Hospitals boost security, seek to stop vaccine ‘line-jumping’

Hospitals and health care systems are taking unprecedented steps to safeguard the limited supplies of coronavirus vaccines amid concerns over security and the potential for black markets to emerge across the globe.

Operation Warp Speed, the government drive to develop and distribute the vaccines, requires medical facilities to develop a security plan. Every dose of vaccine shipped from manufacturing centers in Michigan and Belgium is tracked from the warehouse to hospitals where they are injected in staffers, medical officials said. 

Extra security personnel and constantly running cameras watch over storage units, where the locks have been upgraded.

“We’ve known from the start that this was going to be a vaccine that’s going to be rationed, so we’ve been thinking all along about how to secure it in a couple of different ways,” said Melanie Swift, a physician leading the vaccine rollout at the Mayo Clinic. “That’s making sure none of it goes missing.”

Some doctors and medical officials said they were concerned about rumors of illicit markets for vaccines, in which wealthy individuals might be able to secure a dose for themselves before their turn in line. At least one hospital, Mount Sinai in New York, has hired an external auditor to oversee its vaccine distribution plan.

Law enforcement agencies have warned that criminal syndicates may target vaccine supply chains, either to steal doses or to run scams meant to steal money. Earlier this month, Interpol’s secretary general warned member nations to identify potential criminal activity around the vaccine.

“There may be a responsibility to be extra cautious in this case because there might be a pressure to divert this [vaccine] that institutions ought to be aware of,” said Daniel Sulmasy, acting director of the Kennedy Institute of Ethics and a biomedical ethics expert at Georgetown University. “There may be reason to be extra careful that that doesn’t happen with these.”

Nearly a year after the pandemic began, and months after initial trials of potential vaccine candidates kicked off in countries across the world, the United States is still grappling with ways to keep track of everyone who receives a vaccine. 

Early on, scarcity helps. The front-line health care workers who are first in line for a vaccine are known to the hospitals that will distribute it, and alerting them that they are eligible is as simple as sending an email. Some hospitals can simply scan badges of those workers in line for a vaccine and check their names off a list.

Those next in line to receive a vaccine are similarly likely to be easily identified: First responders like police, fire fighters and emergency medical technicians will have government-issued identifications, and those who live in long-term care facilities will be easy enough to identify.

But as the vaccine becomes more widely available, the prospects for line-jumping will become more prevalent. National vaccine registries exist, but they have never been tested under such immediate and critical conditions.

“We’ve had to build new systems in the midst of a pandemic,” said Rebecca Weintraub, a vaccine distribution expert in the division of Global Health Equity at Brigham and Women’s Hospital in Boston. “They have not been tested in the midst of a global pandemic.”

It is not yet clear which subpopulations will be next in line for a vaccine, after front-line health care workers, first responders and those living in long-term care facilities. Hospital systems are waiting on guidance from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, a body that will make formal recommendations about the order of distribution.

About half the states and the District of Columbia are relying on the Centers for Disease Control and Prevention’s Social Vulnerability Index to target those who may be most at risk of contracting the coronavirus. States like Tennessee and New Hampshire are using the index to reserve a portion of the vaccine for those who live in the most vulnerable geographic areas. California is using the index to target people who would be best positioned to help reopen the state’s economy.

“The magnitude of potential impact and benefit is profound, and yet it still needs to be distributed in ways that are balanced and benefit the community at large,” said Jane Jankowski, who leads the bioethics team at the Cleveland Clinic. “Plans need to be consistent with the general principles of fair distribution of not only the resource, but also the risks and the burdens.”

In a race to vaccinate hundreds of millions of Americans, it is inevitable that some people will receive their shots before their turn comes. But because the end goal is to inoculate so many people, a few line-jumpers won’t hurt the overall cause.

“It’s not like we’re only ever going to vaccinate” front-line and high-risk workers, Swift said. “Ultimately we want to vaccinate everybody, so the sieve can be a little bit leaky.”