When Chanel Maronge saw on Facebook that she was eligible to get a Covid-19 vaccine, she seized the opportunity. The only catch? She had to cross the state line to Mississippi last week, driving an hour and a half from her home in Baton Rouge, La., to get her first shot.
“The idea of having to wait an unlimited amount of time in Louisiana to get a vaccine just didn’t work for us,” said Ms. Maronge, 37, a school librarian who has hypertension. Her husband, who has diabetes, and both her parents were able to get vaccinated along with her in McComb, Miss.
With overwhelming demand in the early months of the vaccine rollout, thousands of Americans are crossing state lines on quests for doses. The scramble to get inoculated has turned attention to the patchwork of vaccination rules devised by states, given a lack of national, standardized protocols.
With states varying widely in prioritizing who can get shots, “vaccine hunter” groups, which scour the country for places where people qualify for the vaccine, have sprung into action on social media. That has public health officials grappling with how to handle pandemic travelers: Should strict rules be followed, turning away all outsiders, or should as many shots be administered as possible, even if some may go to people from other places?
“The federal government has created this ‘Hunger Games’ scenario where people are out there doing everything they can to get to the front of as many lines as they possibly can,” said Dr. Francisco García, director of the Pima County Health Department in Tucson, Ariz. “The limited vaccine supply provokes even more anxiety because people are trying to get their hands on a very rare commodity.”
Still, Dr. García said he did not see a problem with vaccinating people whose official residencies were outside of Arizona as long as they spend significant stretches of time in the state, as many snowbirds and other winter visitors do.
“From a strictly public health perspective, my interest is to achieve a level of population coverage that allows us to have a degree of community immunity,” Dr. García said.
Not everyone views the quandary the same way, revealing ethical fault lines at a time of limited vaccine supplies and thousands of daily deaths from Covid-19. Given the pressing need to vaccinate Americans as efficiently as possible, medical ethicists say it is fine to take a vaccine out of priority order if offered one; some hospitals with adequate doses have offered shots to all employees to avoid wasting supplies, and cases have emerged of extra shots being offered to passers-by rather than letting them expire.
But cutting the line — or in this case, crossing state lines — to jump ahead goes beyond that ethical boundary, said Nancy Berlinger, a bioethicist at the Hastings Center, an ethics research institute in Garrison, N.Y.
Each state gets vaccines based on their own population, Dr. Berlinger said. In a public health context, “you’re trying to get another state’s resources for free,” she said. “It’s called being a free rider.”
“When we jump the queue, we’re not only putting ourselves literally in ahead of other people, we are actually working against the health of other people, because some people came into this pandemic with higher risks,” Dr. Berlinger said.
More than 27 million people in the United States have received at least one dose of a vaccine, but it is not known nationally how many people have left their state to get a shot. Some states, however, are tracking the issue. In Ohio, at least 21,501 shots went to residents from elsewhere, according to the state’s vaccine dashboard. The Florida Department of Health has reported that more than 57,000 people who live in another state have gotten shots.
Some states have begun cracking down. Kentucky updated its vaccine eligibility requirements this week so that only residents or individuals providing health care services directly to patients in Kentucky would be able to get the shot. The Washington State Department of Health said last week that people receiving a Covid-19 vaccine at one of the state’s four mass vaccination sites must either work or live in the state.
But elsewhere, people are finding ways to travel for shots.
Ms. Maronge, the Louisiana resident who got a shot in Mississippi, said she was trying to keep herself and her family safe. People ages 16 to 64 who have chronic health conditions, including diabetes, are eligible to get the vaccine in Mississippi, but not yet in Louisiana.
Ms. Maronge’s mother, who is 69, missed the cutoff for Louisiana vaccine eligibility by just a year, but her age group was eligible in Mississippi.
At the vaccination site in McComb, no one asked for proof of residency, Ms. Maronge said, and workers inquired only about medical history and pre-existing conditions. Ms. Maronge said that she and her husband made it clear they lived in Louisiana, but that it did not seem to bother the staff.
In Mississippi, more than 5,300 people from out of state have received a coronavirus vaccine, Liz Sharlot, a health department spokeswoman, said. The department requires people to live or work in Mississippi to get a vaccine, Ms. Sharlot said, but workers do not ask for proof of residency.
For people still waiting for vaccines, it can be frustrating to see others jump ahead. Lawrence Gretz, a retired correctional transportation officer in Mesa, Ariz., said he was incensed after seeing news reports that people from out of state, including people spending the winter in Arizona, were getting their shots before him and his mother.
“It’s just not right and it’s ticking a lot of us off,” said Mr. Gretz, 66, who moved to Arizona 14 years ago from Illinois. He added that he still had no idea when he would get the vaccine since he suffered from severe vertigo, making it difficult to drive to large vaccination sites in the Phoenix area.
The varying vaccine approaches in every state have created a puzzling maze of rules that may be exacerbating the temptation to seek shots away from home.
In Georgia, anyone 65 or older is eligible for a Covid-19 vaccine, but just across the state line — in Tennessee, Alabama and South Carolina — that is not the case. In Alabama, anyone 75 or older can get a shot. In Tennessee, the cutoff is 70 or 75, depending on the county. In South Carolina, it is 70.
Georgia’s health commissioner, Dr. Kathleen Toomey, has called crossing state lines for shots “irresponsible and selfish” but said the state would not crack down to try to prevent it.
Currently more than 150 million people — almost half the population — are eligible to be vaccinated. But each state makes the final decision about who goes first. The nation’s 21 million health care workers and three million residents of long-term care facilities were the first to qualify. In mid-January, federal officials urged all states to open up eligibility to everyone 65 and older and to adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19. Adults in the general population are at the back of the line. If federal and state health officials can clear up bottlenecks in vaccine distribution, everyone 16 and older will become eligible as early as this spring or early summer. The vaccine hasn’t been approved in children, although studies are underway. It may be months before a vaccine is available for anyone under the age of 16. Go to your state health website for up-to-date information on vaccination policies in your area
You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Congress passed legislation this spring that bars insurers from applying any cost sharing, such as a co-payment or deductible. It layered on additional protections barring pharmacies, doctors and hospitals from billing patients, including those who are uninsured. Even so, health experts do worry that patients might stumble into loopholes that leave them vulnerable to surprise bills. This could happen to those who are charged a doctor visit fee along with their vaccine, or Americans who have certain types of health coverage that do not fall under the new rules. If you get your vaccine from a doctor’s office or urgent care clinic, talk to them about potential hidden charges. To be sure you won’t get a surprise bill, the best bet is to get your vaccine at a health department vaccination site or a local pharmacy once the shots become more widely available.
That is to be determined. It’s possible that Covid-19 vaccinations will become an annual event, just like the flu shot. Or it may be that the benefits of the vaccine last longer than a year. We have to wait to see how durable the protection from the vaccines is. To determine this, researchers are going to be tracking vaccinated people to look for “breakthrough cases” — those people who get sick with Covid-19 despite vaccination. That is a sign of weakening protection and will give researchers clues about how long the vaccine lasts. They will also be monitoring levels of antibodies and T cells in the blood of vaccinated people to determine whether and when a booster shot might be needed. It’s conceivable that people may need boosters every few months, once a year or only every few years. It’s just a matter of waiting for the data.
“I think it’s important that everybody know we’re not going to be checking driver’s licenses, we’re not going to police this process,” she said in a news briefing last week. “Does that mean that somebody may slip in from out of state? Possibly.”
But while every state should be prioritizing its own residents, Dr. Toomey said, the collective goal is for as many people to be vaccinated as possible. Rhode Island is the only state that has yet to expand its eligibility to older members of the public.
In Georgia’s northwest health district — a district made up of 10 counties that borders Tennessee and Alabama — some people have traveled from other states to get appointments, said Logan Boss, the district’s spokesman, though he said the numbers were very low.
Every person is asked to show identification, he said. But those who cannot show an ID — and even those who bring an ID from another state — will not be turned away, he said.
Given the differences in states’ supplies of vaccines and the different paces of their rollouts, it is unsurprising that people would go wherever they could to get the vaccine as soon as possible, Mr. Boss said.
“We sort of anticipated that,” he said. “I don’t think it’s problematic. Certainly, every state wants to take care of its own citizens first if at all possible. But the ultimate goal of this vaccination process, which is going to be a marathon, not a sprint, is to get as many people immunized as possible.”
Public health experts agree. Dr. Peter Hotez, a vaccine scientist at the National School of Tropical Medicine at Baylor College of Medicine, said he viewed the notion that people were cutting lines as a false construct. As new variants of the virus threaten to reverse progress in slowing Covid-19 cases, Dr. Hotez said that anybody who was able to get a vaccine should — even if that meant going across state lines.
“We have to stop stigmatizing people who get vaccinated,” Dr. Hotez said.
“We need to get to a situation pretty quickly where anybody who wakes up in the morning could get vaccinated by that afternoon,” he said. “If we don’t get there, we’re going to lose. We’re going to be deluged with these variants.”