ARI SHAPIRO, HOST:
In many states, when you sign up for a COVID-19 vaccine, it is up to you to tell the truth about whether or not you're eligible. It's an honor system, but that system doesn't always work. From member station KUOW in Seattle, reporter Eilis O'Neill has more.
EILIS O'NEILL, BYLINE: Fifty-seven-year-old Steve Baruso got a shot at a recent mass vaccination clinic run by the Seattle-area medical provider Virginia Mason. He admitted he wasn't actually eligible for it.
STEVE BARUSO: I hit the other on the form, and I got an email confirmation and so forth. I don't know how that happened.
O'NEILL: Baruso wasn't the only ineligible person who got a shot that day. Virginia Mason says that shouldn't have happened, but there was a technical glitch. A spokesperson wouldn't say how many people were affected but says the problem has since been fixed. But it's not just technical problems that are allowing ineligible people to get appointments. Some people are purposefully jumping the line.
JEFF DUCHIN: I have heard and seen stories from many people who do not meet eligibility criteria who've been vaccinated.
O'NEILL: That's Dr. Jeff Duchin, the public health officer for Washington's most populous county. He says Washington State is giving out vaccines on an honor system because it's just too hard to make sure that every single person who gets a vaccine is eligible for one.
DUCHIN: I think, you know, we shouldn't let the perfect be the enemy of the good here. We do want to get as many vaccines out as possible.
O'NEILL: Every provider in Washington has to decide on its own how and if to check eligibility. Tom DeBord at Overlake Medical Center in the Seattle suburbs says they give out thousands of vaccines every week.
TOM DEBORD: We do everything we can do to communicate to people, please schedule only if you're eligible. But it would really be difficult for every hospital to take it to the nth level to see if somebody really answered every question honestly. It's almost impossible.
O'NEILL: Rosalinda Kibby at the Columbia Basin Hospital in central Washington says they ask a few more questions. She says the hospital only gives out about 100 vaccines a week.
ROSALINDA KIBBY: We can look them up, usually in several systems, to see if they're eligible or not. But if they're not, it's a very bad conversation. They are irate and difficult for staff to deal with.
WILLIAM MOSS: There's a big lesson to be learned here.
O'NEILL: Dr. William Moss is at Johns Hopkins University's School of Public Health. He researches how to design vaccination campaigns. He says that one of the biggest problems with this one is that the eligibility categories are often so confusing and sometimes ambiguous. In Washington, for example, not just health care workers are eligible. All workers in health care settings are, too. People 65 and older are eligible. So are people 50 or older who live in a multigenerational home. And the State Department of Health's definition of multigenerational is a paragraph long.
MOSS: I think that was definitely well-intentioned when it was thought out. But people didn't take - kind of the next step is, how would we actually pull this off and operationalize this? And then you create confusion, and then you create opportunities for people to cut the line.
O'NEILL: Moss says simpler age-based categories would have been easier to communicate and enforce and would have still reduced hospitalizations and deaths. It is early in the rollout, though, and providers are making adjustments. A Virginia Mason spokesperson says you now need a photo ID and a screenshot or printout of your eligibility confirmation from the Department of Health in order to get a vaccine. That's an honor system in and of itself. There are states that have a tougher approach. Massachusetts, for example, asks people to certify that they're eligible, quote, "under the penalties of perjury." And they make that form available in 11 languages so there's no confusion.
For NPR News, I'm Eilis O'Neill in Seattle. Transcript provided by NPR, Copyright NPR.