Tennessee was deemed the worst place to live in the world for Covid-19 transmission this past winter. That didn’t happen by mistake; it has been a snowball of failures in leadership, lack of education, and tourism economies being left to fend for themselves.
Vaccination in the south has continued that trend, as many states in the region rank last in terms of per-capita vaccinations, even though they are equally preoccupied with opening back up before the majority of populations are vaccinated and ending mask mandates regardless of recommendations from health officials – as Tennessee did two weeks ago, following Texas’s lead.
Amid this chaotic void of clear, enforced policies and alarming metrics, some “vaccine interlopers” are taking advantage of low demand in rural counties and skipping the line to get their vaccination, even if they don’t meet the criteria. From low-risk individuals wanting to return to normal life, to service industry workers who are tired of risking their lives, the phenomenon has opened up a Pandora’s box of ethical issues in Tennessee.
The initial vaccine rollout in Tennessee didn’t have a singular, mass-distributed website for making appointments, getting on waitlists or finding phase information, often leading to wasted doses of the vaccine, especially in rural counties. Currently in Tennessee individuals 55 and over, those over 18 who cannot live alone, healthcare workers, teachers, those who work in critical infrastructure and social services, and those over 16 with high-risk conditions are eligible for vaccination. Despite that rather large pool, over 1,000 vaccines were recently thrown out in Shelby county.
It took few phone calls to some of these distribution sites to learn that people could receive vaccines with little to no documentation of their eligibility – “on an honor system”, as a worker at the White county health department said.
When I received my first dose at that health department on 1 March (for transparency, I actually live in this rural county, and have a qualifying health condition), I wasn’t required to show my driver’s license. This was also confusing because phase 1C for high-risk health conditions didn’t open in Tennessee until 8 March, but when I filled out my vaccine application, it immediately allowed me to make the appointment in my rural county.
In recent weeks vaccine interloping has been discussed openly on social media. Those who are not in high-risk categories, or essential workers, are posting their vaccination appointments in their Instagram stories – along with the website where others can do the same.
The State health department’s website for Covid-19 instructs residents to only attempt to book a vaccination once the state has entered their corresponding phase and to do so “in your county”. However, it doesn’t have any information about documentation to bring to your vaccination to be validated. With some hospitals, clinics and now pharmacies administering the vaccine in the state as well – not just health departments – there isn’t efficient infrastructure to verify each individual’s qualifications.
“We were told not to turn anyone away,” a worker at the Dekalb county health department said. “We’re just following the state’s policy and they didn’t give us any instructions for verifying anyone.” The communications director for the Tennessee state health department and the governor’s office did not return requests for comment. In the state’s official vaccination plan there is no information on verifying an individual’s qualifications.
There has been subsequent backlash to vaccine interloping with people posting things like, “If you go take a dose from a grandma in the woods, you literally suck.” And internet discussion is shifting to whether it is considered acceptable to ask someone how they qualified for the vaccine.
It is also important to note that rural communities statistically have poorer health and less access to medical care than their urban counterparts. A 2017 study by the North Carolina Health Research Program reported that rural residents having lower median incomes, more children living in poverty, more uninsured individuals and higher rates of mortality. There are also fewer health providers and facilities in rural communities, meaning people have to travel farther and wait longer for care.
But some have defended vaccine interloping, too.
Nashville’s WPLN senior healthcare reporter, Blake Farmer, posted a video on 10 March saying: “I think it’s time for the vaccine tattling to stop.” He said vaccine interlopers are doing that rural community a favor by keeping demand up, otherwise demand would wane and the state as a whole could end up with less federally distributed vaccine. He also emphasized that Tennessee has no policy against travelling to another county for your doses. A similar point is highlighted in the state’s vaccine distribution plan.
One group also making use of accessible rural vaccinations is service industry workers. With nothing but PPE standing between them and the virus, their unemployment tapped, some are driving to another town for the vaccine.
“I have not felt safe going to work for months, and that has greatly contributed to a decline in my mental health. I spend whole shifts sanitizing the restaurant between guests, so when I see that janitorial work in certain settings – just not mine – is an option to qualify on the vaccination form … I’m going to click that and feel no remorse,” a server at a restaurant in Nashville, who asked to remain anonymous, told the Guardian. With restaurant and bar capacity allowances returning closer to pre-pandemic volumes as well, this anxiety has only increased.
Not everyone agrees. A healthcare worker I spoke to in Davidson county, home to Nashville, who also wanted to remain anonymous, mentioned that the fact that doses expire is no excuse to go take one for yourself if you’re not at risk. During a recent snowstorm in Nashville she pointed out, “Extra doses were taken to the homeless shelters, a population that is very unlikely to have access to the vaccine any time soon.”
In Tennessee, vaccination awareness has quickly shifted from appreciation for the elderly, compromised and for healthcare workers to get their doses, to a clamor for everyone else’s turn.
Tennessee’s governor, Bill Lee, did announce since this story started being reported that all adults in Tennessee will be eligible for the vaccine at some point in April, but with appointment slots having been full weeks in advance for months in urban counties, people will probably still elect to travel to rural counties once that happens where the general process is quicker, and appointments are far more available. The ethics of that will continue to be left up to the individual.