US vaccine covid
Tara Gallion administers the Moderna COVID-19 vaccine to Eddie Williams at the Delta Health Center in Mound Bayou, Miss,. January 30, 2021. Image Credit: NYT

Washington: When Chanel Maronge saw on Facebook that she was eligible to get a COVID-19 vaccine, she seized the opportunity. The only catch? She had to cross the state line to Mississippi last week, driving 1 1/2 hours from her home in Baton Rouge, Louisiana, to get her first jab.

“The idea of having to wait an unlimited amount of time in Louisiana to get a vaccine just didn’t work for us,” said Maronge, 37, a school librarian who has high blood pressure. Her husband, who has diabetes, and both her parents were able to get vaccinated along with her in McComb, Mississippi.

With overwhelming demand in the early months of the vaccine rollout, thousands of Americans are crossing state lines on quests for doses. The scramble to get inoculated has turned attention to the patchwork of vaccination rules devised by states, given a lack of national, standardised protocols.

With states varying widely in prioritising who can get jabs, “vaccine hunter” groups, which scour the country for places where people qualify for the vaccine, have sprung into action on social media. That has public health officials grappling with how to handle pandemic travellers: Should strict rules be followed, turning away all outsiders, or should as many shots be administered as possible, even if some may go to people from other places?

“The federal government has created this ‘Hunger Games’ scenario where people are out there doing everything they can to get to the front of as many lines as they possibly can,” said Dr. Francisco Garcia, director of the Pima County Health Department in Tucson, Arizona. “The limited vaccine supply provokes even more anxiety because people are trying to get their hands on a very rare commodity.”

Still, Garcia said he did not see a problem with vaccinating people whose official residencies were outside of Arizona as long as they spend significant stretches of time in the state, as many snowbirds and other winter visitors do.

“From a strictly public health perspective, my interest is to achieve a level of population coverage that allows us to have a degree of community immunity,” Garcia said.

Ethnic fault lines

Not everyone views the quandary the same way, revealing ethical fault lines at a time of limited vaccine supplies and thousands of daily deaths from COVID-19. Given the pressing need to vaccinate Americans as efficiently as possible, medical ethicists say it is fine to take a vaccine out of priority order if offered one; some hospitals with adequate doses have offered shots to all employees to avoid wasting supplies, and cases have emerged of extra shots being offered to passersby rather than letting them expire.

But cutting the line - or in this case, crossing state lines - to jump ahead goes beyond that ethical boundary, said Nancy Berlinger, a bioethicist at the Hastings Center, an ethics research institute in Garrison, New York.

Each state gets vaccines based on their own population, Berlinger said. In a public health context, “you’re trying to get another state’s resources for free,” she said. “It’s called being a free rider.”

“When we jump the queue, we’re not only putting ourselves literally in ahead of other people, we are actually working against the health of other people, because some people came into this pandemic with higher risks,” Berlinger said.

More than 27 million people in the United States have received at least one dose of a vaccine, but it is not known nationally how many people have left their state to get a shot. Some states, however, are tracking the issue. In Ohio, at least 21,501 shots went to residents from elsewhere, according to the state’s vaccine dashboard. The Florida Department of Health has reported that more than 57,000 people who live in another state have gotten shots.

Some states have begun cracking down. Kentucky updated its vaccine eligibility requirements this week so that only residents or individuals providing health care services directly to patients in Kentucky would be able to get the shot. The Washington State Department of Health said last week that people receiving a COVID-19 vaccine at one of the state’s four mass vaccination sites must either work or live in the state.

But elsewhere, people are finding ways to travel for shots.

Maronge, the Louisiana resident who got a shot in Mississippi, said she was trying to keep herself and her family safe. People ages 16 to 64 who have chronic health conditions, including diabetes, are eligible to get the vaccine in Mississippi, but not yet in Louisiana.

Maronge’s mother, who is 69, missed the cutoff for Louisiana vaccine eligibility by just a year, but her age group was eligible in Mississippi.

At the vaccination site in McComb, no one asked for proof of residency, Maronge said, and workers inquired only about medical history and preexisting conditions. Maronge said that she and her husband made it clear they lived in Louisiana, but that it did not seem to bother the staff.

Puzzling maze of rules

The varying vaccine approaches in every state have created a puzzling maze of rules that may be exacerbating the temptation to seek shots away from home.

In Georgia, anyone 65 or older is eligible for a COVID-19 vaccine, but just across the state line - in Tennessee, Alabama and South Carolina - that is not the case. In Alabama, anyone 75 or older can get a shot. In Tennessee, the cutoff is 70 or 75, depending on the county. In South Carolina, it is 70.

Georgia’s health commissioner, Dr. Kathleen Toomey, has called crossing state lines for shots “irresponsible and selfish” but said the state would not crack down to try to prevent it.

“I think it’s important that everybody know we’re not going to be checking driver’s licenses, we’re not going to police this process,” she said in a news briefing last week. “Does that mean that somebody may slip in from out of state? Possibly.”

But while every state should be prioritising its own residents, Toomey said, the collective goal is for as many people to be vaccinated as possible. Rhode Island is the only state that has yet to expand its eligibility to older members of the public.

In Georgia’s northwest health district - a 10-county region bordering Tennessee and Alabama - some people have travelled from other states to get appointments, said Logan Boss, the district’s spokesman, though he said the numbers were very low.

Every person is asked to show identification, he said. But those who cannot show an ID - and even those who bring an ID from another state - will not be turned away, he said.

Given the differences in states’ supplies of vaccines and the different paces of their rollouts, it is unsurprising that people would go wherever they could to get the vaccine as soon as possible, Boss said.

“We sort of anticipated that,” he said. “I don’t think it’s problematic. Certainly, every state wants to take care of its own citizens first if at all possible. But the ultimate goal of this vaccination process, which is going to be a marathon, not a sprint, is to get as many people immunised as possible.”