Hospitals are contending with tensions over who will receive the first Covid-19 vaccines

Overall, the initial roll-out of the vaccine was rocky in places, with hospital systems in New York and California changing course after they started immunizing workers. Mount Sinai Health System in New York said it had falsely included vaccinations in the first wave at some clinics. Three employees of the clinics received vaccines. Stanford Health Care revised its priority list following Friday’s protests by specialist training doctors who said they had been falsely overlooked.

“Our revised approach, driven by the same principles of equality and ethics, prioritizes health professionals in our clinical settings, including residents, fellows, nurses, environmental services and others, to ensure they are vaccinated first,” said Niraj Sehgal, Stanford The chief physician of health care said Sunday.

The original algorithm took age and other criteria into account to calculate the overall risks of Covid-19, she said.

Doctors in training, known as residents and fellows, at Stanford and the University of California San Diego Health said they had little advance explanation of how the first shots were assigned. However, concerns grew over reports that many of their ranks had not received vaccines. “We all had a lot of questions about how this happened, what was done, what was in this algorithm?” said Jessica Buesing, a Stanford resident.

Early in their careers, doctors have little power in the workplace but do a lot of front-line work in hospitals, said Sean Li, a primary care physician and chair of the Association of Residents and Fellows at UC San Diego Health. The doctors are seeking a say in the plan to distribute further allocation of the vaccine, he said.

Private employers should not disclose details of how they have prioritized employees, but they risk undermining confidence in a fair trial, experts in law and ethics say. “Because they haven’t explained their policies, you can’t give them the benefit of the doubt,” said Govind Persad, an assistant professor at the University of Denver Sturm College of Law.

The introduction of the initial supply of Covid-19 vaccines is forcing tough decisions by federal panels and government agencies about which industries to vaccinate after healthcare. An advisory panel on Sunday recommended that the nation’s oldest, along with teachers, supermarket workers, police and firefighters, and other sectors essential to the economy and at high risk, should be vaccinated next.

The advisory panel, which held its meetings in public and released information on the data and methods used to make its recommendations, stressed the need for transparency in its decision-making.

The range of vaccines is expanding, with two being approved by federal regulators this month for emergency use. US hospital officials say they expect to vaccinate all eligible staff quickly and have tried to do so fairly, but immunizations had to start somewhere.

According to the California Department of Public Health, California hospitals are not required to disclose or disclose vaccine prioritization schedules to the state.

“With limited supply of vaccines, hospitals and health systems immunizing their health workers must establish a process for how to proceed,” the agency said in a statement. “This is a provision at the hospital level or health system.”

Hospitals are unlikely to avoid stress when rationing vaccines, said William Parker, a pulmonologist and intensive care physician who also studies health care rationing at the University of Chicago. “There will never be a perfect plan,” he said. But making choices transparent can allow for pre-rollout feedback, avoiding confusion and mistrust from uneven immunization launches, said Dr. Parker.

Doctors gathered at Stanford Medical Center Friday after discovering through word of mouth that seven of the approximately 1,300 trainee doctors were eligible to receive the first vaccines.

“It is important for us to make it clear to you that residents are currently hurt, disappointed, frustrated, angry and feel a deep sense of mistrust of the hospital administration, given the sacrifices we have made and the promises made to us, ”the leadership of the Stanford residents said in a letter to the top health system managers.

Executives later that day said they would review the process to include more residents.

Stanford doctors immediately recognized the challenges and speed of vaccine rollout in hospitals and praised the health system for its rapid response. But they also called for transparency about the algorithm used to divide doses so that others can understand what went wrong and ensure the vaccine gets to where it is needed most.

At UC San Diego Health, residents and fellows asked to meet with medical leaders late last week after discovering that despite working with Covid-19 patients, many were not offered early admissions, according to an email from the San Diego House Staff Association, a union representing the doctors, reviewed by The Wall Street Journal.

In an e-mail response to the union, Christopher Kane, a physician and dean of clinical affairs at UC San Diego School of Medicine, agreed to the meeting, saying residents and fellows were among the more than 9,000 health workers within three. four weeks.

Residents and fellows expressed concern to the union after noticing that some were not getting injections, despite working with nurses and more senior doctors who were among the first to be immunized, according to a separate email, also reviewed by the Journal.

“There is no transparency on how the risk model was developed,” said Dr. Li.

Dr. Kane said some residents and fellows have already been vaccinated and UC San Diego Health prioritized all hospital ward workers with health workers caring for Covid-19 patients. “We have tried to treat workers with similar risk in the same way,” he said.

In the week of the rollout, UC San Diego Health attempted to communicate its broad priority plans with employees through emails, town halls and direct communications, he said. Residents’ concerns point to the need for further efforts, he added.

UC San Diego Health vaccinates about 500 workers daily, said Dr. Kane.

The health system informed residents by email Sunday evening that it anticipated “significant quantities” of vaccines and would increase vaccination supplies. “The current plan is to include most of the clinical residents and fellows of UCSD who work in predominantly inpatient settings in the vaccination program over the next week,” the email said.

Write to Melanie Evans at [email protected]