Stanford Medicine apologized on Friday for its vaccine distribution plan – a plan that came under fire for leaving out nearly all of its medical residents and fellows, many whom regularly treat COVID-19 patients.

The residents waged a protest on Friday morning, holding signs and demanding answers from Stanford's leadership about why just seven of more than 1,300 residents at Stanford were selected to receive the vaccine in the first round of 5,000 doses.

A council composed of the chief residents sent a letter to Stanford's leadership on Thursday night expressing anger and disappointment as they had learned that residents and fellows would not be a priority in the first allocation. Residents are doctors in training, who have graduated from medical school.

"Many of us know senior faculty who have worked from home since the pandemic began in March 2020, with no in-person patient responsibilities, who were selected for vaccination. In the meantime, we residents and fellows strap on N95 masks for the tenth month of this pandemic without a transparent and clear plan for our protection in place. While leadership is pointing to an error in an algorithm meant to ensure equity and justice, our understanding is this error was identified on Tuesday and a decision was made not to revise the vaccine allocation scheme before its release today," they wrote.

After Friday's protests and subsequent media attention, the leaders of Stanford Health Care and Stanford School of Medicine sent an email to staff that apologized for the debacle.

"We are writing to acknowledge the significant concerns expressed by our community regarding the development and execution of our vaccine distribution plan. We take complete responsibility and profusely apologize to all of you. We fully recognize we should have acted more swiftly to address the errors that resulted in an outcome we did not anticipate," they wrote.

"We are working quickly to address the flaws in our plan and develop a revised version," the executives and deans wrote. They said they anticipate being able to vaccinate "a substantial segment of our community" once a larger shipment of vaccines arrives, hopefully next week.

The university did not make clear what the process will be now for the first round of doses, the first of which were administered Friday. Residents tell NPR that the system has become chaotic, with some residents able to walk up and receive the vaccine, while others have been told to wait. Some faculty members have pledged to give their vaccine to residents instead.

According to an email sent by a chief resident to other residents, Stanford's leaders explained that an algorithm was used to assign its first allotment of the vaccine. The algorithm was said to have prioritized those health care workers at highest risk for COVID infections, along with factors like age and the location or unit where they work in the hospital. Residents apparently did not have an assigned location, and along with their typically young age, they were dropped low on the priority list.

Stanford has not provided an answer to NPR's request for an explanation of its process or its algorithm.

Neurology residents were among those who organized and protested on Friday.

One neurology resident, who was involved in planning Friday's protest, said that a flawed algorithm is no excuse. She requested anonymity for fear of affecting her future job search.

"[A]lgorithms are made by people and the results ... were reviewed multiple times by people," she wrote in an email to NPR. "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."

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