The Covid-19 vaccine could wind up on the black market, experts are warning.
The much-criticized rollout by the Trump administration has laid the groundwork for a scenario in which the rich and the politically connected use their money and power to cut in line and get vaccinated before everyone else, they said.
New York Gov. Andrew Cuomo has already threatened to impose fines of up to $1 million and revoke the licenses of doctors, nurses and others who don’t follow state and federal vaccine distribution guidelines, which currently place a priority on inoculating front-line health care workers and nursing home residents.
There have been reports in Miami of big hospital donors getting the first crack at the vaccine and in New York of tycoons flying their friends down to Florida to get inoculated with doses earmarked for a retirement home.
And in Colorado, some teachers are crying foul after nurses and educators in wealthier public school districts and private schools got inoculated first.
“It’s a little frustrating that districts who already don’t have the same wealth accumulated around them were lower on the totem pole,” said a ninth grade teacher in Aurora Public Schools, one of the poorest in the Denver area, who asked not to be identified by name. “The districts that already were receiving a lot of support got this before districts that need more support.”
Arthur Caplan of New York University’s Grossman School of Medicine and one of the nation’s top bio-ethicists said the lament will likely be heard a lot more as the divide grows between vaccine haves and vaccine have-nots.
“We’re hearing about some politicians, some trustees of big hospitals and others getting shots ahead of health care workers and elderly people,” Caplan said. “I’m also hearing that some [drug manufacturing and distribution] companies are saying that as soon as the government contracts are filled, they’re going to make getting vaccines for themselves a priority.”
The result will be higher prices for everybody else, Caplan said.
“Anything that’s seen as life-saving, life-preserving and that’s in short supply creates black markets,” Caplan said, echoing remarks he made in an interviewlast month.
Scarcity helped turn toilet paper and masks into gold early in the pandemic, and it’s likely to do the same for vaccines, making them especially attractive to thieves and foreign copycat artists, other experts said.
"The danger is there is an already existing market for unregulated drugs," said Michael Einhorn, president of medical supplier Dealmed. "And the issue is that products will be imported from foreign countries that may not have as strict regulations as the United States — where product can be diverted, sold on the side and imported to the United States."
Jonathan Cushing of Transparency International, an anti-corruption watchdog organization, issued a similar warning in November.
“The vaccine is likely to have a high ‘street value’, making government supplies an attractive target for theft and diversion unless adequate safeguards are built into supply chains,” Cushing wrote.
Cushing said in an email that so far, he has not seen “any black market issues in the U.S.,” but the potential is there.
"There have been reports of substandard or falsified vaccines already being made in India, and also falsified hand-sanitizers in the U.S.A. appearing throughout the course of the pandemic," he said. "We’ve also seen people using connections to access drugs purported to be therapeutics, such as hydroxychloroquine."
“I’d argue that much of the planning for distribution in the U.S. has been done too late in the day, and the lack of guidelines, and clear eligibility criteria for receipt of vaccines are probably the root cause of many of the issues being faced in the U.S. at the moment," he added. "And subsequently this lack of planning gives rise to opportunities for individuals to jump the queue, and to exploit their position to get vaccines ahead of others."
Dr. Sadiya Khan, an epidemiologist at Northwestern University’s Feinberg School of Medicine, agreed and added that the lack of a coherent vaccine distribution plan is clear evidence the federal government did not learn from its failure to ramp up testing as a means of slowing the spread of the virus.
“The absence of any federal infrastructure across counties and states is leading to an unmitigated disaster in addition to inefficient distribution,” Khan said. “Vaccine distribution is the Groundhog Day of what Covid-19 testing was in the beginning of the pandemic. These considerable delays are likely to lead to more hospitalizations and deaths that could be preventable.”
President-elect Joe Biden, who has joined the chorus of critics lambasting President Donald Trump's Operation Warp Speed for failing to meet its goal of rolling out 20 million vaccines by the end of 2020, has pledged to “move heaven and earth” to accelerate the pace of distribution.
Biden has also pledged to invoke the Defense Production Act, which allows a president to compel private companies to prioritize the manufacture of certain items for national security.
In Colorado, teachers were thrown for a loop this week after the state Department of Public Health and Environment surprised educators by suddenly announcing Wednesday that it was prioritizing first responders and older people. That announcement came just a week after Gov. Jared Polis placed teachers on the state’s priority vaccine list.
By then, school nurses and health staffers at well-off public school districts like the Cherry Creek School District in the Denver suburbs had already been vaccinated as had several teachers at private schools like the Stanley British Primary School in Denver, NBC News learned.
When asked about two private school teachers who posted photos online of themselves holding vaccination cards after getting their shots last week at a local pharmacy, Stanley British Primary School head Sumant Bhat said in an email that it did not organize any vaccinations for its staff.
“While teachers are now in the 1B category, we have communicated internally that they are currently below the line within that category and, therefore, ‘NOT up’ for the vaccine at this time,” Bhat wrote. “We are in frequent contact with our independent school network and our public health partners to determine when we will be able to roll out a thoughtful plan to make vaccinations available to our faculty and staff.”
With the federal government leaving it up to local authorities to distribute the vaccine, Caplan said the likelihood of a nonpriority person being offered a shot is heightened.
Caplan’s advice for resolving this ethical dilemma?
“We think the employee should accept the vaccine,” Caplan and fellow ethicist Kyle Ferguson wrote. “What goals would be furthered by refusal? Those who feel the dilemma’s force assume that their refusal would free up a scarce resource, that the liberated dose would end up in the arm of someone who needs it more urgently. But that is dubitable. It is likely that the vaccine will not leave the institution.”