At South Florida hospitals, concerns over vaccine equity. Who gets shots soonest?

As doses of the highly sought Pfizer BioNTech COVID-19 vaccine made their way through South Florida hospital systems last week and over the weekend, some of them went to employees you might not think of as “front-line workers.”

That’s because state and federal officials gave wide latitude to the “Pfizer Five” — the first hospitals in Florida to receive the vaccine — to determine who would qualify for a shot during the first phase of the rollout.

The U.S. Centers for Disease Control says only that “healthcare personnel” should receive the vaccine in the first stage of distribution, defining that as “paid and unpaid people serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials.”

With such broad parameters, the two South Florida hospitals in the Pfizer Five, Jackson Health System in Miami-Dade and Memorial Healthcare System in South Broward, have determined on their own which employees qualify for a COVID-19 vaccine.

At Jackson, that is defined as virtually anyone who steps foot in its facilities, including those who work in administrative functions and come in on a part-time basis, working the rest of their hours at home. In a statement, Jackson told the Miami Herald that COVID-19 inoculations are open to “employees with direct and indirect patient contact. Those who work exclusively from home are not eligible.” The statement goes on to list 11 job titles as examples of roles that would qualify, including executives.

“Unlike other health systems, Jackson’s administrative offices are located inside of its hospitals, and hospital leaders round on patient floors regularly,” the spokesperson said.

Each South Florida hospital system appears to have defined the terms of vaccination independently. Baptist Health of South Florida, the largest non-profit healthcare provider in the region, was working with limited doses of the Pfizer vaccine until this week, and adhering to a more rigorous and phased approach.

But other hospital networks, particularly Jackson and Memorial, received more than enough doses for every employee who wants one about a week ago. The two hospitals say they have shared all they can with other hospitals. Both hospital networks received 19,500 doses each allocated by the state, with some extra doses from “overfill,” or more doses per vial than expected.

On Monday, Jackson said it has inoculated 4,474 of its own and has helped to inoculate 13,462 employees in all Miami-Dade hospitals, including its own and its partner University of Miami Health System. A spokesperson for Memorial said it has allocated 11,509, or roughly half of its doses to five other Broward County hospitals. The spokesperson said it was keeping the rest of the doses for its employees, 3,827 of which have already received them.

The remainder is likely enough to vaccinate every employee who wants a dose, but Memorial’s spokesperson said the hospital system was still restricting who could receive one, though she did not elaborate on how the hospital system is prioritizing who receives the doses first.

Amesh Adalja, a physician and infectious disease expert with the Johns Hopkins Center for Health Security, said that hospitals are rightfully given autonomy to decide who should be inoculated, considering how employees are needed to support operations for COVID patients and other patients.

“Hospitals are given a lot of leeway to decide how to do this, and this is predictable that this type of thing will happen, that a hospital will vaccinate all of its employees, especially if they’ve got more than enough to vaccinate everybody,” Adalja said.

But Adalja added that hospitals should also be cautious in inoculating people who serve non-patient-facing functions and that state and federal officials perhaps should have allocated doses more stringently, based upon how many employees fell into Phase 1, to avoid a surplus in the first place.

“There’s probably better ways to do the vaccination to make it more impactful on the pandemic,” he said.

Mixed messages

Last week, Memorial’s CEO, Aurelio Fernandez, told the Miami Herald after a press conference that anyone who stepped foot in the hospital system would be eligible to receive the vaccine.

That statement would be in line with what Jackson has defined as eligible employees, but by the next day, Memorial’s communications team walked Fernandez’ explanation back, saying it was a projection and that Memorial considers Phase 1 to consist of “front-line workers with the highest risks, which include COVID floors, ER, medical staff and support positions all of which come across patients and can be exposed to COVID-19.”

Area hospital officials have held several press conferences in the last week on inoculating their employees, but they have yet to publicly articulate whether they would play any role in inoculating the general public, or when that might happen.

It was in that context that images of South Florida hospital employees who work in administrative functions made their way to social media over the last several days, prompting outrage among some acquaintances who then contacted the Herald.

Spokespeople at UHealth, the University of Miami’s hospital network, did not immediately respond to inquiries about administrative employees receiving vaccines there, but a Friday email sent to employees and obtained by the Herald did not mention non-front-line workers receiving the vaccine.

“We started to vaccinate our front-line workers this week to protect them as they care for our patients,” the email said. “We will continue to vaccinate our healthcare team and will offer the vaccine to our patients as soon as we are able.”

Hospital-by-hospital

As of Monday morning Baptist Health said it had inoculated 2,380 of its employees, the vast majority of them in what it has defined as “Phase 1A.”

That includes those who work in COVID wards, respiratory therapists, employees in other patient care units like intensive care, emergency department workers, those at urgent care centers and any practitioner who sees patients with acute flu-like illness or patients who are at-risk or immunocompromised, according to a system-wide email obtained by the Herald.

Phase 1A also includes personnel who support those areas such as laboratory personnel and pharmacy workers.

Though that definition is broad, it doesn’t include several other categories of employees. Baptist defines “Phase 1B” as all employees who work in a setting where patients are seen. It defines “Phase 2” as administrative personnel in non-patient care settings and “high-risk community members.”

A Baptist official explained that it receives a set number of doses from Jackson that come with a shelf life of about six hours, so some employees in other phases may be called in for inoculation as “backup” if Phase 1A employees do not show up to their scheduled appointments.

A spokesperson at Mount Sinai Medical Center in Miami Beach said the hospital was still in the process of inoculating its first phase of employees and that the hospital system has already used the limited doses it received from Jackson to inoculate front-line workers and anyone on the clinical team. Mount Sinai is anticipating receiving more doses this week, most likely of the Moderna vaccine.

At a press conference in Key Biscayne on Monday, Gov. Ron DeSantis said the first vaccine doses should be allocated to front-line hospital workers, echoing much of his prior messaging during the vaccine rollout.

DeSantis mentioned that would also include people who work in areas such as food service at Jackson, “because they’re in contact and they can spread it.”

“But I would definitely say it’s kind of that more tip-of-the-spear version,” DeSantis said. “And the reason why is just because that’s going to help keep our hospital capacity up.”

Miami Herald Staff Writer Aaron Leibowitz contributed to this report.