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the next morning. "The side effects were short- lived," says Ms. Vasquez. "I'm happy to have expe- rienced eight hours of discomfort to help prevent spreading the virus." The majority of her 12 colleagues at the surgery center have been vaccinated. She understands vac- cination is an individual choice, but is personally grateful to have had the opportunity to be among the first wave of recipients. She's also felt a tinge of guilt. "If I did contract the virus, based on my med- ical history, I think I'd recover fully," she explains. "I typically put others' needs before my own, so it was hard for me to take the vaccination away from someone who might need it more." Jeffrey Blank, DPM, a podiatrist in the Chicagoland area who works at Dundee Foot and Ankle Center in Wheeling, Ill., had access to the vaccine in early January. Dr. Blank, a cancer sur- 2 2 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 1 As America's eagerly awaited but excruciatingly slow and disorganized COVID-19 vaccine rollout machine began wheezing in fits and starts, numerous politicians received vaccines on televi- sion. For healthcare professionals who have had a front-row seat to the rollout, the distribution of doses is spotlighting healthcare inequities. While the great majority of the general public continues to go without, they have witnessed hospital board members and spouses of physicians somehow move to the front of the line. That's why Marty Makary, MD, MPH, a profes- sor of surgery and health policy at the Johns Hopkins University School of Medicine in Baltimore, is refusing to get the vaccine himself — at least for now. He blames the ruling class making rules that benefit themselves, particularly those "low-risk Americans with access and power." The implicit message these people are sending, he says, is that their lives somehow mat- ter more than those of tens of millions of their fellow citizens, particularly those who are most vulnerable to the virus. "High-risk Americans have been devastated by COVID-19," he says. "Why aren't we vaccinat- ing vulnerable populations before younger, low- risk individuals?" Because vaccine supplies remain low, ethical questions are playing out in healthcare facili- ties throughout the country. ICU and ER per- sonnel should be getting the vaccine before office workers, for example, but that's not always the case, says Dr. Makary. He says peo- ple who have already had COVID-19 are being vaccinated, a circumstance he attributes to poor CDC guidance. As long as the vaccine sup- ply remains constrained, he believes those who have been infected already should step back from receiving their vaccinations until the avail- ability situation changes. Dr. Makary says allocating vaccines by pro- fession results in many low-risk individuals getting vaccinated before high-risk people, who are disproportionately comprised of Black, Hispanic and Asian-Americans. Instead, he believes the U.S. should follow Europe's exam- ple of using age and risk of mortality as the leading criteria. This, he says, would maximize lives saved, and he's encouraged to see some U.S. states such as Florida pivoting to the European model. Of course, this points to deep- er, more fundamental questions about the lack of a coherent virus allocation response at the federal level. The CDC's guidance is only advi- sory and leaves crucial decisions to individual states, explains Dr. Makary. He's currently heavily involved in academic work, far from the frontlines of COVID-19 care, and part of a growing number of healthcare workers who refuse to be vaccinated before every high-risk American gets both doses. "Just because you can get the vaccine doesn't mean you should," says Dr. Makary. — Joe Paone VACCINE DISTRIBUTION Rollout Raises Questions About Inequitable Care