Variants mean it’s not who gets the shot, but how many

WASHINGTON — On Dec. 29, 2020, around 6:45 p.m., a nurse in Humble, Texas, slid a needle into a vial of the Moderna vaccine and administered what would be the last shot of the night at a vaccination event the county health department had organized for emergency workers and other eligible people. With the event winding down, it was unlikely anyone else would show up. In six hours, 10 precious doses of vaccine would expire.

Hassan Gokal, the medical director of the county’s COVID-19 response, says he was determined they would not go to waste. After offering the vaccine to everyone on site — all of whom had either already been vaccinated or declined — and to the eligible relatives of a senior colleague, he put the vaccine in his car and began driving home, making phone calls as he went. By midnight, he had dispensed nine of the 10 remaining doses to the sort of patients who need them: seniors with health problems. Caregivers for those seniors. A worker at a health clinic. A mother whose child was on a ventilator. With one dose left, and no more takers, Gokal gave the last dose to his wife, who suffers from severe respiratory disease.

In recognition of his heroic efforts to ensure that not a drop of vaccine was wasted, Gokal has been fired from his job and faces possible prosecution by the local district attorney.

This outrageous story is a particularly horrific example of a broader national problem: We are too often more obsessed with making sure that exactly the right people get vaccinated than we are about getting people vaccinated, period. And unfortunately, some of the worst offenders are the people in charge of distributing the vaccines.

We saw it manifesting even before vaccines were available, when the advisory committee at the Centers for Disease Control and Prevention developed an elaborately phased system for distribution. First health-care workers would get their shots, then other essential workers, then seniors and people with high-risk conditions, then the rest of us. As you may remember, this plan immediately came under fire because the CDC’s own analysis suggested it would result in more deaths than simply vaccinating seniors first — and because one justification for choosing the higher-death plan was that essential workers are disproportionately people of color.

Everyone was so angry about the racial aspect that almost no one pointed out the plan’s greatest flaw: It was a logistical nightmare that was likely to delay vaccinations as public health authorities struggled to define what counted as essential work, contact those doing it, persuade those workers to take the vaccine and then verify their eligibility.

Those CDC advisers were little different from the angry readers I hear every day. All of them have a better plan to prioritize people with disabilities, or caretakers, or use antibody tests to ensure we don’t vaccinate people who’ve already had COVID-19. Whatever their merits, each of these plans would further complicate a process that is already moving too slowly.

Of course, one could ask whether it’s worth taking our time to do it right. Speed is one value, but hardly the only one. There are valid arguments for trying to maximize the number of lives saved by only vaccinating those with virgin immune systems, or for repaying the courage of essential workers who have put themselves at risk for the rest of us. Those arguments might even carry the day if the United States had anything approaching the administrative capacity necessary to carry them out.

But America’s fragmented public health system simply doesn’t. And while speed may not be the only value we care about, the rise of more-contagious variants that may be learning to evade our immune systems means speed has to be at the top of our priority list.

Vaccination used to have two goals: protecting individuals directly by stimulating their immune systems and protecting their communities by denying the virus new hosts who will spread it. But thanks to the variants we now have a third goal: protecting the nation, and the globe, by draining the reservoirs of infection that allow the virus to evolve its way around our immune system. Of course, we’d like to reach those first two goals as quickly as possible. But the third one is why we have to move with all possible speed.

Every completed vaccination is one fewer opportunity for another variant to arise. We dare not waste even a drop of vaccine, nor let it sit in a freezer for one second longer than absolutely necessary, even if that means sometimes vaccinating people we’d have left until later in an ideal world.

Of course it’s hard to watch other people who seem to be winning the vaccine lottery while we’re still miserably waiting at home. But if you remember that each of them is sharing a little of their winnings with the rest of us, that misery might get a bit more bearable.