“Volunteer, and get vaccinated early!” read the cheery message in my university email inbox in February. Obviously intrigued, I clicked on the link at the bottom of the message, followed the instructions to request access to North Carolina’s COVID-19 Vaccine Management System, and 24 hours later received confirmation that I had been approved. I signed up for a shift at a smaller hospital in the University of North Carolina system.
I arrived that morning and received a rushed two-minute set of instructions that served as “training” from a harried doctor. My job was simple: walk individuals from the line to the vaccination rooms, and then seat them in observation for nurses to monitor for any reactions. From snatches of muttered conversations I caught between the other volunteers, I gleaned that there was a slim chance, if you spoke to the right doctors or made friends with the right administrator on duty, you could receive a dose at the end of the day.
I received my first dose of the Moderna vaccine at the end of my second volunteer shift, a day that I had signed up for because I heard the nurses whisper it would be promising for volunteers, since the state was set to receive a large shipment of doses the night before. For several hours I walked mostly elderly and lovely individuals from room to room, reveling in their excitement about being vaccinated. As the afternoon wore on and they started tallying appointment no-shows, it became clear that there would indeed be leftover doses that day. Shaking, I gave my name to the clinic coordinator and watched her scribble it down on a Post-It note. I cried in my car after my shot. It had been such a long time since I felt any sort of relief.
Ever since my injection, I have grappled with my early vaccination experience. The volunteers I have worked with have all been like me—younger, white, educated, not yet eligible, and able to take time off their jobs to seek extra doses. I have listened to similar stories from friends and family around the country, all from my same demographic, about their experiences volunteering in pursuit of extra doses.
The opportunities to get vaccinated early by volunteering are hodgepodge and very dependent on how each state chooses to administer its doses. In Rhode Island, Brown University’s college newspaper reported on March 16 that some students had received leftover doses at the end of the day, despite a city of Providence spokesperson writing that he “strongly discouraged” students from volunteering in pursuit of a vaccine in order to “prioritize the most vulnerable.” In California, officials advertised the opportunity to get vaccinated early if you completed a four-hour volunteer shift, yet many hopefuls have been unable to sign up for shifts through the state’s system for weeks due to an overload of interest and website glitches. The University of Alabama at Birmingham has been openly vaccinating its volunteers since early in the year. The UNC clinics were initially open to everyone in the university system, and volunteering was named as a way to jump the line in February. They changed their rules in early March—shortly after I received my first dose—so that only UNC Health employees were eligible to volunteer.
For several weeks after I was vaccinated, I was hesitant to tell anyone about my experience. I felt like I had gamed the system. I believed—and still believe—that vaccine clinics are missing a huge opportunity to more equitably distribute their leftover doses. It turns out that, as Katherine J. Wu reported in the Atlantic, many of us have chosen to keep our vaccination a secret.
I spoke to Arthur Caplan, a professor of bioethics and head of the Division of Medical Ethics at NYU Langone who specializes in vaccine ethics, to try to make sense of the moral questions volunteering in pursuit of a vaccine raises.* My internal conflict, he says, demonstrates that “no good deed goes unpunished.”
Volunteer opportunities are unequivocally geared toward people like me—those who are able to take paid time off work and who have the resources, connections, and technological savvy to find opportunities in their states. These demographics are also more likely to take advantage of opportunities to get vaccinated before they are eligible.
“I don’t think too many people in the bus driver world or people who are trying to clean rooms at nursing homes are going to be volunteering,” Caplan said. “A volunteer system takes the disparity of the better off and the safer and gives them an advantage. That’s inherently unfair, and we should feel bad about that.”
But at the same time, guidance on who is eligible for a dose—and on a more micro level, what vaccine sites should do with leftover doses—has been so poor, Caplan says, that it makes sense for clinics to try to use their end-of-day doses in the most convenient way possible, often by injecting the volunteers who are there on the premises.
“There has not been five words of guidance about that issue since it appeared,” Caplan said of surplus doses. “The worst thing you could do is waste vaccine.”
When Caplan himself was vaccinated at an end-of-day appointment in Connecticut, he was asked if he knew anyone who wanted a leftover dose. He of course did, and called his connections to let them know extras were available.
The open pursuit of leftover doses—through volunteer opportunities or through more directly marketed opportunities, like the website Dr. B—demonstrates how poorly structured the Centers for Disease Control and Prevention’s guidelines were for vaccinating anyone other than health care workers with clear patient contact. Once those demographics were vaccinated, definitions took precedence over efficiency.
“The whole idea of trying to vaccinate essential workers was, in my opinion, ethically ludicrous,” Caplan says. “Trying to vaccinate by who is essential opens up a question that we’re not prepared to answer—who is essential?”
As more and more doses become available, the question of who is essential fades in America, slightly. But the pandemic is still not over. Just over a quarter of the U.S. has received at least one dose of a vaccine. The opportunity for volunteers to seek out early doses remains, especially in areas with high demand. Some states have already made all adults eligible or will soon, but others are still several weeks away. And eligibility is not the same as access, at least not right now. Extra doses will still need to be administered. And we may go through this rigmarole again if boosters or entirely new vaccines are eventually needed, should variants continue to pose a threat to herd immunity.
That means the ethical question of leftover vaccine access will also persist. Widening the volunteer pool, actively recruiting in higher-need areas, could be one way to administer extra doses more equitably. Some cities have already undertaken more targeted initiatives to try and make dose distribution more equitable. In Baltimore, churches are administering pop-up clinics for some of the most underserved communities. In Los Angeles, similar initiatives have cropped up in Koreatown. In Chapel Hill, one of UNC’s larger vaccine sites started a leftover dose Twitter page on Wednesday to try to increase access to extra doses.
These initiatives are a start, especially in a system that has completely forsaken, as Caplan points out, clarification of any definitions about who qualifies for a vaccine or who should receive a leftover. But I imagine a future—perhaps even a future achievable during this pandemic, but certainly for the next public health crisis—where these clinics could do more. Where volunteer opportunities and chances at early vaccination are not just presented to those with access, but to those who need them most.
Correction, March 26, 2021: This piece originally misidentified the Division of Medical Ethics as the Division of Bioethics.