Let’s Stop Punishing Doctors for Vaccinating People

A doctor in Texas is the latest to be charged for skipping the line to give out expiring vaccine doses. After a very rocky rollout, the effort to vaccinate Americans against the coronavirus has steadily picked up pace, and relative to other countries, the U.S. has so far done a surprisingly good job of distributing and administering vaccines.

But it’s still going to be months before most — let alone all — Americans have been vaccinated, which is one of the many things that makes what recently happened to a Texas doctor named Hasan Gokal utterly enraging. Gokal was until recently the medical director for the Covid-response team for Harris County (which is where Houston is). That is, he had that job until he got fired, and then charged with theft by the Harris County DA’s office. His crime? Not letting vaccines go to waste.

There are two basic principles that are (or should be) governing the vaccine rollout. First, we want to prioritize vaccinating people who are at highest risk from Covid, and those who care for them. In the U.S., that has generally meant vaccinating health care and other emergency workers, nursing home residents and staff, and older Americans. Second, we ideally want everyone to be vaccinated (even though some people will refuse to be) because vaccinated people are not only less likely to get sick from the virus, but also less likely to spread it.

What this means, given that we have a limited supply of vaccines (and will for the foreseeable future), is that we do not want to waste any vaccine doses. So if the choice is between throwing vaccine doses away or vaccinating people out of order, the correct thing to do is to use the doses to vaccinate people, regardless of who they are. That’s why North Carolina’s Secretary of Health recently told health care providers in that state, “If you can’t find someone on that priority list, find the closest arm of who wants to get vaccinated and get that in, because we as a state don’t want to waste any vaccine.”

And that is precisely what Gokal did on December 29. As Dan Barry detailed in the New York Times, Gokal was at a vaccination event that day for emergency workers. Near the end of the event, a nurse opened up a new vial of Moderna vaccine to administer a dose to a late-arriving emergency worker. Once a vial is opened, you have six hours to administer the remaining doses (in this case, 10 were left) before they go bad. So Gokal asked everyone at the event if they wanted a shot — all had either been vaccinated already or didn’t want one. He called a colleague and then started calling people in his contacts list, looking for older people or people with chronic conditions who might want to be vaccinated. He found nine — four who actually came to his house to get the shot, and five whom he visited in their homes to administer the vaccine. But with time running out, he still had one shot left, so he vaccinated his wife. The next day he told the office what had happened, and submitted the list of names and addresses for everyone (so they’ll be able to get their second dose).

Since you can’t get in trouble for not vaccinating people, but you might get in trouble for vaccinating them, the safe thing to do is just toss the punctured vial away.

This was not a new story, since there have been a number of accounts of doctors and nurses roaming city streets, asking people if they wanted a Covid vaccine. What made it unusual is what happened next: Gokal was fired from his job for administering the vaccines, and then, even more remarkably, he was charged, on January 21, with theft for allegedly stealing the 10 doses he administered. In other words, Kim Ogg, the Harris County DA, was treating him essentially as a shoplifter.

One of the things that makes this remarkable, in a bad way, is that Ogg was elected to her position as part of a national wave of progressive prosecutors who supposedly understood the dangers of overweening prosecutorial power and were going to be leery about using criminal sanctions when they didn’t make sense. Yet Ogg’s office not only tried to send Gokal to jail for vaccinating people, but even after a criminal court judge dismissed the case in strong terms, Ogg’s office still suggested it might take the case to a grand jury and ask it to indict Gokal.

Now, there is a logic to having punishments for violating the vaccination priority rules — you don’t want doctors selling vaccines to the highest bidder, or deliberately letting their friends jump the queue. But there is no evidence that that’s what happened in this case — which is why the judge dismissed it. Instead, you had a doctor who managed to make the best of a bad situation, and who is being treated, literally, like a common criminal.

Aside from the fact that firing Gokal and prosecuting him did him an incredible injustice, the DA’s decision to try to prosecute him (and to trumpet the charges publicly) was terrible from a public health perspective, since it means that the next time a doctor is left with a few extra doses in an already-punctured vial, they will be more likely to just discard those doses, rather than risk losing their job or being put on trial by an overzealous prosecutor. And this is true not just in Harris County, but all over the country. This has already happened. In Portland, dozens of doses were discarded when officials couldn’t find enough health care workers to be vaccinated. And in New York, threats of punishment for violating prioritization rules led to unused vaccines being tossed.

From a public health perspective, of course, this makes absolutely no sense, since every vaccinated person reduces the risk of the virus spreading. But from a risk-management perspective, it’s rational behavior by health care providers; since you can’t get in trouble for not vaccinating people, but you might get in trouble for vaccinating them, the safe thing to do is just toss the punctured vial away. That’s why the Harris County Public Health Department should give Hasan Gokal his job back. And it’s why public health officials and governors and mayors need to make it clear that no one is going to get in trouble for simply vaccinating people out of order. Let’s stop trying to ensure that no good deed goes unpunished.

Leave a Reply

Your email address will not be published.