptions.”
Sometimes, they exhaust all their options: No one on the waitlist answers the phone, and all the nearby staff is already vaccinated. Time is running out. So they call friends and family.
“Does it happen that occasionally you have a dose and you don’t have anybody nearby and we end up dialing phones to people who we know that have wanted it? It does happen,” Schwartz said. “It is a very big exception for us.”
The pandemic fatigue frontline workers have been grappling with for more than a year now also plays a part in that desperation.
“This is an exhausted staff, by that time they have done it for 12 hours,” Schwartz said. “And for us, we don’t want to waste the dose. The question is: Who is close?”
Vaccine inequity
Houston Methodist isn’t alone in this.
A Harris County Public Health doctor drew national attention after he was accused of stealing vaccines for his family. The doctor argued the nine doses he was accused of stealing were leftover, and that he tried to give the shots to eligible residents before resorting to administering the last one to his chronically ill wife. A Harris County judge dismissed a theft charge brought against him and the Texas Medical Board cleared him of any wrongdoing.
Dr. Janet Malek, Associate Professor at the Center for Medical Ethics and Health Policy at Baylor College of Medicine, said the practice is not unheard of in the hospitals that make up the Texas Medical Center.
As a medical ethics expert, she finds it “very inequitable,” but said the solution to fixing vaccine inequity is not a simple one.
“The logistics of that kind of system are pretty hard to imagine because more vulnerable people are going to be the least available to come and just wait in line to see if they get a dose at the end of the day,” Malek said. “Those are people that it’s hard for them to even make it if they have an appointment and can plan ahead.”
Malek said those who are connected to health care professionals, especially in the Medical Center, are likely to already have more advantages than most, increasing inequity.
Sites across Houston are taking different approaches to addressing vaccine inequity. At Baylor College of Medicine, staff use a prioritized list of eligible patients that are “on call” and prepared to receive a leftover dose if one becomes available, according to Dr. James McDeavitt, Baylor’s senior vice president and dean of clinical affairs and director of the COVID Incident Command Center.
“We at Baylor have interpreted that (state vaccine eligibility guidelines) strictly and those are the people we are vaccinating,” McDeavitt said. “Not friends and family, not people that are tied to our physicians in some other way. I think there has been variable interpretation of that across different organizations…but we really have tried to stick to the state’s intent.”
McDeavitt said Baylor has a very low no-show rate and usually only has a “handful” of leftover doses each day. He added that the hospital has been “successful 100 percent of the time” in distributing doses.
“The vaccine appointments are so valuable, that they are like gold,” McDeavitt said “People are really hesitant not to take advantage of them.”
Harris County Public Health allocated its leftover doses to teachers before they were recently given priority access. Now those doses go to first responders.
The Houston Health Department calls people with upcoming appointments to see if they can arrive earlier, according to spokesman Porfirio Villarreal. “Also, at the end of the day when there are few people waiting, department nurses begin to draw from the remaining open vials to avoid any unused doses,” Villarreal added.
At St. Luke’s Health there are “systems in place” to quickly reach eligible patients who could receive a leftover dose. In a statement, the hospital system said its “process to allocate doses at the end of the day may vary per vaccinate site.”
Schwartz said that while others may question how some hospital systems dole out extra doses, the pandemic is an unprecedented challenge for health care workers, who are doing their best to get everyone vaccinated.
“Everyone has all of the right intentions working through this very complicated, challenging but exceedingly important vaccination program,” Schwartz said. “There is no one who has gotten this perfect.”
For Gomez, seeing her son receive a shot at CVS was just what her family needed. Now, she won’t have to worry a COVID diagnosis could cost him his life. He towers over her in the pharmacy, recalling the lengths she went to get him vaccinated.
“She really loves me,” he laughs.