Don’t be mad about individuals getting the vaccine. Be mad about vaccine inequity.
When I get one of the many Covid-19 vaccines available in the US — and I will surely be jumping at the first opportunity — I am not going to tell anyone. I will make my difficult-to-procure appointment, wait for the day to come, probably take an Uber to the glass mountain called the Jacob Javits Center, get my little jab, and keep my vaccination a secret between me and the volunteer who injected me.
I won’t tell anyone because, frankly, people are ruthless.
On social media, various users are screaming into the ether about the people they feel have “cheated” to get vaccines. While eligibility varies from state to state, allegations of cheating the system usually manifest when someone sees — usually also on social media — a person getting a vaccine who they don’t believe fulfills the requirements.
People have scammed. A certain semi-famous cycling class instructor made national news, including on this website, last month when she obtained a vaccine by saying she was an educator. But while Stacey Griffith was fudging the rules in plain sight, the discourse has exploded in all directions: into allegations that people might be lying about underlying health conditions; into anecdotes about people going to different states entirely to obtain injections; into interrogations about how much a person weighs, since body mass index (BMI) is a vaccine qualifier in states like New York. A newscaster in DC was suspended because he ranted vociferously online about how fat people don’t deserve the vaccine.
While this entire rollout feels like the Hunger Games with a vicious peanut gallery, one of the things that keeps getting bandied about is the idea that more vaccines in more arms is better. While public health officials and bioethicists say those who qualify should not hesitate to get it, the equation might not be as simple as “the more, the better” either.
The vaccine, we’ve been assured over and over, is the light at the end of the tunnel. But the rollout has also awakened American fears of inequity and sharpened them into shame and blame. It’s coaxed ugly behavior that, it turns out, really does nothing when it comes to equity or access or eliminating “cheating.”
Shaming someone comes from a place of fear
Shaming people, especially when it comes to disease, is something Americans have proven themselves to be really good at. The US has a history and culture of associating disease with blame, shame, and personal failure. One of the big reasons why we scapegoat people who get sick is that it helps us rationalize our own fears about a disease.
The pandemic has been no exception.
We’ve seen shaming of people who weren’t wearing masks. Then, the shaming of people who flout social distancing rules and post on social media. Now, the shaming Eye of Mordor has spotlit people who might be skipping the vaccination line. The targets have changed over time but the shame is constant.
Vaccine shaming is very different from the other two examples. Someone getting vaccinated doesn’t visibly put anyone else in danger of getting the virus the way a maskless person or quarantine traveler does. But the perception is that because this person is getting the vaccine before others who still need it, they’re somehow pulling the ladder up behind them — especially since the vaccine is so scarce.
That’s a narrative underscored by fear.
“This is speaking from my personal opinion, but I think those fears are normal and are very understandable,” Jen Balkus, an infectious disease epidemiologist at the University of Washington, told me.
She points out that doctors, health experts, and the general public have, essentially, been learning as we go along. There was no guidebook or roadmap for the pandemic and no timetable for when it will end, and we’ve all been trying to survive, all while dealing with the looming threat of disease hanging over us.
Fears and frustration are high. So is the demand for the vaccine. Because of the vaccine’s scarcity, and because the rollouts have been clunky and difficult for some people to navigate, those feelings have been amplified.
“Because we still are in this trauma, I think we still don’t fully comprehend how incredibly difficult our lives have been. It’s been so hard and now there’s something that can drastically reduce the likelihood of infection, which is vaccination,” she said. “I think our feelings about this might be a little bit different if people had more faith in the rollout and had it been a smoother process.”
James Delaney, a professor at Niagara University who specializes in the philosophy of medicine, explained that what we’re seeing happen with the rollout isn’t unlike the way the US determines someone’s place on an organ donation list. Those lists, similarly, are cultivated and created by experts to determine who needs what most. Those discussions are usually rife with rigorous philosophical and ethical debates.
For example, who do you give a new liver to, the person with liver disease caused by alcoholism or the one caused by genetics? Is a 30-year-old or an 80-year-old a better candidate for a heart transplant? If you’re going to say no to one person, why did you say yes to the other?
The same scenario is happening with vaccine allocation and distribution. Experts have determined the order in which people get it. And while that looks great on paper, that doesn’t eliminate the human impulse to question it.
“The hard thing is, for almost anybody, you can make the argument, ‘Here’s why this person really should get or really needs a vaccine,’” Delaney told me. “But here’s the catch. Whenever you ask that question, you also have to ask, ‘Okay, then who do you want to take it away from?’”
Seeing how we’re all living in a state of fear and frustration and being told to adhere to this tiered determination of need, people lashing out at “cheaters” who they believe skirted the system makes a lot of sense. What doesn’t help the situation are, say, semi-famous SoulCycle instructors getting the vaccine by claiming they are educators, or anecdotes about various people obtaining the vaccine through unseemly means.
Young and healthy people who aren’t essential workers getting the vaccine “feels like fucking cheating and I hate it,” a public health expert who asked for anonymity because they’re working on a state’s vaccine rollout told me. They explained one bright side, though: “Honestly, probably a lot of the people who are cheating are the ones who are fucking stupid and going out anyway. And you know what? Fine, vaccinate them.”
The problem is that if you start thinking everyone is cheating around you, it’s tempting to start judging, based on a person’s appearance, whether they deserve to get the vaccine.
Caught in the crossfire are people living with disabilities or underlying health concerns who now have to justify their vaccine appointments. Those people, incorrectly shamed, likely outnumber the actual line jumpers. That shame may inhibit people from getting an appointment. All the public health experts I spoke to said that if you fulfill the requirements honestly, you should make an appointment.
“If you qualify for the vaccine, absolutely get the vaccine,” the angry anonymous public health expert told me. “Everyone who is eligible should be trying to get appointments.”
The actual problem with vaccine “cheating” is inequity
Lashing out at someone is really fun and satisfying because you could ostensibly ruin their day. Yelling at structural inequality does not, unfortunately, have the same payoff.
Vaccine cheating urban legends, and the shaming they inspire, are actually symptoms of a very big, much tougher problem of vaccine inequity.
Balkus, Delaney, and my very frustrated and angry anonymous epidemiologist, all pointed out that the communities disproportionately affected by the virus — Black and brown people, and people living under the poverty line — aren’t the people who are getting the vaccine.
“What you’re seeing on social media is outrage at privilege,” Balkus told me. “But there isn’t a comparable level of outrage at the real issue that needs to be addressed. We need to get back to work with poor communities and communities of color to be able to provide vaccines to those individuals that need it. In many areas, that process has not gone smoothly. And that is a massive issue.”
An example of that happened in New York City, where a vaccination site was set up in Washington Heights to service a hard-hit Latino community. Instead of the Latino community getting the appointments, the vaccines went to a large number of white people who came in from neighboring areas.
In New York City and beyond, getting a vaccine in most places requires participating in a process that resembles trying to get tickets for your favorite pop star’s concert. It’s endless refreshing, clicking, and checking websites throughout the day — a process that favors someone who has the ability to work from home, has resources, and possibly friends and family to help them get a vaccine. That process doesn’t favor someone who has to work a job all day, commute back and forth, and live paycheck to paycheck with a limited schedule.
The current system, quite simply, isn’t built to tend to people who need the most help.
“That kind of ‘if you build it, they will come’ model of vaccine distribution is just not terribly effective. And that’s not because of vaccines, that’s just because of the way that public health crisis functions,” Nicholas Evans, a bioethicist at the University of Massachusetts, Lowell, told me. Part of Evans’s research includes Ebola outbreaks, which he cited as examples of how to get care to people who don’t have means and resources.
“If you want public health to be equitable and effective, you need to go to people in their communities and spend the resources to meet them on their own terms, and make sure that you’re giving these scarce resources to the people that need them, and not expecting those people to come to you,” he said. “It would be more costly to do so. But wars take a lot of money, why shouldn’t public health?”
I asked Evans about a popular refrain I’ve been hearing, that there’s a greater good to be had if everyone gets vaccinated — that more shots in arms means we’re all safer, regardless of how deserving you may think someone is.
Evans challenged me to think beyond that idea.
He argued that the goal with the Covid-19 vaccines was to determine who is at risk and protect the people who are most at risk of landing in an ICU. Prioritizing speed and numbers isn’t exactly congruous with that if those vaccines aren’t going to the most vulnerable people.
“You don’t get to say you care about equity and then just throw it out the second a bit of speed is involved,” Evans said. “Speed doesn’t matter if you’re only vaccinating people who are never going to end up in the ICU in the first place. I think that people who say it’s about shots in arms are not taking the function that equity plays in health care seriously. Equity isn’t just about protecting individuals, it’s about protecting society in general by stopping ICUs from overflowing and stopping people from crashing health care systems.”
That said, Evans, and all the public health experts I spoke to, said that if you’re available to receive a vaccine — get one. One can both be incensed about vaccine inequity and not waste time trying to guess who deserves it on an individual basis. The key is to direct that energy toward calling public health officials and lawmakers and voicing concerns about inequality. We can ask the system to be better, instead of individuals.
“People have the fights that are close to them; some can only fight the battle that’s in front of you,” Evans said. “And for most people, the battle that is in front of them, it is the yoga instructor who’s getting the vaccine ahead of the homeless person or the prison inmate. But if you step back, there are looming threats and systemic issues that are much harder to deal with and require us to act together collectively.”