Many experts have written about the importance of making covid-19 vaccines available to family caregivers of frail older adults and younger people with disabilities. But how can states do this? It turns out to be really complicated.
Massachusetts shows what happens when one state decides to vaccinate not only older adults, but also the people who bring them to get their shots. On one hand, this system holds the promise of getting shots relatively easily and cheaply to those who most need them. On the other, it has created opportunities for people to effectively cut in line to access a scarce resource. And, predictably, it has generated a firestorm of criticism about fairness.
The vaccine exception
Here’s the story: In the Bay State, you must be age 75 or older (or meet certain other criteria) to get a shot now. But because many older adults struggle to get to a vaccination site, the state made an exception: It also vaccines a “companion” if they accompany a senior—even if the driver is otherwise not yet eligible.
At first glance, this sounds like a great idea. A family caregiver or friend could take an older adult to get the vaccine. This could deliver doses to both frail elders and their caregivers quickly and easily.
But any economist could have told state officials what would happen next: Young people would begin to drive seniors they do not know so they could get their own shot faster.
Within a few days, Craigslist began to fill up with offers to drive seniors for free. Then, some young people offered to pay (sometimes up to $200) to drive seniors to vaccine sites. Next, people reportedly began acting as brokers—for a fee, of course– connecting drivers looking to score a quick vaccine with older adults seeking rides. Within days, an entire vaccine-driver market developed.
A fine idea, or not
On one hand, this is all just fine. For a low marginal cost—vaccinating people who eventually will get the shot anyway—the state found a way to get more older adults to vaccine centers. And it will help get doses to family caregivers, an important step.
On the other hand, it is not so fine. With shortages, every young person who gets a shot means the vaccine will be delayed for someone at higher risk. And since there is no vetting of these drivers, frail seniors risk being scammed by random strangers.
Most of the time, there will be no problems. Family members, good Samaritans, or honest people looking for a quick vaccine, will serve as drivers. But not every time.
Then there is the matter of cutting in line. Vaccine is, of course, scarce, and states are carefully rationing doses. And they are doing so in extremely complex ways—by age, occupation, location, race, pre-existing medical conditions, and on and on. Every new category makes the appointment and distribution process more complicated and slower. Now, government is adding yet another criterion—people with a car, time, and a desire to get a quick shot.
No way to stop gaming
Short of having enough doses or making the vaccine available to all comers, there is no realistic way to stop the gaming. As long as vaccine is being rationed, people will find ways to avoid the rules.
Critics of the Massachusetts plan say the state ought to create a waiting list for those who want to get left-over doses that otherwise would be destroyed. That is an excellent idea—one already being used in West Virginia and in Israel—both places that have had good success vaccinating their residents.
But doing that would make it easier for young people to get the vaccine without accompanying seniors. And that would reduce the availability of willing drivers and leave those older adults with fewer ways to get their shots.
Another solution would be to bring the vaccine to frail seniors. That’s a good idea too. But it would be much more expensive than having a bunch of Millennials drive older adults for the price of a quick dose of vaccine.
Some states, such as California, are trying to avoid gaming with paperwork. California gives shots to caregivers of people with developmental disabilities. However, it requires documentation that someone is in fact a caregiver of someone with a recognized disability.
The result of that strategy seems to be both gaming and angry caregivers. Some people are faking the documents. Others with legit paperwork are being turned away by the vaccine center staffs who don’t know what to do.
The bottom line: States can take steps to maximize vaccine distribution to older adults and their caregivers but by doing they may limit doses for other high-priority residents and create other risks for the seniors. Given the great risk of serious illness and death among older adults, that’s a trade-off that may be worth making but, like everything else in covid-world, it is complicated.