When Holly, 33, received her first COVID-19 vaccine dose on Jan. 23, she felt conflicted. Although she was eligible because of her job at a mental health clinic and is diagnosed with an autoimmune disorder that puts her at higher risk for blood clots, she told Austonia, "I still had some guilt." She added that she was able to make an appointment before either her parents or her mother-in-law, who is unwell. "There was a gap in the overall system."

Holly, who asked to use a pseudonym, also kept her immunization status mostly private. She is involved in a holistic wellness community, where many members are anti-vaccine. She was, too, until recently, when she decided that any risks of getting vaccinated were outweighed by the risks of contracting a severe case of COVID. "I felt like there was some judgment around if I got the vaccine," she said. "And I just haven't wanted to open myself up to having to justify myself."

So-called vaccine guilt is a common experience among recipients given the limited availability of doses across Texas and the nation. It may become even more so on Monday, when the state will expand vaccine eligibility to all residents 16 and older. Amid this change, vaccine providers will still be asked to prioritize the elderly, who are especially high-risk and may have difficulty navigating the online registration process.

The Texas Department of State Health Services expects to receive an increased number of vaccine doses next week, which it cited as one reason for expanding eligibility. But supply remains limited. Midway through week 15 of the rollout, 292,161 Travis County residents are partially vaccinated and 121,769 are fully vaccinated, representing 28% and nearly 12% of the estimated population 16 and older, respectively, according to DSHS. This leaves around 40% of the currently eligible groups, not including those in the recently added 1C group, unvaccinated.

It may also lead some Austinites who will become eligible next week to question whether they should seek out an appointment. "I can see why people feel guilty because I feel guilty," said Christine Mitchell, executive director of the Center for Bioethics at Harvard Medical School. She received a vaccine early in the rollout because of her job, which is in a healthcare field but does not involve direct contact with COVID patients. "And many of us who are vaccinated … feel guilty because it has not been handled well in getting (doses) to grocery workers, for example."

The rollout, which Mitchell called "intensely problematic," has been logistically challenging for many reasons: the Pfizer and Moderna vaccines require ultra-cold storage, which limits the number of providers that have the necessary equipment to preserve them; mass distribution events serve more people but may exclude those without a car; online registration systems exacerbate the digital divide; mobile events in rural communities risk wasted doses if not enough people opt in.

It's these issues that have led some to feel guilty about accessing a vaccine that they know remains inaccessible to people at higher risk than themselves. "In an ideal world, what you would like is for everyone ... to be sort of rank-ordered in terms of their risk of dying from COVID and get the vaccine to the people at the top of the list first," said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Health Sciences Center.

Instead, the rollout has relied on categorization, which means that there is often a spectrum of risk within each group. Wynia urges people who are eligible for the vaccine to seek out an appointment. Not doing so could give the false impression of less demand for doses or higher rates of vaccine hesitancy than actually exist. "Don't neglect to get the vaccine when it's your turn even if you don't think it should be your turn yet," he said.

People who are bothered by this process can act in ways other than forgoing a vaccine. Wynia suggested supporting efforts to hold vaccine clinics in underserved communities, participating in phone-based outreach to people without internet service and volunteering as a vaccine angel.

Although some Austinites may feel that it is too soon to open up vaccine eligibility to the general public, there are benefits to doing so. For one, it will eliminate the guessing game of whether people are eligible or gaming the system. "If you really are jumping the queue and you're ineligible … now you are creating an unfairness," he said.

But both Wynia and Mitchell believe that such cheating is uncommon. "The whole fact that we're having this conversation about vaccine guilt is an indication that a lot of people are so honest about this that they're worried they're taking advantage of a system when they're not even really taking advantage of anything but playing by the rules," Wynia said.

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