Washington state will rely on an honor system to determine eligibility for COVID-19 vaccinations, so those administering vaccines do not have to police who qualifies.
The state plans to launch an online questionnaire — called PhaseFinder — soon where people can determine their own eligibility for vaccination.
When more vaccination sites are available, members of the public could present screenshots of their questionnaire results at vaccination sites, said Mary Huynh, a deputy director at the state Department of Health. The state also plans to provide a template letter for employers to vouch for workers’ eligibility.
“This tool will help with all the questions we’re getting from people about which phase I’m in, where can I get vaccine?” said Huynh, of PhaseFinder, during a Thursday meeting of the state’s vaccine advisory committee.
As Washington seeks to speed its vaccine rollout, these tools could be efficient means to clarify who is eligible for vaccination, but they’re reliant on Washington residents to faithfully represent themselves. And efficiency comes at a cost — health officials acknowledge people will likely take advantage of the system and attempt to jump their spot in the priority line.
“It’s all self-reported. It’s all trust-based,” Huynh told the committee. “We really wanted to relieve the burden of the vaccination site to have to assess phase eligibility. It’s just awkward conversation …”
As hospitals vaccinate health care providers outside of their systems – nurses from small community clinics, dental hygienists and others – it is difficult to know who is eligible, said Darcy Jaffe, the vice president of safety and quality at the Washington State Hospital Association.
“The hospitals have been pretty clear that they don’t want to be the vaccine police,” she said.
Administrators don’t want to have to “interrogate someone” who shows up requesting a vaccine, Jaffe added.
Department of Health officials have told hospitals they wouldn’t face official repercussions if they happen to vaccinate someone ahead of their priority phase, Jaffe said.
The PhaseFinder tool, which the health department plans to make broadly available to the public, is designed to take care of any questioning.
It will include questions about someone’s age, ZIP code, preexisting conditions, their occupation and living situation, according to a DOH presentation for vaccine providers posted online. A pilot version of PhaseFinder, for people in the first vaccination phase, asks for age, and if the user works in a health care setting or lives in a long-term care facility, whether they plan to get the vaccine, and if they want to be notified by email or text when eligible.
The tool will come in multiple languages, according to the presentation, and will refer a user to a vaccination site through VaccineFinder.org, an existing national platform for seasonal flu vaccines, vaccines for travel and other routine vaccines.
Some people might not have internet access or the ability to use an online tool. Huynh said the health department wants to provide multiple routes for people to determine their eligibility, and suggested that providers could ask questions in person at vaccination sites, provide an iPad or other device for people to use PhaseFinder on-site or rely on voucher letters.
Dr. Jeff Duchin, of Public Health – Seattle & King County, who said he had used a demo version of the PhaseFinder tool, noted that people could repeat the questionnaire to get the desired results about their eligibility.
“We recognize people can game the system. That’s going to happen. We really wanted to stick to principles of having this be trust-based,” Huynh said.
Duchin said he suspected it will soon become common knowledge how to manipulate the questionnaire and get vaccinated more quickly.
“We don’t have a good system set up to easily create verification, so we want to err on the side of vaccine getting into arms,” said Michele Roberts, the state Department of Health’s acting assistant secretary.
During the vaccine advisory meeting, Duchin said he was concerned about public perception if the system could be easily manipulated.
“I do worry about the perception that there’s no control over who’s getting vaccinated before we get through the high risk adults,” Duchin said. “It just makes me wonder whether we should abandon the pretense of prioritization after a certain point.”
The honor system could face its first big test as soon as this month, when the state could open up its next priority phase.
While the state Department of Health hasn’t released its Phase 1b priority list, observers say it is likely to follow the recommendations from the Advisory Committee on Immunization Practices, a national group of doctors and health officials who counsel the Centers for Disease Control and Prevention on priority.
That group recommends Phase 1b include people 75 and older, and people with “front line essential” jobs: food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers and others whose jobs are critical for society and require them to be on-site and in proximity to others.
A national grocery chain may have human resources personnel who could notify workers when it’s their turn, and provide a corporate voucher letter, but a small deli, for instance, may not have the same capacity and employees may have to vouch for themselves, said Dr. Amesh A. Adalja, a senior scholar at Johns Hopkins Center for Health Security.
Preexisting medical conditions will pose another challenge. Medical records are generally not centralized. A pharmacy, for instance, wouldn’t have time to verify if someone has type 2 diabetes. Again, it will require trust.
“The majority of people would follow the honor system, I would hope,” Adalja said. He noted that during the H1N1 pandemic in 2009, people generally adhered to their priority groups for vaccines.
“If you vaccinate somebody outside of their schedule, it’s not the end of the world,” he added. “Ideally we want to get everybody to be vaccinated.”
Much of the U.S. will rely on an honor system.
“We really don’t have a choice,” Tinglong Dai, an associate professor specializing in health care at Johns Hopkins University Carey Business School.
The CDC’s priority system is nuanced and harder to implement, Dai said, compared to an age-based priority scheme like the United Kingdom’s. “The reality is we have such a highly fragmented health care system that makes information sharing costly, time-consuming, and often impossible.”
Dai said finding ways to verify eligibility will be important.
“Nothing is more important than public trust for this mass vaccination to be successful.” Dai said. “Verifying priority eligibility is essential because nobody will trust a system that can be easily gamed.”
During the first phase of vaccination, vaccine providers could choose to ask for employee identification badges along with voucher letters, said Danielle Koenig, a health department spokesperson.
“We have not yet shared a system for verifying eligibility past phase 1a,” Koenig wrote in an email to The Seattle Times. “We hope everyone in Washington will be honest and get the vaccine in the phase they’re eligible for to make sure their friends, family members, and community members who are more impacted by the disease get protected first.”
Gordon Oakes, the director of clinical support services who is leading vaccinations at Bellevue’s Overlake Medical Center, said he was glad the state had created a way to screen vaccine eligibility. Oakes said Overlake had vaccinated about 1,500 people high-risk health workers so far, including some Bellevue firefighters.
As the vaccination effort expands, Oakes said he would “hope for the best in my fellow man” when it came to observing the priority line. He planned to concentrate on getting everyone through as efficiently as possible.
“If you have somebody maybe who misrepresents themselves, I’m not going to get worked up about that. I want people to get taken care of,” Oakes said. “We’re all in this together.”