Dr. Jeff Kane: Vaccine purgatory
Where is your place in the COVID immunization line?
Vaccine is on the way, but there isn’t enough for everyone yet. Pfizer has said it can’t supply before June any additional doses to the U.S. beyond the 100 million already ordered. Since that immunization requires two doses, that’s enough for only 15% of Americans. Eventually we’ll all have access, but meanwhile we’re living in a state some call “vaccine purgatory.”
Because of the shortage, we’re waiting to learn who gets immunized first, and that’s no simple task.
Beginning as far back as the 1950s committees of experts, anticipating future deficits in healthcare provision, debated priority recommendations. They’ve considered patients’ age (how many years are likely left?), degree of infirmity, likelihood of survival, and even income and “value to society.”
Prioritization remains far from a settled question. Most of us agree that healthcare workers who have close daily contact with COVID patients — including nonmedical people like housekeepers — need the earliest attention. But then who? We generally feel that people more at risk of infection and death ought to be near the head of the line. Included are residents of long-term care facilities (who constitute 40% of COVID deaths) and their staff. But prison inmates are equally vulnerable; does placing them down the line constitute cruel and unusual punishment?
There are more factors, too. Some hold that “essential workers” need early immunization. But who’s essential? Colorado deems liquor and firearm salespeople essential. Louisiana puts prison guards and food processing workers ahead of teachers and grocery employees.
American Indians, African-Americans, and Hispanics suffer far greater rates of infection and death than the general population, so it’s argued that they should be served with urgency.
To compound complexity, two national strategies are in competition: preserving lives versus immunizing as many people as possible to halt the pandemic. Said Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans. But if your goal is to reduce the rate of infection, then you would prioritize essential workers.”
So if you were asked to set immunization priorities …?
Jeff Kane is a physician and writer in Nevada City.
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