Case Study – Weight Stigma Impacts COVID-19 Vaccinations

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People of all sizes had difficulty getting the updated COVID-19 vaccine but, as it often does in healthcare, weight stigma can turn a situation in which it is difficult to get care into a situation where it becomes impossible.  

We have known for decades that higher-weight patients need longer needles for intramuscular vaccines, which includes the COVID-19 vaccines. I wrote about that in detail here.

I recently heard about a higher-weight person who attempted to get a COVID vaccine with a longer needle but was told that it wasn’t possible because the facility was using pre-filled syringes. I reached out to them and they gave me permission to share their story anonymously, and I’ve since learned that they are not the only one to receive this misinformation.

While it may be happening at other facilities, the experiences I’ve heard about this are happening at Kaiser Permanente. That’s important because Kaiser insurance is not portable, which means that if a Kaiser facility tells someone they can’t have the longer needle that is required for vaccine efficacy, they can’t simply go to another facility or pharmacy that does have the correct size needle and have it covered by their insurance.

The next step, for those who can afford to do so, might be to cash pay around $200 at a different pharmacy. Except those pharmacies have been (mistakenly, according to what I’ve been told) turning away patients who are out of network for the pharmacy, telling patients that they can’t use their  insurance at the pharmacy and that the pharmacy can’t accept cash payment from them because they have other insurance (one such story was covered in the Washington Post.)

A patient in this situation, who has been waiting for an appointment for the vaccine, only to arrive and be told that they can’t be correctly vaccinated, and who either can’t afford to cash pay or can’t find a pharmacy where they can cash pay is put into a terrible situation. Of course, vaccination with a shorter needle is better than no vaccine, but higher-weight patients deserve to be vaccinated with the proper size needle, just as thin people are.

I want to point out that this can be even more difficult for multiply marginalized fat folks including disabled people and/or those who don’t have easy access to transportation or healthcare.

But it gets worse. The story that these patients were told about pre-filled syringes not allowing for a longer needle is false. I called one of the facilities where a patient was told this story and the nurse I spoke to was baffled, explaining that they add the needle to the pre-filled syringe and so they can choose the size. She said that the facility did have 1.5inch needles available, though she was unaware (until I told her) that higher-weight people require longer needles for optimum vaccine efficacy and that the CDC had, in fact, issued clear guidelines on this.

Just to be sure, I found the Pfizer vaccine’s prescribing information which, under section 2.1 Preparation for Administration states “Remove tip cap by slowly turning the cap counterclockwise while holding the Luer lock and attach a sterile needle.” (emphasis mine)

Every bit of this is unacceptable. It should be common knowledge that higher-weight people require longer needles, those needles should be available at every facility that is administering vaccines. Until that equality is a reality, higher-weight people will be put into the position of advocating for this basic healthcare need. It’s not right. It’s not fair. It needs to be fixed. If you are a healthcare provider at a facility that is offering intramuscular vaccines, now would be a great time to make sure that you have the proper size needles and that those administering the shots are aware of the guidelines.

I also created printable cards to help people ask for longer needles that include links to both the CDC guidelines and the study that they are based on, as well as scripting that you can practice, modify, and use. You can find them here.

Major thanks to those who allowed me to share their stories.

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More Research

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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrisons Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.