California began a new phase of the COVID-19 vaccination on Monday, which nearly half of all residents are eligible for a shot – and more than ever relied on public trust and honesty to make sure the doses were those get what it needs most.
The changes contribute to the fitness list of more than 4 million people, especially those 16 and older with disabilities and underlying health conditions.
Previous qualification levels have focused on certain positions and age groups – factors that are easily verifiable in determining whether those seeking the vaccine are entitled to it according to state guidelines.
But there will be a much looser authentication system for this new group due to privacy and access issues. And despite the fitness lists provided by the state, there is still confusion about what health conditions are covered, so the true size of the new group is unclear.
The ambiguities bring new ethical and logistical challenges.
“I think we have seen over time that there is a great hunger to get people vaccinated,” said Dr. Kirsten Bibbins-Domingo, chair of the epidemiology and biostatistics department at the UC San Francisco School of Medicine, said. “What I hope is that we trust our fellow Californians to basically rely on the system of honor.”
There is definitely potential for fraud as people are asked to testify for themselves if they are eligible. Cutting the line has already been a major problem in California, especially in cases where access codes intended for members of underrepresented communities have fallen into the hands of more affluent residents.
Advocates, health experts and public health officials are optimistic that most residents will not benefit from a system that relies on trust, although they acknowledge that it would not be difficult to do so.
A more immediate concern is that the supply of vaccines is still limited. This puts this new group in direct competition for appointments with previously eligible groups, including residents 65 and older, health workers, and a variety of essential workers.
As more people fight for the vaccine, advocates advocate for a system that would not create unnecessary barriers to obtaining shots, following situations in which people forged documents and misuse the access codes intended for high-risk communities. Public health officials have begged people not to make use of the lax regulations.
Dr. Aaron Kheriaty, director of the UC Irvine Medical Ethics Program and a member of the Orange County Vaccine Task Force, said the implementation of stricter requirements such as doctor’s notes would have overwhelmed medical offices and, more importantly, left out large groups of people. . in the cold.
“The challenge is that if we make the verification criteria too strict, it becomes too burdensome and cumbersome to actually implement on the ground, and that people are really caught up in all sorts of red tape,” he said.
For example, a person with a cell phone and medical service can easily secure a doctor’s certificate within a day, while a person who is not insured or underinsured, or does not have a regular healthcare provider, without the necessary documentation can stay behind.
Tory Cross, a 27-year-old man with severe asthma and Ehlers-Danlos syndrome, said the lack of verification requirements is indeed crucial to California’s commitment to equivalent vaccine.
“It is very important for people to be able to take self-testimony,” she said. Many people lost their health care during the pandemic and may not have easy access to a doctor. ‘In addition, I have as many disabled people as I know, with invisible disabilities [like asthma] was really worried that we would have to reason with vaccine providers to make them believe we were at high risk. ”
When Cross got an upcoming appointment at Safeway, she “sobbed like a baby” of relief, she said Monday.
Others have not been so happy yet. Some people, including asthma sufferers, have already expressed confusion on social media about whether they are eligible for vaccination according to the latest extension. Some complained that appointments had already been booked when they tried to obtain a lock, and wished the state had started the process earlier.
Under current guidelines, Californians do not have to disclose what condition they have, only that they are eligible – a ruling expert reviewed the health privacy legislation and pointed out that not all people involved in vaccine administration, including volunteers at provincial sites, bound by doctor-patient confidentiality.
In Los Angeles County, public health officials estimate that 1.5 million to 2 million residents qualify under the new fitness list and this week reserved about 19% of the allocated 181,560 first vaccine doses for those with underlying conditions.
“We don’t really have a definite number … how many people are eligible under the current new guidelines issued by the state,” Barbara Ferrer, director of public health in LA County, said Monday. “The bigger unknown is how many people have a disability, or a condition that puts them at risk, that was not on the list.”
The state provides a list of ten common conditions that are eligible for vaccination, but also includes a non-specific category of “individuals who are likely to develop serious life-threatening illnesses or deaths due to COVID”, which is intended to help local health care providers enable their clinical judgment.
Some people may suffer from diseases that they think are high risk; others have rare conditions for which there is little or no government data. Ferrer said people who are not sure if they are eligible should consult their doctor or provider.
In guidelines released Thursday, the state provided examples of who is eligible for the vaccine under categories not clearly listed, including those who receive home care or receive care at an independent center.
“California has been from the middle ground of priority to accepting the vaccine to the best in the country,” said Andy Imparato, executive director of Disability Rights California, and a member of President Biden’s COVID-19 health equity task force. .
Other states have also implemented a system of honor by not requiring extensive verification. The belief is that eliminating the barriers to getting the vaccine will benefit those at greatest risk and help fairness.
‘Some can reason,'[California] open the lock, are you not worried? “My answer is a resounding no. I think anything the state has done to try not opening the floodgates would create obstacles, ”said Imparato.
It is possible that some jurisdictions may implement a stricter verification process outside of state guidelines. But for now, experts are optimistic that the deployment will not be overwhelmed by fraudulent behavior.
“I think most of society in a situation is interested in fair play,” said Dr. Jeffrey Luther, a member of the state’s vaccine advisory committee and a board member of the California Academy of Family Physicians, said. ‘You’re starting to think there’s a crazy rush for vaccines and no one can be trusted. I do not think that is true. ‘
Luther had earlier asked patients questions about when they would qualify and how they could get a chance. Over the weekend, he said questions were rather from people asking if their condition met the requirements.
While vaccinations are on the rise, the state still has a long way to go. As businesses and schools begin to reopen, many Californians are still waiting their turn to be vaccinated. And all the time coronavirus variants are increasing.
But the latest expansion of the vaccine is a significant sign of progress, Bibbins-Domingo said. “I think things are moving in the right direction,” she said.
Although the system does allow fraud, many accept it as it means that people at high risk can get doses.
“I would much rather know that someone lied about being vaccinated than know that they are not getting it at all,” said Emma Alvarez-Gibson, 45, who is diabetic and has been in quarantine for a year. is. “The goal is for everyone to be vaccinated.”
Experts have said that fraud is inevitable in some 40 million people.
“Public policy cannot force people to be good,” Kheriaty said, pointing out that the system can only “shift or discourage” people from making wrong choices.
“To make society work, especially in such circumstances,” he added, “you have to try to trust that most people will act in a reliable and fair way many times.”