Tight controls on COVID-19 vaccine may limit queue-jumping for the well connected

With vaccinations against COVID-19 now underway, at least one prominent individual has said he won’t jump the queue to procure a dose for himself — the CEO of the giant pharmaceutical company and vaccine manufacturer, Pfizer.

“None of the executives and board members will cut the line,'” Albert Bourla recently said on CNBC’s Squawk Box.

With a limited supply of doses, government officials around the world have prioritized who gets the vaccine first. That means front-line health-care workers, people living and working in long-term care facilities and the elderly are generally first in line.

The initial scarcity of the vaccine has prompted concerns that those with wealth, power and celebrity may be able use their position to cut in line to get a dose. But the tight controls placed on the initial rollout could make queue-jumping challenging, say some experts.

“I don’t see a lot of room for queue-jumping early on, given the adoption of explicit prioritization criteria and the controls in place on who gets immunized,” Dr. David Naylor, co-chair of Canada’s COVID-19 Immunity Task Force, said in an email.

Dr. Isaac Bogoch, an infectious disease physician and member of the Ontario government’s distribution task force, said that vaccines are purchased in bulk at the national level and then distributed to the provinces for distribution.

“So it is unlikely that there will be opportunities to jump ahead in line,” he said in an email. “Still, I’m sure in a population of close to 38 million there is always the possibility that it could happen, but it will likely be an infrequent event.”

‘Pretty tough to game that system’

In the United States, Dr. Eric Toner, a senior scientist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said he believes it would still be difficult for the wealthy to get priority access, considering the registration process of getting the vaccine.

“Nothing’s impossible, but it’ll be pretty tough to game that system,” he said. “I suppose one could, and there are ways you could cheat.

“But I don’t think there are a lot of ways for a wealthy person to cheat any more effectively than somebody who wasn’t wealthy.”

The issue of queue-jumping was raised just last week following a report that the National Hockey League was looking into the private purchase of the COVID-19 vaccine.

That professional athletes might be able to receive the vaccine ahead of others sparked a social media backlash and prompted a clarification from the league that it would only consider purchasing any excess doses.

Yet the hint that some with access to power might have a quicker path to the vaccine may have led U.S. President Donald Trump to announce a reversal of course after the New York Times reported that his administration was planning to rapidly distribute doses to its staff.

Meanwhile, National Football League commissioner Roger Goodell said on Monday that players and personnel would not be jumping the queue for vaccinations before Super Bowl LV, scheduled for Feb. 7, 2021, in Tampa, Fla.

Currently, the ability to jump to the front of the line may also be made more challenging by the requirements of storing the Pfizer-BioNTech  vaccine — it must be kept frozen at between –80 C and –60 C.

“It’s possible that a wealthy organization like the Toronto Maple Leafs or the NHL could do a deal directly with Pfizer and   procure the refrigeration units necessary to just store it,” said Dr. Joel Lexchin, an emergency physician and an associate professor of family and community medicine at the University of Toronto.

“For individuals, I don’t think that’s realistic.”

Pfizer says no private sales during pandemic

So far, however, Pfizer has been adamant that during the pandemic, it will not be making private sales.

“Our COVID-19 vaccine contract is only with the federal government, and we’ll be providing doses according to the designated vaccination locations,” Christina Antoniou, a spokesperson for Pfizer Canada, said in an email.

“During the pandemic, [we] are committed to bringing this vaccine to help meet the global public health need and only plan to sell the vaccine to the Government of Canada.”

Ben Osborn, Pfizer’s U.K. manager, made a similar commitment, telling the Financial Times that “there are no plans to supply the private sector for the foreseeable future — no chance at all.”

WATCH | Trudeau says vaccine rollout won’t be affected by private companies’ interests:

Following a report the NHL is interested in purchasing COVID-19 vaccinations for their players, Prime Minister Justin Trudeau told the media on Friday there is nothing any private company can do to “slow down the delivery of [free] vaccines to Canadians.” 0:56

Still, Lexchin, who co-authoured a piece about jumping the queue in The Conversation, which publishes articles from the academic and research community, said the opportunity to queue-jump could change when more vaccines are approved.

“I think it’s definitely a concern,” said Dr. Monika Dutt, a public health physician based in Sydney, N.S., and a board member of Canadian Doctors for Medicare.

“At any time, if there’s a company willing to sell something and someone willing to buy it, that is a risk.”

Arthur Caplan, a professor of bioethics at New York University, said that certainly in the U.S., the potential that celebrities or persons of wealth might jump the queue to get a vaccine is “very real.”

“It’s definitely the case that there are clinics, hospitals, concierge practices, private companies that can throw money and try to divert some amount of supply either to an individual or to a group,” he said.

He acknowledged that with the supply currently controlled by government, it would make it more difficult to divert vaccines.

“But nonetheless, if you send your supply to Hospital X and CEO is there and somebody calls him up and says, ‘We need to get this,’ that’s where you might see some diversion.”

Caplan said he doesn’t believe queue-jumping would result in a major shift in resources, but even a small degree of diversion undermines trust and support for the rules.

Essential worker debate

However, Toner, of the Johns Hopkins Bloomberg School of Public Health, said what will likely be a bigger issue is the debate over who should be declared an essential worker in order to move ahead in line to get a shot.

“I’m already seeing lots of it here, that everybody, every group that has a national association, that national association is advocating for them to be a priority group.”

Naylor, of Canada’s immunity task force, suggested there could be some “gaming later on,” when the priority groups are larger and the delivery is highly decentralized.

“At that point, I doubt it will be only the wealthy and powerful.”