One of Pennsylvania’s largest health networks allowed employees' family members to skip the COVID-19 vaccine line, raising questions of fairness at a time of strong public demand and scarce supply.

Geisinger's decision to give special access to employees’ relatives earned a rebuke this week from the Pennsylvania Department of Health, which said the health care giant shouldn’t have held vaccine clinics for eligible family members of employees.

“DOH has been in contact with the provider to ensure that going forward they follow the agreement they signed, or risk losing access to first doses of COVID-19 vaccine," said Maggi Barton, a Health Department spokesperson.

The state agency said it was unaware that Geisinger had arranged for family members to be inoculated until alerted by The Associated Press.

Geisinger said that since the family members who got the shots met the state’s eligibility requirements, it didn’t need to tell the Health Department that it had set aside vaccine for them. Geisinger also insisted it followed state guidelines for vaccine eligibility and administration and said “at no time were we informed that our vaccine program could be at risk."

Geisinger, which has 24,000 employees spread across central and northeastern Pennsylvania, held employee vaccination clinics on three consecutive Sundays in late January and early February. Each employee was permitted to bring two family members, so long as they were eligible under the state’s phased vaccine rollout, Geisinger acknowledged in response to an AP inquiry. Family members did not have to live with the employee to qualify, the health system said.

About 3,600 relatives of Geisinger employees were vaccinated under the program. No additional vaccine clinics for employee family members are scheduled.

“The situation in mid-January was very different than where we stand today,” said a Geisinger spokesperson, Matthew Van Stone. At the time, he said, Geisinger had an adequate supply of vaccine, and “we felt opening up Sundays to employees and up to two Phase 1A-eligible family members would make it easier for the community to find appointments throughout the week."

It is unclear if members of the public lost out on appointments because of doses given to employee relatives.

But the vaccine clinics allowed family members to avoid the frustrating, tedious and often fruitless hunt for an appointment that has plagued the state’s early rollout and led to widespread complaints among Pennsylvania residents. The state has been among the nation’s lowest ranked in how efficiently it is vaccinating its population.

“Even if their intentions were good, we shouldn’t be using vaccines as a ‘friends and family’ perk of employment,” said Gabriel Lázaro-Muñoz, a professor in the Center for Medical Ethics and Health Policy at Baylor College of Medicine. “This was just prioritizing the wrong people at the wrong time.”

The health system, which runs nine hospitals and a 550,000-member health plan, gave family members a leg up at the same time that newly expanded eligibility rules prompted a statewide surge in demand.

Geisinger’s first weekend clinic was held Jan. 24. That was five days after the state made people age 65 and older and younger people with high-risk medical conditions eligible for the vaccine. Geisinger said at the time it was facing overwhelming demand for vaccine appointments marked by extremely high call volume and online traffic.

Linda Thorne, 65, who works in her family’s pizzeria, said she has been trying for weeks to get an appointment with Geisinger, but the health system is not scheduling first-dose appointments right now.

“It’s really frustrating,” she said. “I see all these people my age getting really sick, and it’s scary. I don’t want to end up in the hospital on a vent.”

"I don’t think it’s fair," Thorne said, that Geisinger accommodated family members given the scarce supply of vaccine.

Other major health networks, including UPMC and Penn State Health, said they do not make separate arrangements for employees’ relatives to get vaccinated.

“Absolutely not,” said Brian Downs, spokesperson for Lehigh Valley Health Network. “We follow the (state's) Phase 1A guidelines and have from the start.”

The Health Department said that while Geisinger did not violate the letter of its provider agreement with the state, “we would hope providers would not prioritize employee families over community members who are also eligible,” said department spokesperson Barry Ciccocioppo.

Federal guidelines say that people in the same class of eligibility should have equal opportunity to get the shots. The guidelines also say that no person should be disadvantaged “because of social position or other socially determined circumstances.”

Nancy Kass, deputy director for public health in the Berman Institute of Bioethics at Johns Hopkins University, said that if Geisinger used the family member program as a way to get more vaccine to underserved populations, she would view it as “an extremely clever strategy” to increase equity.

“If it is simply a perk, it is not appropriate,” she said.

Kass said that while the Geisinger program is problematic, the national vaccine rollout as a whole has been inequitable because it rewards some people over others - in particular, those with the time and computer skills to find an open appointment.

Geisinger said that employee and family-member participation in the Sunday clinics was low, and it began using Sundays to vaccinate patients who needed their appointments rescheduled because of bad weather or shipment delays.

Geisinger’s vaccination of family members has been a relatively small part of its overall program. Through Monday, the health system has administered more than 112,000 vaccine doses.