When Algorithms Fail
After approval by the United States’ Food and Drug Administration on December 10, 2020, the Pfizer vaccine made its way to hospitals all over the country. By Monday the 14th, I started seeing colleagues and friends’ social media posts about receiving the vaccine – all very uplifting: excited, ecstatic, emotional about what people called the glimmer of hope and the beginning of the end. All well and good, and as a healthcare professional sitting out this pandemic and waiting my turn with the rest of the world, I had some sort of vaccine envy.
Then I saw this article about Stanford University. Their first shipment of 5,000 vaccines were allocated to employees via an algorithm. The good news: using an algorithm to efficiently help make decisions. The bad news: it was a flawed algorithm.
The algorithm put residents and fellows (doctors in specialty training) at the bottom of the list because they were young, and there was no “location” of work to plug in – residents rotate everywhere (for example, working in the ICU means you’re high risk, while being located in a radiology reading room is less risky… the algorithm would prioritize the ICU location). So the residents and fellows, who are the frontliners of the frontline, landed near the bottom of the pile and were eased out of the algorithm because they were young and generally healthy, while their older supervising physicians who had less patient contact were pushed to the front of the line. Residency itself is hard enough, add the pandemic on top of that makes it even more difficult.
Kudos to the Department of Surgery chair who saw this and made efforts to correct it for her department (also: the chair is a she – that’s another story, because female department heads are few and far between, especially in surgical fields). Kudos to the residents who realized this and spoke out about it – they participated in protests and garnered more media attention. But unfortunately the administration wouldn’t have known about it unless the residents said something. NPR’s news desk quotes an email from one of those residents: “The ones who ultimately approved the decisions are responsible. If this is an oversight, even if unintentional, it speaks volumes about how the front line staff and residents are perceived: an afterthought, only after we’ve protested. There’s an utter disconnect between the administrators and the front line workers. This is also reflective that no departmental chair or chief resident was involved in the decision making process.”
This is why you ultimately need a person with clinical experience deciding who gets the vaccine first. And you need someone who has a good grasp of the system as a whole. Algorithms help, but they are not perfect – they are a tool, but a human (or humans) still needs to look over this and make sure it makes sense in the bigger picture.
Read the article here:
Chen, C. 2020. Only Seven of Stanford’s First 5,000 Vaccines Were Designated for Medical Residents. [Online] Pro Publica. Available at https://www.propublica.org/article/only-seven-of-stanfords-first-5-000-vaccines-were-designated-for-medical-residents [Accessed 19 Dec. 2020]
Wamsley, L. 2020. Stanford Apologizes After Vaccine Allocation Leaves Out Nearly All Medical Residents. [Online] NPR. https://www.npr.org/sections/coronavirus-live-updates/2020/12/18/948176807/stanford-apologizes-after-vaccine-allocation-leaves-out-nearly-all-medical-resid [Accessed 20 Dec. 2020]
