Pfizer-BioNTech COVID-19 vaccine coronavirus
(Image: AP/Esteban Felix)

A COVID-19 vaccine opens doors — from health advantages to international travel to peace of mind. So it should come as no surprise people are pushing to be first in line to get the jab.

Most countries are purchasing vaccines to distribute to their populations based on need, including the Australian government which will reportedly begin doling out the vaccine ahead of schedule in mid-February based on priority.

But abroad, rollouts have already become problematic. In the European Union, distribution has been delayed thanks to red tape, vaccine supply, logistical problems and vaccine hesitancy. In the UK deliveries are taking longer than expected, while in the US only a portion of the doses shipped across the nation has been distributed.

So, how might those getting impatient try to skip the vaccine queue?

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Everything has a price

Vaccine manufacturers can choose to sell vaccines privately, and in many countries, including Australia, it would be legal to purchase them with proper regulatory approval.

Canada’s National Hockey League has already scoped the market out, reportedly planning to buy COVID-19 vaccines for its players.

Australian National University bioethicist Nathan Emmerich said wealthy international students wanting to come to Australia may also be eyeing a private purchase: “If we put the vaccine as a demand to avoid quarantine that might create a problem of them trying to buy vaccines or skip the queue,” he told Crikey.

But doses have been backordered by the millions for all major vaccine candidates, meaning that by the time companies open doses up to the private market it might not be worth it. Pfizer has said it is currently focusing on government deals over private sales.

Private markets also open the door for scammers: scam artists have been selling fake vaccines and cures since March last year. The Australian Competition and Consumer Commission (ACCC) told Crikey it had received dozens of reports of vaccine scams since the start of this year. In December, the US Federal Bureau of Investigation (FBI) warned of fake offers for early access to a vaccine requiring payment of a deposit or fee. ;

Company lobbying

In the US, essential workers are next in line to get the COVID-19 vaccine after long-term care residents and healthcare workers. But it’s up to each state to decide who’s in that pool, and companies have already gone hard lobbying governments to get their employees essential worker classification.

Food delivery and rideshare services DoorDash, Lyft and Uber have sent letters to state governors, and Amazon has sent a letter to the Center for Disease Control and Prevention arguing the company is getting important products to people’s homes. Airline, hotel and trucking industry heads are also lobbying for their workers to be fast-tracked.

Australia hasn’t announced who will be second in line for the vaccine. Crikey is not aware of any similar lobbying taking place in Australia. Despite Qantas’ plan to require passengers to be vaccinated, the company has no plans to privately buy the vaccine.

Priority access

Concerns have been raised in the US that there is a profit incentive for doctors to distort a patient’s health data to get them moved up the queue, and keep their customers — ahem, patients — happy. This could mean portraying a patient’s mild asthma as severe enough to justify early access.

Emmerich said that thanks to Australia’s dual public-private health system, similar exaggerations may be possible here. Research has found total government Medicare spending favoured kids from richer families.

“There’s a big class dimension to people being able to get health statements,” Emmerich said.

But, he added, things like age, significant disabilities and chronic health issues were impossible to fake.

“By the time you get down to the point where [manipulating reports] would be a useful thing to do, you’re not going to be jumping much of a queue.”

A Health Department spokesperson told Crikey: “It is likely the first doses will be available to those who have an increased risk of becoming very sick or dying from the virus, those who are at an increased risk of exposure and those working in services critical to the functioning of our society.”

How do we avoid this?

University of Sydney associate professor Barbara Mintzes told Crikey vaccine queue-jumping brought about all kinds of problems.

Those buying the vaccine privately might not get the one best suited to their needs, she said, with some vaccines more effective in older populations than others. The vaccine might not be stored properly either, she said.

Finally, proper follow-up is crucial to make sure people get the second dose of the vaccine and the vaccine’s effects are monitored.

“You don’t want a situation where people who are lower risk … are able to take doses away from someone who is a higher priority level,” she said.

To help avoid queue jumpers, a clear rollout plan and flexibility is key.

“If everything is very clearly laid out and there’s a timeline that looks reasonable that there’s less of an incentive to jump the queue,” she said.

For those who needed the vaccine to work or travel, exemptions needed to be available.

“You’d want to have the possibility of applying separately for approval if you have a legitimate reason to do so,” she said.

The Health Department spokesperson said the government was currently focusing on vaccine rollout of priority groups, but understood there were exceptional circumstances for people needing to travel.