Vaccine line jumpers force states to rethink distribution

California set aside a share of its COVID-19 vaccines for poorer, hard-hit communities, but Gov. Gavin Newsom saw something odd with his own eyes in East Los Angeles.

The White governor said he watched this month a site serving Hispanics in public housing and “these Audis pull up, folks that look like me.”

Interlopers forced the state to revamp its vaccine system so that appointment codes would be tied to specific people and wealthy folks didn’t get their hands on them.

“It’s whack-a-mole every single day,” Mr. Newsom, a Democrat, said at a press conference.

The city of Pasadena, meanwhile, had to reschedule a vaccination clinic on March 11 after a registration link was shared with a large group of entertainment, news and production workers.

“Please wait your turn. Unfortunate circumstances such as this inhibit our ability to vaccinate residents as quickly as possible,” the city said in its rescheduling notice.

The COVID-19 vaccine is a tiny vial of liquid, but it is the hottest commodity of 2021. It has turned internet operators into access-code hunters and tempted the wealthy and connected to hop the line or tread where they don’t belong.

Florida deputies in Orange County intercepted two women, both younger than 45, in late February. The women were dressed like “grannies,” including glasses and bonnets, to try to circumvent age restrictions. Their driver’s licenses gave them away. They were flagged as cheats, scolded as selfish and told not to return until they are eligible for the vaccine.

Advisers to the Centers for Disease Control and Prevention set general guidelines for vaccine priorities. They gave top billing to health care workers and nursing home residents before moving on to seniors, essential workers and the medically frail.

Governors, however, set final rules. Some have moved from the most elderly to younger ages in five-year increments. Others mix eligible seniors with people who hold certain jobs or suffer from medical conditions, even smoking and obesity.

President Biden wants everyone to be eligible for the vaccine by May 1, which might lead to jockeying for appointments but make line-jumping officially moot. Alaska, Mississippi and Ohio have taken steps to expand eligibility to all adults within their borders.

“I think you will soon see more states moving in this direction,” said Claire Hannan, executive director of the Association of Immunization Managers.

For now, states are doing what they can to tighten registration systems so web-based appointment links or codes aren’t shared with ineligible people.

California has shifted from “group codes” that could be shared easily or leaked to an individual-based system as it tries to vaccinate Hispanic and Black communities that have been hit hard by the virus. Health care systems in Virginia and other states scramble to revise their systems after realizing that web-based appointment links could be shared, causing an unsustainable spike in sign-up attempts.

Some places are dealing with outright fraud.

A Florida man named 2020’s “paramedic of the year” was arrested on charges of helping a supervisor steal Moderna vaccines in Polk County by falsifying records, and a 22-year-old lost a vaccination contract in Philadelphia after swiping some doses for friends.

Other vulnerabilities are baked into the system, making it difficult to tell whether or not someone is jumping the line.

Walgreens said it requires IDs, but people sign affidavits to attest to eligibility under state requirements. CVS Health said customers must attest that they meet requirements, but “we reserve the right to cancel an appointment if we determine a patient does not meet eligibility or the information they submitted was not truthful. In certain states, we are also required to ask for identification to validate age eligibility.”

Immunization managers say many states will require a letter for proof of employment as an essential worker, but not for a high-risk medical condition.

In Pennsylvania, recipients may have to show proof that they are older than 65, but eligibility based on medical conditions or health care work is based on self-attestation as they attempt to balance equity with efficiency.

“As eligibility is based on the honor system, we know Pennsylvanians will respect the plan in place to ensure the most vulnerable and health care workers have access to the vaccine as the plan was designed to ensure,” said Maggi Barton, deputy press secretary at the Pennsylvania Department of Health.

Experts say it can de difficult to document all the chicanery, though the problem is real and undermines the overall effort.

“No one tracks cheating, lying or cutting in line. All there are is stories, anecdotes, allegations and self-admissions,” said Arthur Caplan, director of the division of medical ethics at the New York University Grossman School of Medicine. “How much of this goes on is utterly unknowable without some systematic surveying, and even then people may not be honest.

“All that said, constant stories of cheating and line-cutting destroy trust and confidence in government-run rationing rules,” Mr. Caplan added.

Others say it reveals more about society at large.

Line-hopping “breaks their faith in other human beings. I haven’t heard anything in the sense of, ‘Oh, we can’t trust the system,’” said Panagis Galiatsatos, an assistant professor at Johns Hopkins School of Medicine and a critical care doctor who treats COVID-19 patients.

It’s not just the U.S.

A Canadian casino executive resigned this year after he was charged with failing to self-isolate for 14 days after arriving in the Yukon with his wife to seek out the vaccine from mobile clinics in the remote territory.

Local residents were offended that a wealthy couple showed up at a clinic serving the Indigenous population.

People in hard-hit Latin America, meanwhile, were enraged by reports of ministers granting special access to themselves, family or other connections.

Many U.S. politicians aren’t hopping the line so much as confronting an optics dilemma. Plenty of congressional lawmakers rolled up their sleeves to build confidence in the shots, though some viewed it as high-level taunting as they wait for weeks or months.

Some politicians decided to wait until their age and demographic comes up on the list.

“Leaders eat last,” said Rep. Brian Mast, Florida Republican and Army veteran. “It’s one of the first lessons a soldier learns as early as basic training.”