Vaccinate The Vulnerable - Honolulu Civil Beat

About the Author

Larry Tool

Larry Tool is a former college instructor and a longtime reviewer for the San Francisco Chronicle. He is happily retired in Waipahu.

I’m 71, retired and in good health. If necessary, I can afford more months of quarantine. Yet, according to our state health department, I’m next in line for vaccination ahead of thousands of younger folks who have severe underlying medical conditions, many of whom still have to work and take care of kids.

While I applaud Hawaii’s devotion to kupuna, I still have to ask: Does this really make sense? Does it make sense to privilege age over illness? Why aren’t we vaccinating all of the most vulnerable, along with kupuna?

In a small state like this, is it really too hard to ask each health care provider to list their most vulnerable patients, combine those lists and get those people vaccinated?

When I direct these questions to state officials or hospital administrators, I am told, “We’re following the Centers for Disease Control and Prevention guidelines.” Really? The very first sentence of the guidelines says, “Each state makes its own plan.”

This gives state health departments (and governors and legislatures) an opportunity to tailor the guidelines to fit each state. It would be interesting to know how far, and how carefully, that opportunity was explored by public health officials here in Hawaii.

Since the guidelines are only recommendations, they don’t really answer my questions. The CDC guidelines also state that, “Adults of any age with certain underlying medical conditions … may receive a COVID-19 vaccine.”

We do know that our state officials have already modified CDC phase 1c, and their own published plan, to include only persons aged 70 to 74 and to defer the CDC recommendation to vaccinate persons aged 65 to 69, as well as “people aged 16 to 64 years with underlying medical conditions.”

Following the CDC, Lt. Gov. Josh Green told Hawaii News Now on Feb. 18 that “health officials also want to prioritize people over the age of 16 who suffer from certain chronic diseases … individuals who … are actively getting chemotherapy … require oxygen or who are dialysis dependent.”

If you also include individuals with multiple diseases (co-morbidities), then this would make sense. Unfortunately, it seems that Green does not speak for “health officials,” even though he is our duly elected lieutenant governor. Four days later, Libby Char, the director of the Hawaii Department of Health, told lawmakers, “Younger people with chronic diseases will have to wait.” Why was this change made? Who’s in charge here?

Registered Nurse Alexis Lagasca from Kalihi Palama Health Center gives COVID-19 vaccinations at St. Elizabeth Church.
Alexis Lagasca from the Kalihi-Palama Health Center administers a COVID-19 vaccination at St. Elizabeth Church in Honolulu. Cory Lum/Civil Beat/2021

Throughout this pandemic there have been mixed messages coming from the fifth floor of the capitol. Green has taken it upon himself to become the face and voice of the state response to COVID-19, our own Dr. Anthony Fauci.

He’s everywhere — across social media, in the paper, on TV and radio — and seems to attend every public health meeting and event. He’s tireless, and he’s been tremendously helpful explaining to the general public what the virus is, how it spreads, its dangers and the means to combat it. He has argued with the governor and other officials when he thought they were giving wrong advice or making wrong decisions. For this, we all owe him a debt of thanks.

The problem with Green, however, is that we never know when or if he is speaking for the administration or DOH. He has been contradicted, silenced and sidelined and then grudgingly rehabilitated by Gov. David Ige and other officials.

He has been called a rogue operator. Some have tried to dismiss his efforts as campaigning. But the overwhelming reality is that Green is operating in a vacuum. He could not have become the face of public health if Ige and Char were putting out clear, consistent messages and engaging with the public on a daily basis.

“Hawaii’s people are patient, respect authority and have ancient traditions of cooperation. This is one reason we have the lowest death rate among the states.”

Ige’s aversion to risk has its charms and uses, but it’s not what we need in a crisis. Char is new to her job and comes across as caring and highly competent, but we still need her to explain her decisions, to answer everybody’s questions every day and to make sure the government speaks with only one voice. If this is outside her job description, then we need to hire her a skilled press secretary, at least for the next year. It would be money well spent.

Think about where we are, emotionally. We’ve weathered a whole year of disinformation and denial from the former Trump administration. We’re mourning half a million dead. People are confused, frustrated, scared and angry.

Most of us are not doctors, nurses or scientists. Every news cycle brings a new worry. Today it’s the mutation of potentially vaccine-resistant variants; tomorrow, it will be something else.

If we look around the world, countries with the highest capacity for common action have done best – New Zealand, Vietnam, Taiwan, etc. Efficient rollout of vaccine is obviously a huge problem on the mainland, but Hawaii should be able to do better.

Hawaii’s people are patient, respect authority and have ancient traditions of cooperation. This is one reason we have the lowest death rate among the states.

Yet we’re not doing better than the others with vaccine rollout. Green claims we’re number seven; Becker’s Hospital Review says we’re actually number 37. What’s missing here in Hawaii are consistent, confident and articulate leaders.

Our DOH, like other state agencies, is made up of highly skilled and knowledgeable people who often don’t get enough credit. In normal times, most of their work is invisible to the general public.

But in any department the top job is always political, not just in the minor politics of hiring and firing, but — potentially at least — in the major politics of inspiring and leading other officials and the general public.

For example: Some years ago, when Molokai fishermen were in an uproar over poaching, we didn’t hear from the governor or from our U.S. senator; it was Bill Aila, the director of the Department of Land and Natural Resources, who flew in immediately, hosted public meetings and put out the fire.

Like it or not, fair or not, during a pandemic the DOH director is actually flying the plane. Whoever holds this job must have high energy, great communication skills, political savvy and the ability to win public trust.

Green may have made mistakes; perhaps he has indulged in a bit of self-promotion; but in the midst of this crisis, he has been the only one consistently trying to fly the plane.

Ige needs to choose. He and his appointees should either make Green their official spokesman and support him 100%, or they should take over his role so effectively that there is nothing left for Green to do. I’m sure the good doctor could use a vacation.

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About the Author

Larry Tool

Larry Tool is a former college instructor and a longtime reviewer for the San Francisco Chronicle. He is happily retired in Waipahu.

Latest Comments (0)

Aloha- surely teachers are as critical to Hawaii’s economic recovery as medical workers and should be prioritized over kupuna

Peggy_Hill_WBA · 2 years ago

Advanced age is the single greatest predictor of morbidly and mortality associated with Covid-19.  Advanced is highly correlated with pre-existing conditions like diabetes, heart disease, lung disease and kidney disease.  Since time is of the essence in combating Covid, it makes the best sense to vaccinate the elderly first. With respect to the efficiency of our rollout we have much room for improvement.  Many Covid-19 clinic volunteers can attest that although the sites are well run, we don’t have enough sites up and running and we aren’t utilizing our licensed volunteers efficiently. Also, it is far too difficult for people to register online for getting vaccinated; there are never enough open slots.  Too many young people are being vaccinated ahead of the elderly.

be_data_driven · 2 years ago

There are those who say "we got what we voted for", but I don't remember incompetence being spelled out on the ballot.I'm neither vulnerable nor essential, so I will learn firsthand how long it's taking to vaccinate those who are. At the current rate of 40K/week with a 2-dose regimen, it's going to be well over a year.

maximus · 2 years ago

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