States Rely on Trust as Smokers, Diabetics Step Up for Vaccine

States will largely use the honor system as they broaden the lists of people eligible to receive Covid-19 shots to include those with cancer, diabetes, or other underlying health issues—without having an easy or legally viable way to verify whether someone has those conditions.

The expanded eligibility is part of a larger U.S. effort to speed up vaccinations, but could also open the door to people gaming the system and doing whatever they can to get inoculated.

“We want our vaccinators to be concentrating on vaccination, not being police officers and getting put into dangerous or uncomfortable situations,” Sree Chaguturu, CVS Caremark’s chief medical officer, said on a panel hosted by the Network for Excellence in Health Innovation. “There is an element of trust as a country that we all wait for our turn but when it’s our turn we stand up and roll up our sleeves.”

CVS technicians helped administer vaccines for people living or working in long-term care facilities, who were part of the first prioritization group. The company is increasing the pace of vaccinations in its pharmacies across the country, even as demand outstrips supply. Roughly 1.2 million people are being inoculated daily, White House officials said Jan. 29.

Vaccine administrators likely won’t require a doctor’s note or other sort of documentation to prove eligibility for the next groups. For some states, signing up for a shot will simply involve self-reporting health conditions via an online quiz or portal.

It’s unclear what health officials will do with that information. But guidance is coming from the White House on how to de-identify Covid-related data, which would strip personally identifiable information and ensure compliance with the Health Insurance Portability and Accountability Act, the federal health privacy law.

Honor System

The first round of vaccines prioritized health-care workers and long-term care residents—two groups relatively easy to verify because they were inoculated based on where they live or work. The next group of eligible arms relied on the person’s age, another easy-to-check trait. Checking medical conditions is not so easy.

Even in early stages of vaccination, gaming the system has been an issue.

In early January, two real estate moguls were accused of arranging to have a group of wealthy friends vaccinated at a Florida retirement home. Some of those friends reportedly flew on private jets from New York to get the shot.

In another case in Canada, the former president and CEO of a casino operator and his wife face charges that they broke Vancouver’s quarantine requirements, flew a private plane to an isolated indigenous community in Yukon, and posed as locals to get the vaccine.

Mississippi, Pennsylvania, and other states have opened up availability to people with a wide array of health conditions that could result in severe Covid-19 cases.

Pennsylvania’s online quiz asks people to self-report whether they are smokers or have underlying health conditions like heart disease, diabetes, or obesity. If they mark “yes,” they will see a map outlining administration sites to choose from throughout the state.

“For health care workers not affiliated with a health care system, they do need to provide proof of employment,” April Hutcheson, communications director for the Pennsylvania Department of Health, said. “There is not a requirement for people to provide proof of a condition, however providers are requiring people indicate which underlying condition they have at registration.”

Mississippi has a similar online portal. It asks several questions, including if a person has an underlying medical condition like chronic kidney disease, diabetes, or cancer.

If they mark “yes,” they move on to a list of potential administration sites. If they mark “no” and don’t meet other criteria like age or occupation, the site instructs them to “please schedule your appointment when you are eligible to receive the vaccination.”

Still Figuring It Out

Other vaccine providers are still figuring out what they’ll do when their area expands vaccine priority groups to people beyond health-care workers or the elderly.

The Centers for Disease Control and Prevention laid out a general vaccine prioritization list, but each state is tweaking it slightly. Who counts as an “essential worker” or someone with health issues might vary from state to state.

Imelda Dacones, president and CEO of Northwest Permanente, Kaiser Permanente’s northwest branch in Oregon and Southwest Washington, said providers in her area are still working out how and if they’ll verify the “essential worker” group of participants when their time comes for a shot.

For health-care workers “it’s been word of honor for the most part,” she said at the NEHI panel along with Chaguturu. In other instances, people get a link to schedule their vaccine from their employer, so the employer acts as a screener for who gets vaccinated, she said.

“When we get down to essential workers, as broad as that category is, we are talking about ‘is it a badge from work?’ or in terms of efficiency, do we take them at their word?” Dacones said. “Those are extremes that are in discussion.”