In theory, random extra-dose lotteries give anyone a chance at early vaccination. In practice, though, they privilege those who have the time to wait all day and the wherewithal to know that’s even an option. The lines are not organized by vulnerability or social good; they’re organized by who wakes up earliest. At the H Street location, Angelean Redman seemed to be in prime position on Sunday morning. She arrived at about 4:30 a.m., early enough to snag the second spot in line. Redman, a retiree who told me she’d worked for more than 40 years at the Pentagon, falls within two of the pandemic’s most vulnerable demographics: She is Black and older than 65. (On Sunday, the city had not yet opened its vaccination campaign to people older than 65.)
In line, Redman slept in a chair, did crossword puzzles, and made a pact with the young man ahead of her to save each other’s place when one of them went to the bathroom. At the end of the day, the pharmacist announced that only one extra dose remained, and it went to someone less vulnerable. Redman had waited 10 hours around other people for nothing, at considerable risk of exposure to the virus.
To some extent, this whole mess was inevitable. “The fact that there’s some doses left at the end of the day is the nature of the beast,” Saad Omer, a vaccinologist and the director of the Yale Institute for Global Health, told me. Pharmacies have no choice but to decide what to do with the leftovers, and anything is better than letting precious doses go to waste. “It’s obviously not ideal to have that kind of a situation, where you have high-risk groups and they’re not receiving it,” Omer said. “One thing I hope people realize is that the staff there are trying to do their best.”
Still, he stressed, the problem is that no clear, widespread plan exists for what to do with the extra vaccines, and the root of that problem is the lack of guidance from the federal government. Because the Trump administration did not issue a comprehensive national vaccination plan, states have no recommendations to refer to when faced with a tricky situation like this one. And because states could not begin developing their own vaccination plans in earnest until late December, when Congress finally allocated nearly $9 billion for vaccine distribution, they had virtually no time to run the simulations and tabletop exercises that could have foreseen these sorts of problems. At a moment when the pandemic is infecting 250,000 people and killing more than 3,000 every day, these delays matter.
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As far behind as the U.S. is, there’s still time to solve these problems before the vaccination campaign’s next phases, the logistical challenges of which will be far greater. One solution, Omer said, would be for states or companies to institute a system to notify unvaccinated people in the highest-priority groups when an extra dose was available nearby. Within each group, recipients could be chosen by lottery, and if a candidate didn’t respond quickly enough, the system could select a new one. No one would have to wait for hours in dangerously crowded conditions for an extra dose that, on any given day, might or might not exist.