Credit: Illustration by Ronan Lynam

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Natalie drove more than 100 miles on March 25 to get a COVID-19 vaccine at the Wicomico Youth and Civic Center on Maryland’s Eastern Shore, where Gov. Larry Hogan’s administration set up a mass vaccination site. Traveling that far, she says, made sense because she figured she’d never get the COVID-19 vaccine in D.C., where she’s lived for the last three years.   

The National Guard welcomed Natalie when she arrived at the arena in Salisbury, Maryland. They checked if she had an appointment (she did), and requested to see some form of photo identification (which she had). She showed her D.C.-issued ID, which lists her address in Ivy City, a handful of times before she got the jab, but says no one at the vaccine site asked her about it. 

“They never did a double take. They never questioned if I was moving to Maryland. I never felt judged,” said Natalie, who requested to be identified by only her first name due to the nature of her work. “They’re all doctors and nurses. I feel like they were focusing more on their job of just helping people, as opposed to gatekeeping help that people need.” 

Natalie, who is 31 and works at a global philanthropy non-profit, says she has a qualifying medical condition that makes her vaccine-eligible in Maryland and the District. But booking an appointment in the jurisdiction where she lives proved frustrating. She became eligible in late February, when DC Health opened the vaccine portal to residents 18 and over with qualifying medical conditions. She was among the tens of thousands of people who tried to claim one of the couple thousand appointments that became available two days a week. 

The Hunger Games-style system, which was riddled with technical issues, is Natalie’s main gripe with the city’s vaccine rollout. Natalie believes the new pre-registration system that launched March 10 is better. But once her partner got an appointment through D.C.’s lottery system and family members in other parts of the country got vaccinated, Natalie decided she could wait no longer and started searching for other ways to get the shot. She became a vaccine hunter.  

“I was not lying. I was not trying to get around the system just to get one,” says Natalie. “If they’re going to bar me and say that my address is not allowed, OK. That’s fine. I can wait. But I felt like I was very welcomed in that they were flexible in letting me in. So I thought, I’ll just take advantage of this.” 

Natalie booked an appointment through Maryland’s website for mass vaccination sites. She says she saw hundreds of appointments available and used her D.C. address when she signed up. Maryland officials are not encouraging D.C. residents to get vaccinated in their state, but they are not turning away any of them for doing so either. 

These so-called “vaccine hunters” have sometimes been characterized as rule-breakers. Natalie does not see herself this way. She is one of countless individuals who have gotten vaccinated out-of-state, based on anecdotal reports. Some people may have lied about their eligibility, while others learned of places where eligibility is open to a wider population and residency requirements are not strictly enforced. Each individual has their own reasons for getting vaccinated as soon as possible. Natalie, for example, says she lost a family member to COVID-19 and hasn’t socialized with anyone but her partner in person in the last five months.  

Waiting for your turn to get the vaccine seems relatively simple. Local governments have rolled out vaccination plans that keep those most at risk of serious illness from COVID-19 top of mind, and residents are expected to trust that their elected leaders are acting in good faith. Anyone deciding to cut the line takes the place of someone who really needs the shot, the thinking goes. But what if it is your turn and you can get the shot sooner somewhere else? D.C. residents frustrated with the city’s rollout say this is true of them. 

Crossing borders to receive better health care is nothing new. This phenomenon tends to happen when care in a particular area is inaccessible or medication prices are inflated. In the U.S., access to quality health care can boil down to zip code. People living in rural areas may travel more than 40 miles for breast cancer treatment, and those seeking more reasonably priced insulin have gone to Canada or Mexico to buy it. 

In D.C., demand for the vaccine still exceeds supply, so it’s still out of reach for many eligible people. Some cast all the blame on the D.C. government, but there are practical reasons for why doses are so scarce for residents. Enthusiasm for the shot among the unvaccinated is higher in D.C. than most other cities and states nationwide, according to the latest Census Bureau Household Pulse Survey. The Bowser administration has also used nearly a third of its supply on non-residents because so many of the city’s essential workers live elsewhere. 75 percent of D.C.’s 85,000 health care workers live in Maryland and Virginia, for example, and DC Health moved to vaccinate these workers first. The federal government has denied the Bowser administration’s multiple requests for more doses, given the uniqueness of its worker population. Even Virginia Sen. Mark Warner’s legislative attempt to bring parity to the allocation of doses proved unsuccessful. A request to the Federal Emergency Management Agency for a mass site in D.C. that would result in increased supply was also rejected

Even if supply were to increase, it appears as though D.C.’s current vaccinators would still struggle to quickly vaccinate eager residents. Community health centers and pharmacies who get supply directly from DC Health and the federal government are having logistical troubles. Giant, for example, temporarily requested that the federal government stop sending any more vaccines because the company needs additional personnel to administer any more shots, according to the Post. DC Health has so far not requested any support for federal personnel. “We have plenty of vaccinators in the District and so that’s not very helpful to us,” DC Health’s emergency response director, Patrick Ashley, said during a March 24 conference call with the D.C. Council.   

Access to the vaccine varies greatly from place to place, since states and providers receive different amounts of doses and have different eligibility standards, so many vying for an appointment have turned to social media to identify opportunities. Natalie, for example, turned to the District Vaccine Hunters Facebook group. That’s how she learned about the appointments available in Salisbury.

The private group of roughly 6,000 members has become a forum where people offer tips on how to get vaccinated. Membership grows daily—in one day, alone, there were one thousand requests to join. In D.C., there aren’t a lot of ways people can try and book an appointment because a lot of health providers that are vaccinators use the government portal. Officials argue it’s the best way to avoid a free-for-all and ensure equity. DC Health has a zero waste policy, so people on the Facebook group offer one another advice on how to find spare doses in the city. One of the rules for joining the group is to be ethical. 

“This group maintains the highest ethical standards w/ regard to vaccination,” says a post in the group’s “About” section. “Be honest. Do not jump line, exploit loopholes or lax verification of eligibility, or encourage others to do so.”

The woman who started the group says she did not initially allow any information on traveling outside the District to get the COVID-19 vaccine. She reviews every post before it goes live for thousands to see. (She requested anonymity for privacy reasons.) Part of her thought it was unfair, and part of her worried about the unintended consequences. If too many people ventured to, say, Virginia, officials there might start requiring ID and this could hurt undocumented residents.  

“I just decided to allow it,” she tells City Paper. “Hopefully it’s the right thing to do. It’s kind of morally ambiguous.” 

“The group has really undergone evolution. And I haven’t enjoyed the process at all because I’m a really literal, kind of morally rigid person,” she continues. “I’m a rule follower.”

Inspired by similar online groups, she launched District Vaccine Hunters, her second Facebook page about COVID-19 vaccines, on Feb. 15. The first offered information to those who have the same medical condition she does, which makes them allergic to many vaccines. Once she realized it was safe for her to get the COVID-19 vaccine, she decided to create an online forum to promote facts about the shot and identify opportunities. “I was imagining that I was going to be helping people that were the most in need of help. And then everybody who joined the group seemed to be people who are least in need of help,” she says. 

She believes the people who join the group nowadays are those for whom pre-registering on vaccinate.dc.gov is not enough. According to Facebook’s demographic data, the group skews younger, between the ages of 25 and 44. Polling of a couple hundred members shows most people live in Ward 1 and 6, followed by Wards 2 and 3, the District’s more affluent wards. According to another poll, nearly 200 people say they’ve gotten vaccinated in another state. Demographic data says the vast majority of members live in D.C. 

Daniel got vaccinated in Baltimore after learning he could book an appointment at a mass vaccination site in Maryland through District Vaccine Hunters. He fits the group’s demographic: Daniel, who has asthma, is 24, lives in Adams Morgan, and was not satisfied with just pre-registering. “I did a few times honestly. Like every week I was pre-registering because I wasn’t hearing anything, and I was told that I was in a group to be vaccinated right now,” he says. 

“I never lied about my eligibility,” he continues. “Everyone in my family got vaccinated very quickly. I just hadn’t seen them in forever, and I just was like, ‘I really need to get one.’” Daniel, who requested that only his first name be printed out of privacy concerns, became more motivated to hunt for a vaccine when he saw people his age with asthma but living elsewhere get the shot. “I just felt completely let down by the city of D.C. … You do what you gotta do and I’m just happy I get to be vaccinated. Hopefully D.C. gets it together so I can get my second dose here and not in Maryland.”

Daniel tried but failed to make an appointment for his second dose in the city. After he got a call from DC Health, inviting him to get vaccinated, Daniel looked into getting his second shot in D.C. instead of Baltimore. A DC Health representative told him he had to get his second shot at the same site he got his first one. He had no luck getting a shot to be fully vaccinated through his provider, MedStar Health, either.

DC Health says each site that someone visits for their first shot sets aside vaccine and staff resources so that person can return for their second one. That’s because a site receives a second dose for every first dose administered. For D.C. residents or workers who have chosen to get vaccinated in Maryland or Virginia, DC Health says they must return to the same location for their second dose. For those who received their first shots in non-neighboring states, DC Health will work to accommodate second doses, as available. 

“While we appreciate the desire to have a vaccination appointment here in the District, our appointments are prioritized for first and second doses obtained here in the District so that we can quickly get all District residents vaccinated,” a DC Health spokesperson says. “Providing second doses to individuals who received them outside the District, ultimately limits the number of vaccines available in the District.”   

Residents have justified leaving D.C. to get vaccinated in many ways. The D.C. government has vaccinated so many people who live elsewhere, they’ll say. So many people in their networks have left D.C. to get vaccinated. They’ve gone to California, New York, New Jersey, and North Carolina. Citing national news trackers that offer muddled data, they insist other states are doing a better job than D.C. Borders are arbitrary, anyway. They have the means—be it money, access to transportation, or physical fortitude—to, so why not? 

“The vast majority of them seem to not be from priority zip codes,” says the creator of District Vaccine Hunters, referencing DC Health’s way of identifying communities hit hardest by COVID-19 but with less medical coverage. “Maybe sending them off to Maryland and Virginia and elsewhere, where there isn’t such an access problem and where many more people are vaccinated, maybe allowing that is fine and will free up vaccines for people who really need them in D.C?” 

Jessica, who’s lived in the District for two decades, returned to her home state of Ohio to get vaccinated. She drove ten hours in one day to get the shot in Youngstown. Diagnosed with asthma, she is eligible in D.C. but questioned her qualifications, since her asthma is not moderate or severe. But when her sister who still lives in Ohio told her the state was vaccinating anyone over 40, regardless of residency, she considered it. “I called my father, who was a physician, and Googled some ethics articles. And I’m a lawyer, so I really could convince myself of the ethics, pro and against, going into another state,” says Jessica, 46. “I obviously convinced myself that it was OK and I really felt more comfortable because I didn’t have to lie.” 

She says she called the pharmacy ahead of time to let them know she lives in D.C. The pharmacist said that wouldn’t be a problem and sure enough, no one asked for ID when she arrived at the Giant Eagle Supermarket. (Ohio’s health department confirmed they are encouraging providers to vaccinate individuals regardless of residency.) While she’s confident in her decision, Jessica worries about the public backlash. She let City Paper use her full name at first, but changed her mind after Washingtonian published an article on this topic and she saw the initial reactions to it.   

Bioethics experts seem to agree that this is all very complicated. There are obvious examples of people cheating the system, like the two women in Florida who dressed as if they were elderly to get inoculated. That is different from someone getting lucky with a spare dose at the grocery store, which is different from someone traveling to another state just to get vaccinated. Bioethicists City Paper spoke to see people’s behavior resulting from anxiety, exhaustion, and failure of national leadership, which started once the Trump administration shifted responsibility to local governments.      

“We’re in this kind of moral fog because a society of this complexity needs direction, and the institutions that we expect to give us direction have failed,” says Jonathan Moreno, a bioethics professor at the University of Pennsylvania. “If people don’t have confidence that everything is being played straight with them, how much of their moral responsibility do they have to shoulder?”  

“I’m most worried about people who really are at high risk and might be unable to get appointments because other people are snatching,” says Melissa Goldstein, an associate professor of health policy at The George Washington University and expert in bioethics. “I’m worried about the people who are able to take advantage of the loopholes or the ambiguities or however we want to characterize it, positive or negative.”

Local officials are aware that D.C. residents are leaving the city to get vaccinated. A DC Health spokesperson says it is likely that more residents are vaccinated than what is shown on the government website, which says about a fifth of the local population got at least one dose. The D.C. government agreed to participate in an immunization data exchange run by the Centers for Disease Control and Prevention, so the agency should be receiving other states’ data “in the next few weeks,” the spokesperson adds.  

D.C., Maryland, and Virginia do have a joint agreement that says they are committed to vaccinating eligible residents and out-of-state workers because there is so much spillover. “We prefer that Marylanders are prioritized for getting a vaccine allocated to us by the federal government; however, Maryland will not turn away a person from out of state who needs a vaccine,” says a bulletin from the Maryland Department of Health.   

At an April 1 press conference, Hogan said he is not encouraging D.C. residents to get vaccinated at mass sites in his state like the one in Salisbury. “They’re federal assets,” Hogan said of FEMA sites. “We’re required to vaccinate people, we do Marylanders in other states, other people from other states in our state, we have no way to change that.” However, he says federal officials intend for the site that will open at Greenbelt Metro station this week to serve residents from D.C. and Virginia in addition to Maryland. 

“Our mass vaccination sites are to primarily serve Marylanders, and by the numbers, they by and large do,” writes Michael Ricci, a spokesman for Hogan, via email. “Overall, a little under 4% of those vaccinated at mass vaccination sites are in the unknown/out of state category.” 

It’s unclear what government officials really make of the phenomenon of traveling out-of-state to get vaccinated. No D.C. officials have commented on this. This also isn’t entirely unique to the District. Pennsylvanians are going to Ohio for vaccines, for example. It is clear that some D.C. residents are taking drastic measures and traveling hundreds of miles because they’ve lost faith in the systems that currently exist. The pandemic is an unprecedented public health crisis, and mistakes along the way were inevitable. Squishy guidelines and botched communication have left many people upset. 

“I’m just kind of vaguely angry, but I’m not particularly angry at anybody,” says the woman behind District Vaccine Hunters. “Like whose fault was it? I don’t really know.” 

This post has been updated to include more information about Daniel’s efforts to get his second dose in D.C.