Hospitals are facing tensions over who gets the first Covid-19 vaccine

In general, the initial launch of the vaccine was rocky in some places, with hospital systems in New York and California changing course after workers began immunizing. Mount Sinai Health System in New York said it stopped vaccinations at some clinics wrongly included in its first wave. Three clinic staff received vaccines. Stanford Health Care has redefined its list of priorities after Friday’s protests by doctors in training who said they were unfairly ignored.

“Our revised approach, guided by the same principles of fairness and ethics, prioritizes health care workers in our clinical settings, including residents, peers, nurses, environmental services, and others, to ensure that they are vaccinated first.” , Niraj Sehgal, Stanford Medical Director of Health Care said Sunday.

The original algorithm took into account age and other criteria to calculate the overall risks of Covid-19, she said.

Doctors in training, known as residents and peers at Stanford and the University of California San Diego Health, said they had little explanation in advance about how the first photos were allocated. However, concerns have risen amid reports that many of them have not received vaccines. “We all had a lot of questions about how this happened, what was done, what was in this algorithm?” said Jessica Buesing, a Stanford resident.

Doctors at the beginning of their careers have little power in the workplace, but they do much of the front-line work in hospitals, said Sean Li, a resident physician and president of the UC San Diego Health Residents and Peers Union. Doctors are looking for a voice in the plan to distribute the additional allocation of the vaccine, he said.

Private employers cannot publicly disclose details about how they have given priority to workers, but they risk undermining trust in a fair trial, experts in law and ethics have said. “Because they haven’t explained their policy, you can’t give them the benefit of the doubt,” said Govind Persad, an assistant professor at the University of Denver Sturm College of Law.

The launch of the initial supply of the Covid-19 vaccine is forcing tough decisions by federal commissions and state agencies on which industries to immunize after health care. On Sunday, an advisory group recommended vaccinating the elderly in the country, along with teachers, grocery store workers, police and firefighters and other sectors essential to the economy and high risk.

The Advisory Group, which held its meetings in public and provided information on the data and methods used to make its recommendations, emphasized the need for transparency in its decision-making.

The supply of vaccines is expanding, with two being authorized this month for emergency use by federal regulators. US hospital officials say they expect to vaccinate all eligible staff quickly and have sought to do so fairly, but immunizations have had to start somewhere.

California hospitals are not required to make vaccine priority programs public or disclose them to the state, according to the California Department of Public Health.

“Because the vaccine is limited, hospitals and health systems that immunize their health care workforce need to establish a process for how they will proceed,” the agency said in a statement. “This is a determination at the hospital or health care level.”

Hospitals probably can’t avoid the tension because they ration the vaccines, said William Parker, a lung and critical care physician who also studies health reasoning at the University of Chicago. “There will never be a perfect plan,” he said. But making transparent choices can allow for pre-launch feedback, avoiding the confusion and mistrust created by an uneven release of immunizations, said Dr. Parker.

Doctors gathered at Stanford Medical Center on Friday after word of mouth revealed that seven of the 1,300 doctors in training were eligible to receive the first vaccines.

“It is important for us to inform you that, at this time, residents are hurt, disappointed, frustrated, upset and feel a deep sense of distrust of the hospital administration, given the sacrifices we have made and the promises that have been made. made by us, ”Stanford residents said in a letter to senior health care executives.

On the same day, the directors said they would review the process to include more residents.

Stanford doctors readily acknowledged the challenges and speed of vaccine launches in hospitals and praised the health care system for a quick response. But they also called for transparency on the algorithm used to distribute doses so that others can understand what went wrong and make sure the vaccine gets where it is most needed.

At UC San Diego Health, residents and colleagues at the end of last week asked to meet with medical leaders after discovering that many were not offered early photos, despite working with Covid-19 patients. according to an email from the San Diego House Staff Association, a union representing doctors, reviewed by The Wall Street Journal.

In an email response to the union, Christopher Kane, a physician and dean of clinical affairs at UC San Diego School of Medicine, agreed with the meeting and said residents and peers are among the more than 9,000 workers. in the field of health to be vaccinated within three to four weeks.

Residents and peers expressed concern about the union after noticing that they were not offered gunfire, despite working with nurses and several senior doctors who were among the first to be immunized, according to a separate email also reviewed by the Journal.

“There is no transparency in the way the risk model has been developed,” said Dr. Li.

Dr. Kane said some residents and peers have already been vaccinated and UC San Diego Health has given priority to all employees in the hospital’s departments, with health care workers caring for Covid-19 patients. “We tried to treat employees with a similar risk in a similar way,” he said.

In the week of the launch, UC San Diego Health sought to communicate broad priority plans to workers via email, town halls and direct communication, he said. The high concerns of residents indicate the need for additional efforts, he added.

UC San Diego Health vaccinates about 500 workers a day, Dr. Kane said.

The health system on Sunday evening informed residents by e-mail that it anticipates “significant amounts” of vaccines and will increase vaccination offers. The current plan is to incorporate the majority of UCSD clinical residents and peers working in predominantly inpatient settings into the vaccination program next week, the email said.

Write to Melanie Evans to [email protected]