When UChicago Medicine received the go-ahead to vaccinate their patients, they knew they wanted to first target people most at risk of dying from COVID-19.
Dr. William Parker, a faculty physician at the health system, said they pulled up maps from the City of Chicago that showed vaccination and mortality rates by ZIP code. And then they reached out to patients in those neighborhoods.
“Every vaccine that’s administered in the hard-hit communities on the South and West sides is literally more valuable from an ethical perspective—in terms of maximizing benefits—than vaccines administered in the communities in the North side that were spared from a pandemic,” said Parker, who is also assistant director of the MacLean Center for Clinical Medical Ethics and an assistant professor of pulmonary and critical-care medicine. “That may not be the most popular thing politically to say, but definitely it is ethically correct.”
The rollout of COVID-19 vaccines across the country was fraught with potential ethical quandaries, some of which have come to fruition. Reports of health systems offering vaccines to donors—before the general public—came out almost immediately after hospitals first received shipments in mid-December. And concerns over how, and if, health providers would reach the neighborhoods most at risk—mainly Black and Latino communities—still haven’t subsided.
For the most part, health systems’ involvement varies widely county by county, as do distribution guidelines. The effort is a strong example of how local healthcare really is. It’s also an example of how a fragmented system affects community access, as hospitals created their own distribution playbooks in the absence of a national version early on.
But hospitals do have lessons learned and best practices for moving forward even as they’re still learning.
Parker said what they did starting with the hardest-hit ZIP codes, which is something any hospital could do, was actually easier than setting up their own registration website that could crash continuously. “If you actually want to save lives with these vaccines, you should give it to the people who are at the highest risk of death, which of course, is based on age, but is also based on where you live and the social determinants of health,” Parker said. “And almost every hospital has an underserved patient population that they come into contact with.”
Other ethical questions popped up early on, like what to do with unexpected surplus vaccine doses, which James Orlikoff, president of consulting firm Orlikoff & Associates, said there really wasn’t any guidance on. In at least one case, a doctor was fired from a health department for giving expiring Moderna vaccines to family members.
“You remember back in January, the phrase ‘shots in arms’ wasn’t used a lot, and it got used when people began to realize this isn’t just a traditional supply chain issue,” Orlikoff said. “If you don’t have the ability to administer vaccinations, it’s for naught.”