Monitoring the providers of vaccines — at what cost?
Some oversight urged, but experts push for balance
When a San Francisco-based health care company came under fire this month over claims it didn’t properly screen the people it was vaccinating to be sure they were eligible, it set off a backlash and a question: Once vaccines are distributed, is anybody watching to be sure medical providers are following the rules?
Surprisingly, though, it’s also prompting caution from some health care experts who worry that cracking down too hard on bad actors could slow down the rollout as new variants of the deadly disease are gaining steam.
“It’s a balance,” said Anthony Wright, executive director of
Health Access, a Sacramento-based consumer advocacy group.
The debate over monitoring vaccine providers revved up this week after NPR published a report, based on leaked internal communications, alleging that One Medical, a high-end health care provider popular with tech companies, allowed people who were not eligible to book coronavirus vaccine appointments and get the coveted shot. Some of those people allegedly worked at the company or were friends or relatives of employees. Patients were allowed to sign up for a free trial to book a vaccine and the company allegedly did not verify eligibility when people arrived for vaccinations.
One Medical has disputed the idea that it knowingly disregarded eligibility requirements and the company said it has improved its vetting process.
The state has tapped Blue Shield to decide how vaccines are allocated, but it’s not clear how the government oversees who gets shots after vaccines are distributed. State health officials did not immediately respond to a question about whether they conduct audits, unannounced inspections or take any other steps to prevent health care providers from misusing vaccine. Santa Clara County requires vaccine providers to sign distribution agreements that assure only those eligible under California Department of Public Health guidelines are vaccinated. San Mateo County said it has “ongoing communications” with providers to make sure vaccine is appropriately distributed. But it appears most of the policing comes after questions arise.
The governor’s office said Wednesday it will rework how it gets vaccine to vulnerable communities after news surfaced that appointment access codes were widely shared with people who were not eligible, allowing them to book appointments at mass vaccination sites, including the Oakland Coliseum.
In response to the One Medical controversy, several Bay Area counties, including Alameda, San Mateo and San Francisco, said this week they have stopped supplying the company with vaccine. San Francisco County asked the company to return about 1,620 doses of Pfizer-BioNTech vaccine. Santa Clara County said it provided One Medical with about 300 doses for health care workers on the company’s staff but has no future plans to allocate more vaccine to One Medical.
Increasing stories about people jumping the line for vaccines have caused anger among residents, particularly those in eligible populations who are still struggling to find an appointment. One Medical is not alone. Good Samaritan Hospital in San Jose came under fire recently when news leaked that it had vaccinated Los Gatos teachers before they were eligible.
But health care experts and ethicists warn that policing or coming down too hard on bad actors could have unintended consequences.
Santa Clara County, for instance, withheld vaccine from Good Samaritan and the hospital closed its vaccine clinic, sending some residents scrambling for shots elsewhere.
“It’s clearly not fair that people who are healthy and young and have means would jump the line and would get it above others,” said Monica Gandhi, an infectious disease expert at UC San Francisco. “On the other hand, my entire thought about vaccination and logistical challenges are that the fewer barriers we have, the fewer tiers we have, the fewer restrictions we have, we’re actually just going to get it into people faster and we’re all going to get there anyway.”
Herd immunity, she said, is the end goal, and people are better protected against the deadly disease when those around them are vaccinated.
Gandhi also pointed to voting rights as a cautionary tale about what could happen if vaccine distribution is too restrictive.
“I just keep thinking of voting and what happened with all those voter statutes that ended up creating voter suppression,” she said, pointing out that efforts to boost turnout and make voting easier during the pandemic in Georgia paid off with record turnout.
Charles Binkley, director of bioethics at the Markkula Center for Applied Ethics at Santa Clara University, said there should be a system of checks and balances, but “I worry about that old adage of cutting off your nose to spite your face.”
Rather than counties pulling vaccine supply from One Medical, he said, he’d rather see health departments work with and give the company time to improve.
“I’d rather have a system where we let some bad players in rather than having it so restrictive that we turn people away, particularly the vulnerable,” Binkley said.
Wright, the consumer advocate, hopes that with a new coronavirus vaccine from Johnson & Johnson expected to be approved and available soon, vaccine supply will increase to the point that figuring out who to prioritize is no longer an issue.
“Hopefully in a few weeks, we’re in a world of surplus rather than scarcity,” he said. “And then the question is not about prioritization but outreach.”