Stanford Hospital erupts in protest after vaccination plan left residents out

One of the most difficult aspects of the first round of vaccinations is deciding who will get the first doses from a limited supply. The need to have a functioning medical system in the face of an out of control pandemic has meant that most places have prioritized the doctors and nurses who provide most of the patient care in person. But an apparent failure to prioritize these caregivers at Stanford Medical Center has prompted many of its doctors to stage protests today.

Ars received a copy of an open letter sent by chief medical residents to the Stanford administration that describes the issues that sparked the protests.

In the United States, residency takes place after graduating from medical school and is a requirement for the practice of medicine. Residents typically work under the supervision of a physician in a training program at teaching hospitals, and they learn to practice a specialty branch of medicine, such as internal medicine or pediatrics. In many cases, residencies are followed by scholarships, which are used to develop other specializations. As these positions are both temporary and necessary for the practice of medicine, those who occupy them have little political clout within hospitals.

Despite their lack of input into the management of most hospitals, residents and fellows provide most of the direct patient care that is provided by physicians (nurses and other patient care specialists also provide a lot). As such, residents are expected to be most at risk of exposure to the SARS-CoV-2 coronavirus. However, according to figures cited in the letter, less than one percent of Stanford residents and fellows will be vaccinated using the first set of doses.

Despite what appears to be an obvious loophole, an email sent to residents by Stanford Chief Medical Officer Niraj Sehgal, and provided anonymously to Ars, indicated that the plan would go ahead regardless. Despite Seghal’s email explicitly stating “I couldn’t feel worse about this,” Thursday’s post suggests that the priority for the administration is simply to figure out what went wrong. Residents are expected to wait until next week, when more vaccines should be available.

Enlarge / Protests at Stanford Medical Center. Credit: Ars Technica

This response sparked an outraged letter (also sent yesterday) from 17 chief residents of the hospital. He also launched the protests that took place today. The letter from the main residents describes the problems in detail.

Despite repeated promises to prioritize front-line providers of household staff in this initial phase of vaccine delivery, we learned that only seven residents / fellows were ultimately included. There is still no articulated plan to vaccinate the remaining 1,300+ residents and fellows, including those on the front lines directly treating COVID-19 patients.
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Stanford’s decision to de-prioritize residents and fellows is helpless on the basis of science, reason, ethics, and equality. Many of us know of senior professors who have worked from home since the start of the pandemic in March 2020, without the responsibilities of in-person patients, who have been selected for vaccination. In the meantime, we residents and scholars are donning N95 masks for the tenth month of this pandemic without a transparent and clear plan for our protection in place.

This letter asks for a number of steps in response to the immediate problem, including an explanation of how the algorithm produced the results it got, and an explanation of why, if its output was apparently known. as of Tuesday, the administration decided to follow up with the plan it produced even if it had three days to design a better one. Residents demand a plan that gets them vaccinated as quickly as possible, while allowing for staggered injections due to expected flu symptoms that often result from the immune system’s response to the vaccine.

In the longer term, it lists the elements that would be needed to restore residents’ confidence in the administration of the hospital. Much of these revolve around placing resident representatives in positions of power within the hospital hierarchy, including the hospital board of directors and the advanced medical education committee. In the meantime, protests continued throughout the day on Friday.

Figuring out how to prioritize a finite resource is going to create a lot of tension over the next six months, and there will be some questionable decisions, even if they are well intentioned. If the chief residents’ account is correct, however, it’s hard to consider this plan to be well-meaning. Instead, it appears the administration outsourced the decision-making to an algorithm and didn’t question its output even after it was obvious it was problematic.

We asked Stanford for comment and will update this story if we receive any.