The front of the line

Friends, mostly health care workers who are working abroad, have been posting on social media about getting the coronavirus vaccine, sharing snapshots of their vaccination record cards. We are pleased for them; we are wary of possible adverse effects; we are hopeful for the best. Still, the situation does put me in mind of a phrase I once heard on a John Finnemore radio show: “I suppose I feel the way any rat on a sinking ship would feel if he saw one of the other rats leaping into a passing speedboat: pleased for my fellow rat… but a little jealous of his speedboat.” It isn’t only that incompetence on several levels has barred us from both virus containment and timely vaccine acquisition; it’s that we, or at least the health workers and high-risk persons I know, have very low expectations about our own access to the vaccines, once they are available in the Philippines.

Most places with vaccine roll-out, supported by guiding principles from the World Health Organization for “fair and equitable access,” are doing a phased allocation of giving out the vaccines. These begin with first responders and high-risk health workers, individuals with conditions that put them at high risk of infection, and vulnerable residents of long-term care facilities; they are followed by other essential workers, those congregated into homes or prisons, teachers, moderate-risk individuals, and so on, down a ladder of decreasing risk. It seems fair to assume that the Department of Health will follow a similar template (or at least make a pretense of doing so) in COVID-19 “epicenters.” This sounds well and good, but from what we’ve seen, reality may sometimes be a little less clear cut. Recently, The New York Times ran a feature about essential workers in the “gray” zone, whose place in prioritization for the COVID-19 vaccine remains uncertain depending on the area: primary care doctors in communities; those who handle body disposal; dentists; pathologists; and so on. It’s a question of increasing urgency now that the vaccine has been rolled out, and there need to be decisions on what defines “essential” health workers in the first place.

In some areas, even those who are undisputedly on the frontlines have obviously been neglected in vaccine allocation: controversy broke out in Stanford Health Care in California last week when only seven of more than a thousand frontline physicians (residents and students) were selected to be vaccinated with the first round of 5,000 doses. Meanwhile, senior faculty and administrative staff, who do not perform direct in-person patient care, were selected for vaccination. A protest broke out, and the institution quickly apologized, but it sets a grim forecast for how bad it can get when seniority and politics get in the way of rational vaccine allocation—which is more than likely in our own, local setting. After all, it was only a few months ago when coronavirus testing was supposedly limited to only those who really needed testing, but asymptomatic politicians and high-profile individuals still managed to get tested just because they wanted to.

Fellows and residents, like those in the Stanford debacle, constitute a highly important, but vulnerable, group of health care workers, who often receive stipends rather than true salaries and who have few if any benefits; who definitely work overtime in high-pressure environments; and who risk endangering their slots in training or future prospects if they protest for better work conditions. The Stanford community may have been brave to mount a protest, but it is just as likely for a group of trainees not to protest under similar, neglectful circumstances. And if our local fellows and residents are similarly vulnerable, what more the nursing and ancillary staff, as well as other essential workers, of our health institutions?

Nearly 10 months since the first lockdown, the cries for just (and actually law-mandated) compensation, timely hazard pay, and special risk allowance are far from being heeded. Every small victory in the fight for fair compensation seems impossibly hard-won. Take, for example, the long-delayed one-day deadline—later generously extended by a few days—given to qualified health care workers to submit their requirements for hazard pay. Given this degree of insensitivity and exploitation, it would be sheer naivete to imagine that our frontliners will actually be at the front of the line to receive the vaccine once it’s actually available. Politicians; influential persons brandishing exaggerated medical certificates of “high-risk” illnesses; and the police force are much more likely to be at those “front lines” than high-risk health workers are.

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