Vaccine Diaries is a series of dispatches exploring the rollout of COVID-19 immunizations.
On Monday, the news that I am eligible to be among the first phase of people in America to receive the COVID-19 vaccine arrived in my email inbox. My vaccine appointment is scheduled for Dec. 18. I knew it was coming; the vaccines have been in the news for weeks. Being at the front of the line, as an ER doctor, seems to be a foregone conclusion. But I’ve also been thinking about if it’s really right for me to get the vaccine first.
Many other physicians, nurses, and others who participate in patient care in the hospital where I work, and in hospitals all over the country, will not be getting the vaccine along with me. The Centers for Disease Control and Prevention guidelines state that health care providers should get the vaccine first, but there aren’t yet enough doses of vaccine ready for all 20 million of us. And certainly, there’s some obvious stratification of risk: A plastic surgeon whose specialty is Botox and tummy tucks doesn’t have the same chance of getting COVID-19 as an ER nurse who sees dozens of patients a night, many of whom might have the disease. But the federal guidelines do not get granular as to who among health care workers should have first priority for the vaccine. Like many other things COVID-19, this was left to be decided at a local level. People at each hospital must ultimately figure out the order.
It feels strange to get priority for something that everyone needs and deserves. Early in the pandemic, I took care of a young man who was a combat veteran. He expressed his sympathy and admiration for what we were doing in the ER and bought pizza for everyone working that day. “I’d rather be shot at by a sniper than do what you’re doing,” he said. “At least I could see where the bullets were coming from.” Although that is a kind and appreciative sentiment, it cannot possibly be true. I have yet to confirm this with anyone I know who has experienced both snipers and the medical care of COVID-19 patients, but my own imagination leads me to believe I would prefer to avoid combat, if forced to choose. There have been a few moments where I have been worried for my own safety, but I do not live most of my working hours in fear of death, as I probably might if confronted with a constant threat of gunfire. But then again, we usually do not fear what we have come to know. There isn’t clear data on the risk of catching COVID-19 that doctors with adequate personal protective equipment take on, compared with the general population. Data collected earlier this year suggests it’s higher for us. But work, at this point in the pandemic, to me feels as risky as going to the grocery store.
I’m not the only medical provider who feels they perhaps don’t deserve to be among the first to get the vaccine. In the U.K., doctors and nurses will go after the elderly and their caregivers. I would rather that someone I love who is high-risk (my parents, for example, are in their mid-70s) get their dose before I get mine. Others feel they would rather see vulnerable members of the population they serve—the elderly, those with other illnesses that increase their risk of death, the occupationally at-risk—be earlier in line. “If you want to help me, I think what I need for you to do is unclog the ICU,” one doctor told NPR, arguing that the vaccination program should target people on Medicare and Medicaid before doctors. There is also the argument that, from a public health point of view, it is the behaviorally vulnerable—the people who go to bars, host group dinners, travel to see family over the holidays, attend church without masks—who should be vaccinated first. If we want to eradicate the disease, attacking the reservoir where it proliferates would make a lot of sense. But the people who have been staying home in lockdown might be mad if the careless get it first.
There is a practical reason to immunize medical providers first, even if we aren’t as likely to die from COVID as the elderly, or as likely to spread it as the bargoers. As hospitals are inundated with COVID-19 patients, and thus work, the absence due to illness or exposure of even a handful of providers is a huge hardship for those who are left to hold down the fort. I keep reminding my residents: I don’t want them to get sick because I care about them, but I also don’t want them to get sick because my job involves keeping a busy emergency department fully staffed. It’s not just their individual safety that is important, but their collective well-being, without which the system cannot function. We can and should hold ourselves to a high standard of safety—no hanging out at restaurants or multihousehold holiday gatherings—but we are not infallible. Even essential activities like food shopping come with risk. The vaccine allows us to protect our patients and our colleagues from our potential illness and its fallout. The vaccine will not be a magical fix for the increasingly grim situation the country is in: As America apparently gives up on social distancing, we will be needed more than ever in the coming months.
Weighing all of those factors, I feel OK about my upcoming appointment to get the vaccine. Realistically, I cannot give my dose up in order to give it to any of the handful of people I care about whom I would rather see get it before me. There aren’t enough doses yet to vaccinate all the vulnerable among us, however that is defined. And there’s no indication at my hospital that we would be able to trade appointment slots with other physicians (although, since the vaccine is optional, not required, turning it down would mean another, lower-priority provider could get it). So as a first, early, manageable, and accessible group to vaccinate, we doctors are reasonable enough. And as the free lunches and heroes’ laudations have dried up, offering us the vaccine first could also be seen as a symbolic recognition that we accepted a societal risk in caring for COVID-19 patients and carried on. For anyone who has a loved one who is a front-line provider, the vaccine must come as a huge relief. As much as I perceive little risk for myself, I know that others perceive me to be at risk, and the alleviation of their anxiety makes me happy. In fact, telling the people who care about me that I’m getting a vaccine has been one of the more positive moments of the pandemic.
Update, December 11th, 2020: This post was updated to note that data collected earlier in the pandemic suggests that health care workers are at higher risk for COVID-19 than the general public. The relative risk at this point in the pandemic remains unclear.