24 ms·

The Vaccine Had to Be Used. He Used It. He Was Fired

• nathancahill 6y ago
  Spent a long time reading about how vast bureaucratic inefficiencies are created by people worrying that "the wrong person" will benefit from government programs or that someone "undeserving" might get theirs before I do. This falls squarely in that bucket. Tragic.
  • happytoexplain 6y ago
    This is the root of a lot of problems. We spend far too much energy making sure "bad people" get what they "deserve" and don't get what they "don't deserve", and put in too little of that same energy in the case of "all people".
    • Wowfunhappy 6y ago
      And then when we don't spend that energy it's a huge scandal!
      • happytoexplain 6y ago
        I'm not sure what you mean - I'm using quotes because of the dubious definition of justice in the context of shared welfare, but obviously there are plenty of scenarios where more direct consequences for being more directly "bad", for various definitions, makes sense, or is at least unavoidable in a human society.
    • mumblemumble 6y ago
      This is a huge part of why, perhaps surprisingly, libertarian think tanks in the US have started pushing for universal basic income. The sheer weight of the bureaucracy that has accumulated due to this way of thinking means that replacing it with a straight-up program of unflinching wealth redistribution would actually make the government smaller. And also make markets freer. The amount of rent-seeking behavior around programs like WIC is just staggering. And it serves the interests of neither WIC recipients nor the general public; it's only there because pearl-clutching is easy to co-opt for financial gain.
      • clairity 6y ago
        this is an ideological argument devoid of meaningful goals to help residents and create a strong economy. who cares, on the face of it, what size the government is? size is not the goal, it's at best a poor proxy metric for (in-)efficiency, which itself is a proxy metric for how much we help people via public goods (and thereby the whole economy). rent-seeking around wic is a rounding error next to property & capital rent-seeking overall. moreover, the right place to place blame (and seek redress) is with the rent-seekers themselves, not the assistance recipients (or the associated governmental programs) being exploited by them.
        • mumblemumble 6y ago
          I'm not sure I see why killing the engine that fuels the rent-seeking gravy train, and, in the process of doing so, taking a huge monkey off the backs of people who are receiving assistance, would somehow misplace blame on those same people. It's simply suggesting that perhaps we should address a cause of the problem rather than only focusing on its symptoms. And the way in which the market gets freer, in this case, is by taking away unnecessary and paternalistic restrictions that WIC imposes on where recipients shop and what they're allowed to buy. Perhaps framing things in classical liberal terms feels like de-centering assistance recipients. I get that, but I'm not sure that's actually a bad thing, in this case. I can't imagine your average WIC participant actually wants to live under a microscope, regardless of the political leanings of the person who's looking through it.
          • clairity 6y ago
            you're mistakenly associating assistance programs with rent-seeking, and moreover focusing on an entirely irrelevant corner of it. rent-seeking will occur anywhere there is wealth to be extracted, which is basically everywhere else in the economy, so that association is unwarranted. you should be looking at where capital is concentrated and deployed if you're truly concerned about rent-seeking over "big government".
            • mumblemumble 6y ago
  • _jal 6y ago
    A lot of people treat the government as authority to rank people, beliefs, etc. in importance. A lot of people, in fact, want the government to do this.
  • A12-B 6y ago
    This is 90% of people's reaction to UBI.
  • Ecstatify 6y ago
    I think in Israel if there is any vaccines left over from that day because people didn’t attend their appointment anyone can show up and get it. Our obsession with fairness is ridiculous.
  • asmos7 6y ago
    Our education in the US is in the same position. We spend far more time, energy and money on problematic students who don't give a rip than we do on dedicated/motivated students. The goal posts aren't there. If a certain number of students fail it creates red flags for the district and if those students are a certain minority that can viewed as evidence of institutional racism and open up legal liabilities as such the districts are highly motivated to pass everyone along but to not to make the good and willing better.
    • TeaDrunk 6y ago
      Isn't the parent stating too many people are doing exactly what you're proposing, which is protesting that services are being provided to people who don't deserve it? (Separating children into deserving and undeserving categories of educational attention seems that way to me...)
      • da_big_ghey 6y ago
        Not separating into inherently deserving and undeserving, but those who desire a good education and those who do not. There are students in poor schools who push to become learned in spite of obstacles. Think Ben Carson for an example. And there are those who have tons of resources and opportunities but fail to use them, those who don't care about learning something. I knew quite a few of the former, people who would go to the library for extra study or to learn things after school. And I knew quite a few of the latter, who would go home and play video games or go out and drink, who didn't care about learning anything. In today's school system, the resources go to those who do not desire an education. This is because of programs like "no child left behind", and because a higher graduation rate looks better. But I think we should make a normative judgement that those who do not make an effort to better themselves should receive no support from society. Put less money into summer schools for kids who fail, and put more money into before- and after-school tutoring. This will benefit those who put in the effort to the detriment of those who don't care, which is a good trade-off.
        • Tostino 6y ago
  • dqpb 6y ago
    Do you have any recommended reading?
  • colechristensen 6y ago
    I was once involved with a young woman in a homeless program which was entirely defeated by this exact "wrong person" attitude. Get a homeless person an apartment? Great. But it didn't end there, there was a constant stream of documentation requirements, your employer had to, monthly, sign paperwork about how much you earned (advertise to employers that you are/were homeless). The program punished you for making money and took most of your earnings away to pay for the housing. The program constantly threatened to take away your funding if the paperwork wasn't perfect. The program constantly made mistakes, paid rent late, and generally threatened a vulnerable homeless person with further homelessness. It was infuriating to experience this through another person. In attempts to help a person, these programs were taking vulnerable people, dangling housing in front of them, and constantly threatening them with taking it away. That is of course exactly the opposite of what you need to do to someone having trouble taking care of themselves, and sadly mirrors the abusive kinds of situation which so often leads people to homelessness.
    • logicchop 6y ago
      Fraud is real, and vast, and if it creeps in it undermines the whole thing. What's the alternative?
      • alasdair_ 6y ago
        Universal basic income.
        • mc32 6y ago
          Negative taxes are better. No need to give to the wealthy in the first place to come back and tax them later.
          • Wowfunhappy 6y ago
            It may seem pointless, but it may be administratively simpler. Similar to how people with government jobs still pay taxes, even though their paychecks come from the government in the first place.
  • titzer 6y ago
    The incredible thing to me is even given that prevailing attitude, corporations still manage to soak the government for billions and billions. There are two sets of rules in this world.
  • mchusma 6y ago
    This is why I generally support universal basic income if it could replace the US safety net. Currently we spend more than it would take to eliminate poverty if we just gave it away. But the beauracratic machine just destroys so much wealth.
    • abfan1127 6y ago
      > the bureaucratic machine just destroys so much wealth that can be said enough!
    • chadash 6y ago
      Do you have numbers? How much do we spend eliminating poverty? And how much would we spend on universal income? Assuming 200 million adults get universal income, that would cost $1 trillion per $5,000 of income. But $5000 hardly gets you out of poverty.
      • Dma54rhs 6y ago
        I suppose the question is does it mean people don't flock them to em super expensive overcrowded cities if they get UBI. I don't have an answer to it personally.
      • rjmunro 6y ago
        Normally Universal basic income plans are combined with abolition of most other welfare, and changes to taxes so that people on all but the lowest incomes end up paying the money back as tax. So maybe flatten all tax rates below 24%, everyone earning more than $80000 is now paying an extra $6000, but you give that back to them as the UBI. Everyone earning less than $80000 pays more tax than before but still gets $6000 UBI, so is better off.
    • adolph 6y ago
      the beauracratic machine just destroys so much wealth In theory I sympathize with the sentiment, but 1) the dole is not wealth 2) the administration costs of the dole don't make money disappear, its just routed into income for the admin workers, 3) the administration costs of the dole do not necessarily decrease with UBI and might increase given a larger population to administer. I generally do not support UBI since the key problem isn't cash in people's pockets, it is lack of engagement with society in ways that add value. UBI papers over the core problem.
  • refurb 6y ago
    It’s a fundamental desire for fairness. Is it really that surprising? Once people start viewing the system as inherently unfair, then it can start to fall apart pretty quickly. Not saying that the vaccine situation in the article is an example of an unfair situation.
  • badsectoracula 6y ago
    There is a comment exactly about this in the article: > Last week a local vaccine site had extra doses nearing the end of the day and word spread. Ultimately, they put them in the arms of whoever could get there in time. > I personally know two unrelated people who raced there and got vaccinated, despite not meeting the criteria mentioned in the article. The only criteria that mattered in this instance were being present and being willing. > This was also in Houston and at an “official” site. I attempted to get similarly lucky at the same site the next day by visiting at closing time. The worker that turned me away told me that because of complaints from those who missed out the day before, they were told to no longer accept walk-ins. I’m content to wait my turn, but that experience combined with this persecution story...I have to wonder how many doses are going to waste in my community.
  • ip26 6y ago
    It's not just selfishness, I think we've run into something fundamentally unintuitive for people's lower brain. For much of human history, shutting out cheats & freeloaders was an important part of making good use of a resource. These days, we have hit a point where the bureaucratic overhead of shutting them out can become more expensive than just letting them in. That's not intuitive for people.
    • ironmagma 6y ago
      The problem with this take is that it’s more useful than just to preserve a resource. By allowing people to get away with fraud you are encouraging people to do it again, including ways that transcend whatever system that fraud was originally within. I don’t actually know that chasing pranksters has ever been an efficient use of time, but someone should chase them if we expect the boundaries of normal operation to be known as a society.
      • ip26 6y ago
        Right, the $36B lost to unemployment fraud (10% of payments) in the past 12 months definitely illustrates that some amount of guardrails are still appropriate. There is an optimum level somewhere in between where the sum total of losses & overhead together are minimized.
        • ryandrake 6y ago
          That $36B is a drop in the bucket on the scale of a country. It's 25% of Jeff Bezos's net worth. How many $B spent on enforcement is it worth to reduce that to, say, $30B?
          • ip26 6y ago
            If you read the news about it, the scams were depressingly basic & the screening failures were rudimentary. It will not cost billions of dollars to rein that number in dramatically.
  • kryogen1c 6y ago
    the real problem is that two core issues exist in opposition: 1) what is the most cost efficient way to solve the problem 2) how people feel about the chosen solution solving 1 does not automatically solve 2. the slider between anarchocapitalism and state-owned and -operated socialism belongs somewhere in the middle and everyone wants to tug it into a different spot. if theres anything the internet + social media is teaching us, its that the public has a very, very bad habit of watching one 15 second video of anecdata and vigorously extrapolating, thinking they have arrived at actual data. all it would take is a couple tweets about some homeless asshole partying in his free government house with his foodstamp money to upset 2 and overthrow 1, even if it was the best solution on the spreadsheet.
    • sudosysgen 6y ago
      There is no slider between state socialism and anarchocapitalism. Economically, there are quite a few more axes. It's possible to have full socialism without anymore state ownership than today, and it's possible to have capitalism with a lot of state ownership, and it's also possible to have cybernetics-market chimera to organize the economy.
  • cameldrv 6y ago
    This is the flip side of it though: https://abc7news.com/california-edd-unemployment-fraud-ca-scam-insurance/10011810/ https://abc7news.com/california-edd-unemployment-fraud-ca-sc... $30 billion in unemployment fraud in just a year, in just one state.
    • pas 6y ago
      "The EDD says it is working to verify the identities of people who made claims and many remain under investigation" It's identity fraud. (Entirely because of the tragic state of US [and global] privacy and state-citizen communication culture.) It's not people taking advantage of welfare and deciding to not look for work. It's career criminals.
      • cameldrv 6y ago
        I agree that it's career criminals, many of whom are even overseas. The problem is that these agencies have to be able to distinguish legitimate vs. fraudulent claims, and sometimes the processes they come up for doing this could be described as "jumping through hoops."
    • tzs 6y ago
      How does that compare to other years, both in total amount of fraud and in what percent of total paid out was for fraudulent claims? If the system is fine except in situations like a once a century global pandemic that throws way more people out of work than normally happens even in most recessions and throws them out of work for longer than is normal where it jumps to a fraud rate of 30% or so (and presumably returns to normal when the pandemic is over), I'm OK with that.
  • bko 6y ago
    I see it more as a power play by the regulating agencies to maintain control. NY Governor Cuomo for instance threatened severe penalties for anyone stepping out of line. If the "undeserving" argument were true, there wouldn't be talk about increasing eligibility to the prison population, especially given their low mortality rates compared to 65+
• cheaprentalyeti 6y ago
  I guess when you do society with "Everything Not Forbidden is Compulsory!" the corner cases cause problems.
• rjbwork 6y ago
  This is just Kafkaesque. People in a position of authority with blind adherence to rules intended for optimal scenarios. They're literally saying he should have just thrown them away instead of distributing them as best he was able. This whole thing is a logistical clusterfuck and they're trying to throw this dude under the bus. It's obscene.
  • BeefySwain 6y ago
    The really telling part to me is that (seemingly) no one from any of the organizations involved (the hospital and the prosecutors office) will come forward and outright say that what was done was immoral. They are all hiding behind a veneer of "what he did broke the rules and my job is to enforce them", which is about the weakest argument one can make in defense this sort of thing.
    • lotsofpulp 6y ago
      Covering your ass isn’t a weak defense for the underlings. There exists a leader(s) somewhere that made the rules and that can change the rules. They are the only ones responsible, and I don’t see why anyone else should stick their neck out and risk their income for it. It’s actually a strategy for leaders to want the underlings to stick their neck out, so that they can be sacrificed as a scapegoat when convenient. (in these bureaurocratic situations, obviously I’m not talking about a leader asking people to murder others and them not being responsible for that).
      • grayhatter 6y ago
        Where does the moral line lie then? what's difference that makes 'just following orders' suddenly not apply? In this specific case; where's the prosecutorial discretion? If it's coming down from on high, why aren't their names in this article?
        • lotsofpulp 6y ago
          With the prosecutor. In a government, it starts with the politician. I don’t know why the article doesn’t state who is responsible for the rule making, but I’m always an advocate for more transparency. > what's difference that makes 'just following orders' suddenly not apply? I don’t know, but this situation isn’t it in my opinion. It can be fixed with a flick of a pen (or email) by a higher up.
• mStreamTeam 6y ago
  Nobody is safe from a social media drive by. But honestly I'm not surprised. Lockdowns and isolation have turned some of my more reasonable acquaintances into rabid social media junkies who do nothing but judge anyone for the smallest social infraction.
  • ceejayoz 6y ago
    What does this have to do with social media? I can't find any mention of social media in the article. If anything, social media is going after the maliciously overzealous prosecutor on this.
    • rriepe 6y ago
      We have a fickle king. Sometimes he executes you and sometimes he rewards you. Just because he does both doesn't mean it's a good situation.
      • ceejayoz 6y ago
        Sometimes he's not involved at all, but people still try to blame him because they've got an ax to grind. There's no indication social media had anything to do with his actions or the ensuing punishment.
        • deleted 6y ago
          [deleted]
        • rriepe 6y ago
          No, he's always involved. People behave as though he is there even if he doesn't get directly involved.
  • jeromegv 6y ago
    Nothing to do with social media. At all.
    • 6y ago
• throwaway0a5e 6y ago
  When you consider the stacked selection biases that apply to the people who come to find themselves managing the government vaccination programs this sort of thing falls squarely within the expected failure modes. The chain of people who fired this guy got where they were by following rules and covering their butts. People don't wind up managing important things for government by bending rules where appropriate, assuming responsibility and using discretion. The system either marginalizes, removes or crushes the spirit of those kinds of people.
• kayodelycaon 6y ago
  As stupid as this sounds, this is extremely standard policy in many, many jobs. Just because something is expiring doesn't mean you can use it against the standing rules and procedures.
  • jMyles 6y ago
    ...it almost certainly makes sense to push back in those cases too, then.
  • La1n 6y ago
    It could introduce corruption otherwise too, selling doses that are about to expire to the highest bidder. Which then could introduce incentive to let more doses "expire". I agree that in this case it seems stupid, but the rule is there for a reason.
    • arcticfox 6y ago
      It says in the article that he was told to get the doses in arms by any method necessary. His method seemed entirely reasonable. A lot of this "it was policy" argument fails when Harris County failed to produce evidence of said policy and its instruction.
    • jeromegv 6y ago
      You are focusing on a very unlikely scenario instead of focusing on the bigger picture, the more people get it, the better it is for everyone, regardless of anyone's status. The rule is there for a reason is a terrible reason to do something that harms our society.
    • throwaway0a5e 6y ago
      Scale matters. The manager's pet getting first pick of the dumpster at a small machine shop is very different than the same thing at a ship yard.
  • learc83 6y ago
    According to the doctor that was explicitly not the policy. His version is that the health department made it clear that they should do whatever they had to do to keep from wasting doses. This lines up with what I know from family members doing vaccinations in other areas.
• SamBam 6y ago
  The same thing has been happening across the country. This is basically states failing to create a proper portal that can provide a vaccine-provider a list of the next n prioritized people in the city, and then blaming the doctors when they don't have arms to inject. This is a failure of management from the very top, and people lower down getting the blame. It is simply insane to me that most (all?) states haven't used the past six months to build proper portals that can do this. This doesn't even need to be some complex medical-records-transfer monstrosity -- allow people to put in their own information (or the information on non-tech-savvy relatives or neighbors), and verify them at the point of injection. Here in Massachusetts, an extremely tech-savvy state, run by a health insurance exec, there is absolutely no centralized way to register yourself, and no way to put yourself on any kind of list at all, besides calling up individual vaccination sites once you become eligible. And there is no centralized list of what vaccination sites have openings (though a private citizen was able to make one via web scraping).
  • ianhawes 6y ago
    This. You would think that state's had no advanced knowledge of a vaccine. In Maryland (my state) the state health director published a "white paper" on what steps they were planning on taking to vaccinate. Then a few weeks later he retired.
  • galangalalgol 6y ago
    Is hippa partly at fault? I wonder how much of our healthcare cost is related to hippa. The only time I have had to use a fax in the last decade is to get my medical records to a new doctor.
    • SamBam 6y ago
      I don't see why it ought to be. That's why I was specifying a non-medical-records-transferring site. Already when you book an appointment, I believe, you simply state why you're eligible for the current group and when you get to the injection site they double-check that (to the best of their ability). I don't believe that any states are requiring verification that you are, e.g., a smoker. So you should be able to just input your data, your age, if you are a frontline worker, whatever, and check the box that you have 2+ of the listed medical conditions. When you get to the site, the triage person can check that. This is no more or less security than currently exists, it just centralizes it.
• logronoide 6y ago
  In Spain this is not a problem: there are always politicians around ready to sacrifice themselves and accept the jab. https://www.euractiv.com/section/politics/short_news/politicians-early-vaccinations-spark-controversy-in-spain/ https://www.euractiv.com/section/politics/short_news/politic...
• kuu 6y ago
  In Spain we had many cases of politicians and public people using this excuse to get vaccinated before the rest (even bishops used it, and not only one!). I think it would be an easy to fix thing: Have a list of extra people available if you end up with an extra dose. It shouldn't be that hard, we had a year for preparing for this...
  • bagacrap 6y ago
    Politicians assume their position by winning a popularity contest, not a foresight-and-competency contest.
    • StillBored 6y ago
      Its called leading from the rear, and that is basically what I thought when Greg Abbott (Texas gov) got his, since AFAIK he isn't in any of the identified groups. https://abc13.com/health/gov-greg-abbott-receives-covid-19-vaccine/8976979/ https://abc13.com/health/gov-greg-abbott-receives-covid-19-v... At least when Biden (referenced in the article) got his, he exceeded the age requirements in most states. The claim that they are doing it to show people its safe is a bit cynical IMHO.
      • ornitorrincos 6y ago
        that works if you show it publicly(and then there is the debate that its bad because you jumped the queue, or its bad because not getting a vaccine shows they aren't trustworthy) But in spain the cases that have surfaced are of mainly politicians who got the shot and tried to keep quiet about it, which think we can all agree its bad.
        • StillBored 6y ago
          So, thats a loophole, just get it done with the camera's rolling? In the US much of the vaccine resistance is a result of the news/propaganda channels a particular party (which Greg Abbot belongs to) uses to generate fear and doubt in order to win elections. So they generate the problem, then they get to help show its safe? I mean they aren't going to convince any of the hardcore conspiracy theory people they weren't just injected with saline. Plus, many of the politicians assume they are more valuable than the political system which is designed to replace them every couple years says they are. Particularly in TX where the governorship is unusually weak.
• whoisburbansky 6y ago
  The bit that stands out about the article, to me, is > Are you suggesting that there were too many Indian names in that group?” Dr. Gokal said he asked. Exactly, he said he was told.
  • netsharc 6y ago
    I wonder if it would've been a scandal if it were "Smiths" who got the vaccines...
• vlovich123 6y ago
  > Late last month, a judge dismissed the charge as groundless, after which the local district attorney vowed to present the matter to a grand jury Considering that grand juries would indict a ham sandwhich, this seems like the prosecutor is reaching just to prolong the process and pain this doctor is going through. Even assuming the best case argument for the prosecutor that he did “steal it”, he vaccinated 10 people with expiring vials. More realistically, given that it was only 10 expiring vials that went to eligible patients, the doctor should be commended for driving around and finding people who needed it. Who the fuck cares if it was primarily his own community or one of the vials went to his sick wife? This just looks like the DA was caught being overly aggressive (perhaps even racist given the comments in the article) and is just trying to save face. Dollars to donuts the case is thrown away and I hope the doctor countersues for malicious prosecution, although more realistically he’ll take a plea to avoid going to trial and end this nightmare.
  • geophile 6y ago
    While this case is quite bizarre, giving doses to random people rather than having the vaccine go bad is pretty common, and makes sense. Except for one thing: If I am the lucky recipient of this vaccine, ahead of schedule (since I am under 75 and have no comorbidities), then what about the second dose? Do I have to get lucky a second time, the right amount of time after my first dose? (My understanding is that there have been no studies of delayed second doses.) Or am I given priority because I've had the first dose?
    • vlovich123 6y ago
      I don't think anyone really has any formal policies or if there are they probably vary drastically based on your municipality (the US healthcare system is a mess). The data does indicate that even 1 dose gives you some immunity, just not the 95%. That's why there's been a big push from some scientific corners to just get needles in arms to inoculate as many people as people with some immunity & worry about making sure optimal 2nd shot later (broad herd immunity with less efficacy vs smaller more effective herd immunity).
  • analyte123 6y ago
• lexicality 6y ago
  > “Are you suggesting that there were too many Indian names in that group?” Dr. Gokal said he asked. > Exactly, he said he was told. Amazing. I wonder how much of the charges levied against him are a desperate attempt to avoid being sued for unfair dismissal
  • whoisburbansky 6y ago
    The charges levied against him are from the DA’s office. Bit of a stretch to imagine his employer personally reaching out to the DA to try to get cause for dismissal.
• underseacables 6y ago
  Overzealous prosecution, and being told no is the one thing the government will not stand for. This feels like similar power struggles across the country between the government and citizens, where the government is determined that you will abide by its rules and do as it says, or else.
• deleted 6y ago
  [deleted]
• ls612 6y ago
  This just goes to show how people are. They don’t want others to benefit if they don’t also benefit. They would rather more people get sick and die than someone get a shot before their turn. So much about politics can he explained by looking at people this way.
  • btilly 6y ago
    There is a Russian story about a farmer without a cow who lived next to a farmer with a cow. He fumed about the unfairness of it, but no matter what he did he couldn't scrape up the resources to get a cow of his own. So he prayed about it, and God offered him a wish. Did he want a cow of his own? "No," he said, "I want you to kill my neighbor's cow!"
  • hpkuarg 6y ago
    A lot of people have a zero-sum mindset about everything.
    • robin21 6y ago
      This situation however is more of a small benefit to health for a massive loss in reputation for seemingly allowing corruption.
  • robin21 6y ago
    That is short-term thinking. What happens if this is left to slide. Someone hears about it and then you have more open vials that needed to be used late at night - “my family was the only ones awake so I gave it to them”. Bribes could be paid too. It only seems like one dose here but that’s how corruption always begins and then one day you become Russia. It underlines a large ideological difference in politics that exists...let’s help people in front of us here and now...vs let’s do things that will maximize benefits on the long run and reduce risk of negative consequences. A wasted vial here and there is nothing compares to thousands wasted via corruption.
    • CivBase 6y ago
      > What happens if this is left to slide. Then we'd have fewer vaccines expire before they can be used. This wasn't a problem because a doctor vaccinated people out of order. This was a problem because the hospital failed to find recipients for the vaccines they had. If you're going to make an example of someone, make an example of the hospital.
• chadash 6y ago
  The real issue here is that federal and state governments didn't think through the logistics of distributing vaccines even though it has been many months since we've known a vaccine would be coming. Where I live, there are about 10 different places that vaccinate, between county governments, pharmacies and hospitals. All of them have separate registration systems. Meanwhile, appointments go quickly and appointment availability is often announced on Twitter, which is probably isn't the best place for the 65+ crowd. What they needed to do starting in December is create a state-wide (or at least county-wide) registration system. Essentially model it as a priority queue with different buckets: 1) covid ward healthcare workers 2) other front line healthcare workers 3) 65+ 4) preexisting conditions 5) etc. You can disagree about which buckets go first, but that's not my point here. This should have been setup and publicized well before the vaccine rollout started. Now, you get a sense of exactly who wants to be vaccinated, so you don't get wasted doses when 45% of a nursing home's staff doesn't want the shot. You also ask people how far they would be willing to drive for a shot. I know people who drove a few hours. I know others who didn't want to drive more than 20 minutes. So it's relevant. You also ask times of day that people are willing to be vaccinated and if they want to be notified if earlier slots open up. Once vaccines are actually available, you have a central queue and you pick randomly within each priority group. So let's say you are up to 65+ adults in the general population (which is a large group). 1000 appointments open up at a hospital in zip code 12345. You send out a text message and email to 1400 (since not all 1400 are going to respond to the text message) randomly selected people in zip code 12345 or who are willing to drive there. For some elderly people, you might need to make phone calls. You give people some time to respond and if they don't, then add them back to the pool and send messages to more people until you get all slots filled. There are thousands of people in any major city who would drop what they are doing and run out to get the vaccine on a moment's notice. With a better system in place, this should never have fallen on the doctor in the first place.
  • ageitgey 6y ago
    The system you describe is exactly what is happening in the UK. There is a country-wide registry of everyone (already existing, because the NHS covers everyone's healthcare) and everyone is assigned a place in line to get vaccinated based on their estimated clinical risk, from highest to lowest. Everyone gets a letter in the mail when their turn comes up allowing them to register for any of the currently open vaccine appointments at one central website. There's little to no fight to book slots because the appointment system is paced by the letters. When a whole risk group is nearly completely vaccinated (so far, that includes age 80+, 75+, 70+, and social care workers), then that group switches over to open registration to encourage any stragglers to get vaccinated. Anyone who has an invitation letter or is in one of the nearly-finished groups can get an appointment scheduled on a simple central website or by calling their local doctor: https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/book-coronavirus-vaccination/ https://www.nhs.uk/conditions/coronavirus-covid-19/coronavir... The priority queue of people left to vaccinate (and the logic behind it) is widely publicized and progress through the steps widely tracked in the media: 1. residents in a care home for older adults and their carers 2. all those 80 years of age and over and frontline health and social care workers 3. all those 75 years of age and over 4. all those 70 years of age and over and clinically extremely vulnerable individuals 5. all those 65 years of age and over 6. all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality 7. all those 60 years of age and over 8. all those 55 years of age and over 9. all those 50 years of age and over It is estimated that taken together, these groups represent around 99% of preventable mortality from COVID-19. The UK is currently working on group #5 and catching any remaining people left in #1 - #4. My point is not that the UK is doing everything perfectly (obviously not). It's just that a mass vaccination system like this is doable and easily could have been done in the US if the government was more together over the last year. And organization works - the UK is not only significantly ahead of the US in number of shots administered per capita, but it also has a much higher percentage of age 70+ citizens reached (well over 90%) while the US vaccinations so far are more spread across age ranges.
• CivBase 6y ago
  This is dumb. Are we really willing to slow down the vaccine distribution because we're afraid some trivial amount might not be distributed in the correct order? The question should not be "why did he give the doses to people he knows?", it should be "why were there even doses available for him to do this with?". Someone failed to make sure every available dose of a highly demanded vaccine had a patient. That is the real problem and it likely has nothing to do with this doctor. It's a shame the article doesn't name the hospital he worked for because it looks like they're using him as a scapegoat for their own failings.
• JoshTko 6y ago
  This is a complex issue. Ideally we would have a much better organized rollout avoiding these scenarios. I don't think we ever want individual physicians using their own contacts list to find candidates regardless of good intention, it just opens the door up too much abuse. I don't think the penalty matches the crime, certainly not a criminal prosecution.
  • HelloMcFly 6y ago
    If we can confidently confirm that 1) there are leftover vaccines, 2) good-faith efforts were made to administer them to the target audience, and 3) there were leftover vaccines that were definitely otherwise going to go to waste then I'm 100% fine with people administering to their contact list. I'd rather that 1000x over than unused vaccines be tossed into the garbage. We all lose with unused vaccines.
    • JoshTko 6y ago
      It's just poor design to allow for good-faith. It's too easy for a bad actor to artificially create "leftover" doses to give to friends and family. Just don't allow doctor discretion and organize better for the next day, problem solved.
      • NMDaniel 6y ago
        > It's too easy for a bad actor to artificially create "leftover" doses to give to friends and family How? If X people made appointments in a day, then exactly X vaccines should be distributed for that day. Leftover vaccines will only be distributed after all those appointments are over, so it is impossible for any of the X people(assuming they arrived on time) to lose their vaccine.
      • HelloMcFly 6y ago
        You don't need to blindly trust that someone is acting in good faith, you need merely examine the evidence. If what counts as "evidence" is documented in advance this becomes all the easier. For instance, one simply needs documented evidence that 1) the right populations were clearly made aware of vaccine location and time, 2) communications went out to "in-scope" target audiences at least X hours before the doses expired, and 3) if vaccines are at threat of expiring once they are - let's say - two hours from expiring then those that control that particular supply should do everything they can to use them. And while this solution is a bit reductive, it's honestly not that reductive; this is a solvable problem. People on Hacker News solve much, much, much harder problems than this. And I'd rather 20% of vaccines go to the wrong people than 5% of vaccines go in the trashbin, personally.
• PopGreene 6y ago
  There is no down side to the prosecutor for pressing on with this. The state pays for the prosecution. She's already got her name in the NYT. A loss would go unnoticed and a win would be a feather in her cap.
• tedmcory77 6y ago
  I feel like we've lost sight of the fact that we're trying to vaccinate as many people as possible as soon as possible.
  • _cloudkate 6y ago
    totally agree. I get sad every time I hear vaccines were thrown away because people didn't show for their appointment :(
• btbuildem 6y ago
  Aside from the main thread of the article, what blows my mind is how many people he asked who declined the vaccine. Were they just being good samaritans, hoping the vaccine would go to someone who needs it more? Maybe I am a lesser person, but I'd trample people to get a jab right now.
• stevespang 6y ago
  “Are you suggesting that there were too many Indian names in that group?” Dr. Gokal said he asked. Exactly, he said he was told. (Fired doctor is Pakistani). This is the witch hunt culture we live in today. Counter sue them . . .
• Grustaf 6y ago
  The alternative would be to allow doctors to dispose of the remaining doses as they please, and the moral hazard of that should be pretty obvious to everyone.
• fortran77 6y ago
  We have a caste system here in the U.S. and he violated its boundries! We've all seen the reports of the California committees composed of dozens of non-medical people who spend their time ranking the population while vaccine sits in the freezer. For example: https://thearcca.org/california-establishes-vaccine-advisory-committee-to-ensure-equity-in-covid-19-vaccine-access/ https://thearcca.org/california-establishes-vaccine-advisory...
• wycy 6y ago
  It would be so simple to have a system where everyone can sign up with the local health department to receive extra doses at the end of the day. If there are extra doses, you receive a text message and have 10 minutes to confirm that you'll be there within the hour, otherwise it moves on to the next person. There should be no reason a single dose of this stuff should ever go to waste.
  • hntrader 6y ago
    This might be a rare edge case case involving unforseen circumstances. For rare cases like this (presuming that that's true), we probably don't want to set up a whole communication apparatus, since doing so is quite expensive. Instead rely on common-sense ad hoc decision making, just like the doctor in question did. We just need a small caveat in the rules that only people the doctor doesn't know (either directly or through a mutual acquaintance) are allowed to receive an unplanned shot in this manner, to eliminate the incentive to do it on purpose. As well as some accountability after the fact, depending on the details of the case. The outcome of this is fairly tragic, I consider this doctor somewhat of a hero and here he is being punished by unthinking bureaucrats. What a shame.
    • wycy 6y ago
      I don't know that this situation is that rare. I just got Moderna dose 1 last night and heard the nurses talking about no-shows and how many bottles they were going to have left over (I didn't catch the number). Anecdata of course, but I don't think leftover doses is some crazy rarity. Edit: To be clear, I don't know whether these left over bottles were going to go to waste or if they had contingency plans to use them.
      • hntrader 6y ago
        If it's not rare then disregard what I'm saying above. I was just presuming that that was the case (no data either way here).
  • topspin 6y ago
    "It would be so simple" It may seem simple but your scheme a fraught with equity issues. The ability to respond in a timely manner or arrive within a limited timeframe such as you propose is likely to reflect the luxury of privilege. And yes, equity concerns are more important than concerns over whatever minimal delays or waste they create.
• aktuel 6y ago
  To open a batch you should have an equal amount of people already queued up for the shot. If at the end there are still unused shots for whatever reason I would give the doctor in charge full authority to use those however they see fit as long as they are not selling them for money or other benefits. Sadly the US has now a system where everyone with any responsibilities has zero authority and everyone with authority has zero accountability.
  • contravariant 6y ago
    You can hardly expect people to wait around until you have enough people for a single vial. Wasting less than a single vial per day doesn't outweigh the downsides of making it harder to get vaccinated.
    • aktuel 6y ago
      No one has to wait around. They get appointments.
      • tacon 6y ago
        You missed the point of this story. This was in the very, very early days of vaccinations in Harris County. There was hardly any system. Harris County Public Health had to toss their first vaccination registration system, when it turned out signup invitation links could be shared and hundreds of invalid people showed up for appointments.[0] You can be sure this didn't happen after January 1, and protocols for handling extra doses are now very well known. [0] https://www.houstonchronicle.com/news/houston-texas/houston/article/Harris-County-halts-COVID-19-vaccine-registration-15841794.php https://www.houstonchronicle.com/news/houston-texas/houston/...
• passtheglass 6y ago
  How is this not defamation by the district attorney?
  • MertsA 6y ago
    The DA would have immunity in this case because it was in respect to charging him with a crime. https://en.wikipedia.org/wiki/Absolute_immunity https://en.wikipedia.org/wiki/Absolute_immunity
• tareqak 6y ago
  This event will just get doctors to end up wasting vaccines if there are any left for the day. I am surprised that the bureaucracy in place did not account for there being remaining doses in a vial as part of the roll out plan.
• kxyvr 6y ago
  For reference for non-Houston readers, he took the vaccine from a vaccine event in Humble to his home in Sugar Land. That's over 40 miles through the fourth largest city in America. His route home would have had him drive by the Texas Medical Center, which contains 21 hospitals that employs over 100k people. Further, the city/county run vaccine effort has been very strict about verifying addresses. He took the vaccine across county lines. As much as I strongly believe that rigid rules hurt good people, I believe it's a false dichotomy to assert that either he takes the vaccine home or it goes to waste. Further, it is important to maintain some semblance of public trust during this process and the optics of driving across one of the largest cities in America, by one of the largest medical centers in the country, and taking the vaccine home to find eligible people is not good. Now, yes, it's not quite as easy as calling up a hospital as asking if they could use it, but it doesn't sound like he tried. Now, even if we believe he did the right thing, I'll still stress that there will always be a contention between optics, trust, and corruption. Say I work as the mayor of a city and my brother really is the best contractor for the job, do I hire him? I'll contend that's not exactly an easy question and neither is the case with this physician and the vaccine.
  • valarauko 6y ago
    I agree that the NYT article presents a false dichotomy, and offers a rosy picture of the doctor's actions. That said, I genuinely wonder what's the alternative action available to him? I agree that the article creates a false ticking time bomb narrative and he's Jack Bauer. Still, he made good faith (presumably) attempts to eligible people at the vaccination site, who refused. Would the Texas Medical Center have accepted an opened half used vial from some guy who drove up? If the only people who might accept it were people he personally knew and his patients, I'm not sure what he could do besides try Sugar Land. I agree he could have tried harder, but honestly - when his supervisors didn't care when he called them, why should he?
  • civilized 6y ago
    > I believe it's a false dichotomy to assert that either he takes the vaccine home or it goes to waste I don't see a specific, viable, knowable-at-the-time alternative course of action Dr. Gokal could have taken, from you or anyone else. And the events in question happened over a month ago. Dr. Gokal's boss has had over a month to BS about what Dr. Gokal should have done, and failed to come up with anything. Dr. Gokal had six hours. > Say I work as the mayor of a city and my brother really is the best contractor for the job, do I hire him? I'll contend that's not exactly an easy question and neither is the case with this physician and the vaccine. I am disgusted with the laid-back, bureaucratic attitude so many people seem to have about this vaccination campaign. It is truly no surprise anymore that we have managed this pandemic so disastrously, and let so many people die needlessly. Dr. Gokal had six hours to get ten doses into vulnerable people's arms. It was night time and he had no guidance from management on how to avoid wasting those doses. Wasted doses mean dead bodies. Do you understand that? And after understanding that, can you explain to me how armchair quarterbacking Dr. Gokal is anything but unconscionable? This is not a time to gab with the angels on our shoulders about optics, about whether we look like perfect little boys and girls. It is time to actually be good. It is time to save as many lives as we can. Dr. Gokal did that, he made no attempt to hide it, and he paid a terrible price. If you're going to sit in judgment of people, it should be the horrible bureaucrats who dare to judge him, when it was THEIR failures that put him in this position.
• deleted 6y ago
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• mcv 6y ago
  Can someone indict that district attorney and the supervisor for endangering the vaccination effort by persecuting medical professionals who vaccinate people and encouraging the waste of vaccine? That's the thing that should be illegal here.
• umeshunni 6y ago
  Similar incident from San Jose last month where an entire hospital was denied vaccines for giving it to the wrong people (in this case, teachers) https://www.google.com/amp/s/abc7news.com/amp/good-samaritan-hospital-vaccine-distribution-california-teachers-vaccinated-santa-clara-covid-health/10015343 https://www.google.com/amp/s/abc7news.com/amp/good-samaritan...
• nickpp 6y ago
  Over and over again we re-learn that the single proven way to distribute scarce resources is the free market. Anything else we tried led to abuses, aberrations, waste and in the end fewer people gaining access to that resource. I have seen this in the planned economy I grew up in, which was unable to provide even toilet paper to its people - but it was ok, because we didn’t have any food either. Our blindness to the simplicity, obviousness and logic of the market laws and our obsession with the forced, unnatural "fairness" and "equality" make us relearn this lesson the hard way, by paying the price. Unfortunately this time the price is in lives.
  • fitzie 6y ago
    the flu vaccine is delivered annually by experts. now they are creating a whole new vaccine distribution system run by people who have never done it before. the politicians are celebrating their megasites as if that is suppose to impress us. I have no doubt if the money was ever counted that we're spending ten times more per shot for covid then we do for influenza, just on the distribution.
  • acover 6y ago
    I don't think this is true. In emergencies we explicitly do not allow price gouging because it just doesn't work. If it was a free market then the vaccine would cost 10k and few of those who benefit most would get it. That's not efficient or fair.
    • nickpp 6y ago
      Actually freezing prices is the best way to create long term shortages. We saw that last springs when countries with free markets kept having N95 masks available, at slightly elevated prices while countries that imposed priced controls did not have any until fall. In a free market the vaccine would’ve cost 10k for a month while producers would’ve been scrambling to increase availability and production to take advantage of this amazing opportunity. Pretty soon after the price would’ve dropped at a greatly increased availability. Right now the vaccine is free and very few lucky ones can get it. And it’s been months.
• ed25519FUUU 6y ago
  I’m pro universal, single payer healthcare, but these types of stories highlight my main concern with it. The people attracted to these bureaucratic positions select for rule following. It’s a reinforcing thing. Those that follow the policy are rewarded and move up. Pragmatic people sometimes bend the rules and sooner or later are pushed out. These bureaucrats would rather see people die than for there to be a break in sacred government policy. We need to do whatever we can to keep such people from being in positions of power.
• mdoms 6y ago
  I don't believe the American culture is capable of dealing with major crises, particularly crises that require people to pull together.
• LorenPechtel 6y ago
  In the general case actions such as these are quite rightly prohibited--it's so easy to engage in self-dealing behavior. The best solution would be a waiting list of people to be notified. However, this was the initial rollout, glitches are to be *expected*. He found one and scrambled to do the best he could with the situation. There was no right answer, he picked the least wrong one. We have seen other places where the rules were followed and doses thrown away. As far as I'm concerned any bureaucrat who ordered that should be thrown in the same dumpster.
• lumberingjack 6y ago
  After being required to get the vaccination in order to receive hospital treatment. I'm still told that I have to quarantine wear a mask and try to be as safe as possible which tells me that the vaccine didn't do jack and nobody has confidence in it.