Washington navigates ethical minefield on getting first Covid shots

The first Covid shots will soon be available to top officials and essential staff in the White House, the Pentagon and Congress. But they’re already facing a political and ethical dilemma over who should be at the front of the line.

While most of the scarce Pfizer vaccine is now on its way to hospitals and nursing homes across the country, some of the first tranche was reserved for federal leaders to ensure the government can continue to function as U.S. deaths and hospitalizations peak. President Donald Trump, President-elect Joe Biden and leaders in Congress could help themselves to it in the coming days. The question is: should they?

On Monday, Biden’s transition team said no decision had been made, and that the president-elect is consulting with his chief medical adviser Dr. Anthony Fauci on timing. Trump will hold off for now, but Secret Service agents, the White House medical unit staff and those who run critical operations like the Situation Room will be vaccinated on a staggered basis in the coming weeks, to ensure they don’t all suffer unexpected side effects at once. Congress still is waiting to find out how many doses will be available and when, but some lawmakers are already vowing not to elbow their way ahead.

“I will not skip the line,” Senate Minority Leader Chuck Schumer (D-N.Y.) declared in a floor speech on Monday. But “as soon as it’s appropriate and recommended,” he added, “We should all lead by example, take the vaccine and tell our constituents to take it as well.”

The situation is particularly awkward at the White House, considering the number of virus outbreaks it's seen and the fact many senior officials who were infected, including Trump, already have antibodies. Because reinfection is possible, however, researchers are recommending everyone get the shots.

The sensitivity over going first is a marked contrast to what's unfolding in medical facilities across the country, where some critical care nurses and other frontline health workers began rolling up their sleeves Monday morning to receive the injections. Senior citizens in nursing homes will be next, based on guidance from the CDC and state authorities, followed by other at-risk groups.

White House spokesperson Kayleigh McEnany said Monday that Trump decided health workers need to be prioritized when he declared on Sunday night that he and top White House staff wouldn't exercise the option to get the first doses of the vaccine.

But White House officials told POLITICO they are still deciding who else will get the vaccine and when. Trump and Vice President Mike Pence are expected be vaccinated in the coming weeks.

The situation is more uncertain for the scores of political aides and career civil servants in the federal bureaucracy. Shots will be largely limited to those who perform critical functions or are required to be vaccinated for national security reasons, in keeping with long-established government practices, said Nicole Lurie, who coordinated pandemic preparedness for the Health and Human Services Department during the Obama administration and served as a public health adviser to Biden’s campaign.

“There’s always an allotment for the federal government’s security needs,” she said. “That doesn’t mean all federal workers. It doesn’t mean a bunch of folks who have office jobs they could do from home. But it does mean those who need to be protected, like the president and vice president, as well as people like air traffic controllers, health care workers at the VA and executives in the Cabinet.”

Top officials at the Pentagon, for example, will receive the vaccine in the coming days, as will senior staff in charge of the nuclear deterrent, homeland defense forces and cybersecurity.

One senior official at Health and Human Services, which is overseeing much of the pandemic response, told POLITICO it's still uncertain who will get prioritized for a vaccine and why.

“It’s this weird thing, they’re including certain leadership, but not other leadership,” the official said. “It’s still unclear what the plan is internally for this.”

Another senior health official noted that staff at agencies like the FDA who are largely working remotely are not expecting to get priority.

Leaders on Capitol Hill are also grappling with the question — and are highly sensitive to the appearance of getting preferential treatment.

Though hundreds of lawmakers have been putting themselves at risk flying in from their districts each week, and while several have already gotten sick, many said they did not want to appear to abuse their privilege to get the vaccine before more vulnerable groups.

“There are many people with good intentions who are struggling between wanting to lead by example ... versus waiting until they meet the criteria to get vaccinated,” Rep. Raul Ruiz (D-Cal.), a former emergency room doctor, said of his colleagues. “But I don’t think that power or privilege or money should ever be a factor in who gets the vaccine first.”

Ruiz noted that because many of his colleagues are over 65 or have underlying health conditions, they may not have to wait long to receive the vaccine even if they don’t request early access. Schumer also stressed on Monday that the timeline for members of Congress could change based on how much of the vaccine is available, and whether one or more additional vaccines receive an emergency authorization.

Biden is also taking a wait and see approach. An aide told POLITICO that the transition team is consulting with Fauci and will follow his recommendation on when the president-elect and his staff should get vaccinated. Fauci told MSNBC on Monday morning that while he himself will get vaccinated on camera within a week or two, he’s still “in discussions” with Biden on when he will do the same. Because the Pfizer vaccine is administered in two doses 21 days apart, Biden would have to get the first shot around the end of the year in order to be fully immunized by the time he's sworn in.

While he's glad Biden and other officials are being thoughtful about the shots, Ruiz said he's still worried about others in government abusing their positions to muscle in and get early access, which he said could erode public confidence.

“We cannot have a situation with the vaccines like we had with testing, where healthy millionaire athletes could get a test every other day while nurses who were taking care of contagious Covid-19 patients had to schedule one weeks in advance because there weren’t any available,” he said.

Former health officials agree that timing is everything. With just a few tens of millions of vaccines currently available and uncertainty about supplies hitting a “vaccine cliff”, it may not be helpful for Trump and Biden to make a show of getting injected until more contingencies are made, and millions more doses are secured.

“In an ideal world you’d have people in both parties line up and say, ‘We’re getting this vaccine and we think you should too,’” said former CDC Director Tom Frieden, who served during the H1N1, Zika and Ebola outbreaks. “But right now the only people who can get it are health care workers and people living in nursing homes. You don’t want to gin up demand before you get supply.”

Meridith McGraw, Sarah Owermohle, Tyler Pager and Heather Caygle contributed to this report.