COMMENTARY

COVID-19 Vax: Don't Let Perfect Be the Enemy of Good

Arthur L. Caplan, PhD

Disclosures

February 24, 2021

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the New York University Division of Medical Ethics at the Grossman School of Medicine. There's been a lot of discussion about fair allocation of vaccines, with all sorts of opinion pieces, arguments, public officials issuing threats, and advice. It's really one of the hottest topics out there.

The issue is whether individuals should go out of order or jump the line. Is it ever acceptable to take a vaccine when you are technically either not in an eligible group or perhaps not even next in line to get a vaccine?

I hear that some people have flown to Florida because they think that if they get in line in some of the vaccination sites there, they'll get vaccinated regardless of age or priority group. There are allegations that people are getting vaccinated in Florida who are snowbirds, not state residents, or even Canadians. Some people are taking advantage of their money and their resources and just flying down there and getting the vaccine that way.

That's wrong. That's not dealing with waste or surplus; that's trying to push using your resources to the front of the line ahead of others who might be more deserving.

There are also allegations that some private practices have been able to get vaccine supply and just give it out to the people in their practice, whether or not they were high risk or not priority. That's wrong. You don't want to be in a situation where people have a black market and basically say that if you pay a fee, you'll get the vaccine.

Still, it is a situation in which sometimes, even trying to follow the rules to the letter of the law, you're going to find situations where people are going to redefine who's an essential worker. I've seen that happen in some hospitals that got vaccine supply. The recommendation is to give it to people first who are frontline workers and then move on to nursing home residents or others.

The hospital says, you know, who are essential workers? IT, the billing department, security, and people who help people find their way through the hospital as guides. They include them. They said they cannot run if some of their management team isn't vaccinated. They say that's essential to the workforce.

Technically, they're out of sorts with the priority list, but I might well defend those choices if, again, they have a vaccine surplus because they got too much, a refrigerator broke and they don't know what to do, or they've had a ton of refusals. In those kinds of situations, you have to grab the people that you can keep track of, follow up for second shots, and that are in your system. I think that's the right thing to do.

In general, the principles that I think we ought to follow are these. First, get vaccines out of the warehouses and out to as many sites as possible. Second, try to get a consistent policy. If people in one state are getting vaccines and in the next state they're not eligible, that undermines trust and willingness to cooperate with these priorities. The more consistent we can be state to state, the better. We haven't done that, but we should try to do that in the future.

Third, be in a situation where you plan for emergencies, for surplus, for freezers to break down, and for people to say no. Most likely, you're going to have to continue to vaccinate at your own facility because that's where you get the people, that's where you have their records, and that's who's in there.

I would tell someone who feels guilty that they're getting vaccinated when they know there might be someone somewhere else who's more in need of a vaccine, to take it because there's no way right now that we can ship it or get it anywhere in reasonable time to that other person who might be in greater need.

If we, as a country, want to set up rapid redeployment, trucks that can move in or ways to move people to where the vaccines are, that's great. We don't have that now. We can barely get the vaccines to the places where we want them to be.

Last, it's better to get vaccines into people's arms than to let our worries about following the right rules and priorities hinder vaccine administration. The perfect should not be the enemy of the good. It's an old saying, but it's wise. I'd rather see more people vaccinated, even if some of them technically don't meet the priority list, than to waste it, throw it away, or not use it at all.

I'm Art Caplan at the Division of Medical Ethics at the New York University Grossman School of Medicine. Thanks for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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