Who gets in the front row for a COVID-19 vaccine? By the end of next month, U.S. health authorities are hoping to have some draft guidance on how to ration the initial doses, but it’s an irritating decision.
“Everyone won’t like the answer,” said Dr. Francis Collins, director of the National Institutes of Health, recently to one of the advisory groups that the government has asked to help decide. “There will be many people who think they should have been at the top of the list.”
Traditionally, health workers and people most vulnerable to targeted infection are the first in line for a poor vaccine.
But Collins has launched new ideas into the mix: consider geography and prioritize people where an outbreak is hitting hardest.
“We owe them … a special priority,” said Collins.
Huge studies this summer aim to demonstrate which of the various experimental COVID-19 vaccines are safe and effective. Moderna Inc. and Pfizer Inc. began testing last week which will eventually include 30,000 volunteers each; in the coming months, equally large invitations for volunteers will come out to test the shots taken by AstraZeneca, Johnson & Johnson and Novavax. And some vaccines produced in China are in smaller, advanced studies in other countries.
Despite all the promises of the United States that accumulate millions of doses, the harsh truth: even if a vaccine is declared safe and effective by the end of the year, there will not be enough for all those who want it immediately, especially because the majority part of the potential vaccines require two doses.
It is a global dilemma. The World Health Organization is grappling with the same demand that seeks to ensure that vaccines are equally distributed to poor countries – decisions made even harder when wealthy nations hit the market for the first few doses.
In the United States, the Advisory Committee on Immunization Practices, a group set up by the Centers for Disease Control and Prevention, should recommend who to vaccinate and when – advice that the government almost always follows.
But a decision on the COVID-19 vaccine is so complicated that this time, ethics and vaccine experts from the National Academy of Medicine, hired by Congress to advise the government, are asked to ponder.
Setting priorities will require “creative and moral common sense,” said Bill Foege, who devised the vaccination strategy that led to the global eradication of smallpox. Foege is co-guiding the deliberations of the Academy, calling them “both this opportunity and this burden”.
With abundant misinformation about vaccines and fears that politics might get in the way, CDC director Robert Redfield said that the public must view the allocation of vaccines as “fair, fair and transparent”.
How to decide? The CDC opening suggestion: first vaccinate 12 million of the most critical health workers, national security and other essential workers. The next would be 110 million people at high risk for coronavirus – those over 65 who live in long-term care facilities, or those of any age who are in poor health – or who are also considered essential workers . The general population would come later.
CDC’s vaccine consultants wanted to know who is really essential. “I wouldn’t consider myself a critical healthcare professional,” admitted Dr. Peter Szilagyi, a pediatrician from the University of California, Los Angeles.
In fact, the risks for healthcare professionals today are very different from the early days of the pandemic. Now, health workers in COVID-19 treatment units are often the most protected; others may be more at risk, the committee members noted.
Beyond the health and safety sectors, does “essential” mean laborers or poultry teachers? What if the vaccine didn’t work as well among vulnerable populations as among younger and healthier people? It’s a real concern, as older people’s immune systems don’t even get up for the flu shot.
With black, Latin and Native American populations affected disproportionately by the coronavirus, failing to cope with this diversity means “whatever comes out of our group will be viewed with much suspicion,” said ACIP President Dr. Jose Romero, interim health secretary of Arkansas.
Consider the poor of cities who live in crowded conditions, have less access to healthcare and cannot work from home like the most privileged Americans, added Dr Sharon Frey of St. Louis University.
And it might be worth vaccinating entire families rather than trying to locate only one high-risk person in one family, said Dr. Henry Bernstein of Northwell Health.
Whoever goes first, a mass vaccination campaign while people should keep their distance is a high order. During the 2009 swine flu pandemic, families waited in long lines in parking lots and health departments when their turn came, crowding that authorities know they must avoid this time.
The Warp Speed operation, the Trump administration’s effort to accelerate the production and distribution of vaccines, is studying how to quickly transport the right number of doses wherever vaccinations take place.
Drive-through vaccinations, pop-up clinics and other innovative ideas are all on the table, said CDC’s Dr Nancy Messonnier.
As soon as a vaccine is declared effective, “we want to be able, frankly, to start these programs the next day,” said Messonnier. “It’s a long way.”
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science Department. The AP is solely responsible for all content.