US state gives vaccines to aides for elderly, drawing criticism

Boston, Massachusetts, United States – Halee Barlow cannot wait for the COVID-19 vaccine.

But it is not for her. She is desperate to get her father vaccinated – and soon.

Brian Barlow, of Sutton, Massachusetts, about 77 kilometres (48 miles) west of Boston, is terminally ill with liver cancer and immuno-compromised enough to put him at higher risk for serious illness or death from the disease caused by the coronavirus.

The stress of the pandemic and the wait for a vaccine are fraying nerves in Barlow’s family.

“It makes it feel like we’re working against the clock,” she told Al Jazeera. “The more time we wait, the less time we have to really spend with him.”

At 72, Barlow’s father is three years younger than residents now permitted to get the vaccine under the second phase of the state plan.

The next leg of the phase – for people 65 years and older, people with two or more medical conditions listed by the state and residents and staff of low-income and affordable senior housing – is scheduled to start on February 18 but it is unclear when he will get an appointment for a jab.

In the meantime, Massachusetts is offering the vaccine to others.

Under its companion programme, introduced on February 11, the state will vaccinate anyone by appointment who accompanies an eligible senior who is aged 75 or older to one of several mass vaccination sites.

“Now that the vaccines are open to companions, we’re a bit frustrated that it wasn’t first opened up to people who really, really need it, like my dad,” said Barlow, who lives in Revere, about an hour’s drive from her father.

‘Ripe for manipulation’

As of February 16, Massachusetts reported 304,657 full vaccinations and 861,859 first doses administered among its population of six million residents. The state has received a total of 1,527,150 vaccine doses since vaccinations began in December, according to the Massachusetts Immunization Information System.

The state began inoculating in December of last year, first for healthcare workers, nursing and assisted living facilities and first responders. Residents 75 and older were allowed to get jabs earlier this month. Essential workers and people with one comorbidity are next in line, behind the group granted access on February 18, while vaccines are scheduled to open to the general public in April.

In a news conference last week, Republican Governor Charlie Baker said the companion programme is in place to support seniors “who do not feel comfortable navigating the vaccine process” alone. The idea, he said, was to allow the children, spouses, caregivers and neighbours of eligible people to get vaccinated, too.

Criticism was swift.

“The companion system will put thousands of healthy adults ahead of those who have the most significant risk of getting and dying from COVID-19,” 13 state legislators wrote in a letter to the governor the day the programme began.

The legislators called for a halt and for help at the city and town health departments coordinating vaccines for seniors, essential workers and residents with comorbidities. They called the programme potentially “dangerous” for the elderly, claiming it could expose them to scammers as well as the virus.

“I thought it was ill-conceived, stupid, ripe for manipulation and abuse,” Representative Shawn Dooley, a Republican in the state’s 9th Norfolk District, told Al Jazeera. “And that’s been proven out.”

Young vaccine seekers went online in search of senior partners almost immediately, offering rides to vaccination sites. They volunteered to set up the appointments – an online process criticised earlier in the roll-out for glitches and complexity – and provide rides for second doses weeks later.

On the online classifieds website Craigslist, some offered to sanitise their vehicles, open windows, hang plastic partitions between seats and wear double masks and face shields – whatever it takes to make strangers feel safe. “You pick the music,” one person suggested in a short list of perks.

Some offered seniors money in exchange for companion slots – as much as $1,000 – while others shared mini biographies to convince prospective partners of their legitimacy: a college student who claimed to be tested for COVID-19 weekly; a filmmaker in his 20s; a 35-year-old mother of two; a 50-year-old lawyer with a Lexus. “It’s a win for you and a win for me,” he wrote.

Governor urges caution

On the first day of the programme, Governor Baker said his office had already heard “pretty disturbing reports” of people trying to take advantage of seniors, in some cases asking them to pay for the rides.

“Don’t take calls or offers from people you don’t know well or trust, and never share your personal information with anyone,” he urged seniors. “If you’re contacted by someone soliciting to take you to a site, please report it to the authorities.”

Dooley, who called the governor with his thoughts on the programme, said several days later that he was aware of “a bunch” of older people having been approached by strangers via phone and online. The Baker administration, he said, remained “defensive” of the plan despite the criticism.

“It seems like an easy thing to walk back and say, ‘We tried, we were well-intentioned, but we didn’t anticipate people manipulating it,'” he said. “Whenever the government creates loopholes, it creates problems.”

In a statement to Al Jazeera, the Massachusetts COVID-19 Response Command Center said the policy provides “critical care and support” to seniors who are hesitant to visit mass vaccination sites alone. It said the programme has the support of state senior groups, including Mass Senior Care, an association of more than 400 care facilities, and members of the Massachusetts Nurses Association.

Ana, a Massachusetts resident in her late 20s who posted a notice on Craigslist to bring an eligible senior to get inoculated, told Al Jazeera she received two responses to her query – both from non-eligible men offering to sleep with her.

“I put ‘female’ thinking an elderly person might feel more reassured with more info about me, but it’s just led to weird messages,” said Ana, who asked that her last name be withheld due to the “perceived” stigma tied to vaccine seekers.

Ana said she is the caretaker for her mother, who is younger than 75 but has pre-existing conditions that put her at higher risk for serious illness. She said she also cares for her grandparents, both of whom were vaccinated before the companion programme was announced. Her father recently died of pneumonia due to what she suspects was COVID-19, although his nursing home did not test for the coronavirus.

In addition, Ana said she has asthma, which was added to the state’s list of covered medical conditions starting February 18 following pressure from advocates. “I get really sick easily,” she said.

The way she sees it, the companion programme presents an opportunity to help herself, her family and a senior in need of transportation. “I don’t want to cut the line, but I do want to ensure no vaccine doses are wasted and that everyone who’s eligible gets vaccinated,” she wrote in her advertisement.

Unintended consequences

Dr Jonathan Marron, a research fellow with the Center for Bioethics at Harvard Medical School in Boston, said the state’s offer seems well-intentioned but comes with unintended consequences.

“You could argue that this companion plan is sort of treating a symptom and not treating the underlying problem, which is getting vaccines to the elderly rather than getting the elderly to the vaccines,” he said.

“It’s not unique to Massachusetts, but there is a lack of adequate infrastructure as to how we’re rolling out the vaccine programme.”

The state’s three-phase approach and the companion programme in particular highlight distribution inequities that could be abated by setting up more vaccine clinics in under-served communities, Marron said. Then, the elderly who live in isolation or lack regular interaction with others, have better and safer chances of being treated.

“In Massachusetts and other places around the country, the highest rates of vaccine are among the wealthy, among [white people], those in positions of advantage within any given area,” Marron said. “We need to figure out how to get vaccines to those in poorer neighbourhoods and diverse populations and the elderly without expecting them to come to Boston or big vaccination centres.”

Tending appropriately and thoroughly to the most vulnerable populations takes time, money and effort, including a willingness to address vaccine hesitancy in some cases and explain why the COVID-19 vaccines should be trusted – an endeavour that Marron said is easier said than done.

“If there is a perfect system, I certainly don’t think we’ve found it yet.”