California’s COVID-19 vaccine expansion relies on trust
LOS ANGELES — California on Monday began a new phase of its COVID-19 vaccine rollout, making nearly half of all residents eligible for a shot — and relying more than ever on public trust and honesty to make sure the doses get to those who need them most.
The changes add to the eligibility list more than 4 million people, most notably those 16 and older who have disabilities and underlying health conditions.
Previous eligibility tiers focused on certain jobs and age groups — factors that are easily verifiable to determine whether those seeking the vaccine are entitled to it under state guidelines.
But there will be a much looser verification system for this new group due to issues of privacy and access. And despite eligibility lists provided by the state, there is still confusion about which health conditions are covered, so the true size of the new group is unclear.
The ambiguities raise new ethical and logistical challenges.
“I think we’ve seen throughout the rollout that there is a big hunger to get people vaccinated,” said Dr. Kirsten Bibbins-Domingo, chair of the epidemiology and biostatistics department at the UC San Francisco School of Medicine. “What I hope is that we trust our fellow Californians to basically rely on the honor system.”
There is certainly potential for fraud, as people are being asked to self-attest as to their eligibility. Line-cutting has already been a major issue in California, particularly in cases in which access codes meant for members of underrepresented communities have gotten into the hands of more affluent residents.
But advocates, health experts
and public health officials are optimistic that most residents won’t take advantage of a system that relies on trust, though they admit that it would not be hard to do so.
A more immediate concern is that vaccine supply is still limited. That puts this new group in direct competition for appointments with previously eligible groups, including residents 65 and older, health care workers and a variety of essential workers.
As more people vie for the vaccine, advocates have championed a system that would not create unnecessary barriers to obtaining shots, following situations in which people have forged documents and abused the access codes intended for high-risk communities. Public health officials have implored people not to take advantage of the lax regulations.
Dr. Aaron Kheriaty, director of the medical ethics program at UC Irvine and a member of the vaccine task force in Orange County, said implementing stricter requirements like doctors’ notes would have overwhelmed medical offices and, more significantly, left large swaths of people out in the cold.
“The challenge is, if we make the verification criteria too strict, it becomes too onerous and cumbersome to actually implement on the ground, and people are really bogged down in all kinds of red tape,” he said.
For example, a person with a cellphone and a concierge medical service might easily secure a doctor’s note within a day, while a person who is uninsured or underinsured, or doesn’t have a regular health care provider, could be left without the needed documentation.
Tory Cross, a 27-year-old with severe asthma and Ehlers-Danlos syndrome, said the lack of verification requirements is in fact crucial to California’s commitment to vaccine equity.
“It’s really important for people to be able to self-attest,” she said, noting that many lost their health care during the pandemic and might not have easy access to a doctor. “Additionally, so many disabled people I know who have disabilities that are invisible [like asthma] were really worried that we would have to argue with vaccine providers to get them to believe that we’re high risk.”
When Cross secured an upcoming appointment at Safeway, she “sobbed like a baby” from relief, she said Monday.
Others haven’t been so lucky. Already, some people, including asthmatics, have expressed confusion on social media as to whether they qualify for vaccination under the latest expansion. Some complained that appointments were already booked when they tried to obtain a slot and wished the state had opened the process sooner.
Under the current guidelines, Californians do not have to disclose what condition they have, only that they are eligible — a decision experts chalked up to health privacy laws, noting that not all people involved in vaccine administration, including volunteers at county sites, are bound by doctor-patient confidentiality.
In Los Angeles County, public health officials estimate that 1.5 million to 2 million residents qualify under the new eligibility list and have reserved roughly 19% of allocated 181,560 first vaccine doses this week for those with underlying conditions.