Coronavirus vaccine distribution presents opportunity to ‘get things right’ for neglected communities

What’s happening

A realistic path to ending the coronavirus pandemic came into view with news of promising results from clinical trials of three different vaccines in development. The U.S. public rollout of the first vaccine could begin as early as mid-December, according to the head of the government’s vaccine program.

But the start of vaccinations doesn’t mean things will be returning to normal anytime soon. Producing and distributing hundreds of millions doses for the U.S., let alone the billions needed worldwide, is an enormous logistical challenge. Most experts say Americans shouldn’t expect a vaccine to bring life back to some semblance of normal until at least the late spring or early summer.

With that in mind, public health experts around the world have been debating which groups should be vaccinated first. The strategy that’s chosen for distributing the vaccine could have a profound effect on how long the pandemic lasts and how many lives are lost.

Why there’s debate

Experts broadly agree that the very first vaccine doses should go to health care workers because they face a high risk of infection and play a crucial role in fighting the virus. Most plans also call for prioritizing the most vulnerable, like those with underlying health conditions and residents of elder care facilities. The question of who should be in line after those initial groups is where the debate starts to heat up.

Some of the disagreements center on strategy. Is it better to focus on limiting the number of deaths by vaccinating the elderly or should the vaccine go to the people who are most likely to spread the virus to a high number of people? Should the vaccine be distributed proportionally based on population or should areas experiencing major outbreaks receive a larger supply?

There are also moral questions being debated. Should other public-facing workers — grocery store staff or teachers, perhaps — be at the front of the line, too, given the risks they face? Should people of color be prioritized, given the disproportionate toll the virus has taken on Black and Latino communities?

Global distribution brings up its own set of questions. More than 150 countries have agreed to join an international effort to ensure vaccines are distributed equitably worldwide. The U.S. has not. Some experts fear that countries like the U.S. will hoard vaccine supplies until all their citizens, even those who face little risk, are vaccinated while vulnerable people in developing nations are left unprotected.

What’s next

U.S.-based drugmaker Pfizer applied for emergency approval for its vaccine last week. The FDA is scheduled to review their application on Dec. 10. If approval is granted, vaccinations could start as quickly as two days later. A second pharmaceutical company, Moderna, is expected to seek U.S. approval for its vaccine by the end of December.

Perspectives

Health care workers and high risks should receive the first doses

“The low-hanging fruit, as it were, is blindingly obvious, but then it gets tricky. You want to protect heath-care workers and residents of care homes, clearly. Then the extremely vulnerable. That’s easy. Then essential workers? That could be a very large group.” — Public health expert Paul Hunter to Washington Post

Health care workers and people in elder care facilities should be in front of the line

“If the greatest risk is for older people in care homes, and care home staff, then they will be at the front of the list. And if health care workers are critically important in maintaining health care services, you want to protect them, too.” — Immunization expert David Salisbury to Marketplace

The focus should be on protecting minority populations

“There really needs to be intentional effort to get it to the communities that need it most. Because we don’t want to see these disparities reinforced in the vaccine distribution effort.” — Health equity advocate Dr. Uché Blackstock to Yahoo News

Essential workers should be prioritized

“Essential workers — health care workers, grocery workers, and many schoolteachers, among others — are at high risk for infection because they cannot socially distance. [One scientific model] finds that deaths, as well as total years of life lost, are dramatically decreased when essential workers are prioritized to receive the vaccine.” — Jill Neimark, Scientific American

Wealthy nations shouldn’t hoard vaccine supplies

“The nations that discover a vaccine — or that can pay those who discover it — get first dibs. All the other nations just have to wait until more doses can be manufactured. This is ‘vaccine nationalism,’ where every nation just looks out for itself, prioritizing its citizens without regard to what happens to the citizens of lower-income countries that can’t afford to buy up doses. It’s a path that most ethicists think is wrong. It’s also the path the United States is on.” — Sigal Samuel, Vox

Teachers should be next in line after health care workers

“If vaccinating teachers allows schools to reopen, the social and economic benefits likely would outweigh reopening any other essential industry.” — Aaron Strong and Jonathan Welburn, Wall Street Journal

A race-based distribution plan may not hold up in court

“With a strong conservative majority, the court might well strike down any racial preference. Structural racism in the United States has resulted in far higher rates of disease and death among people of color. We must find lawful ways to protect disadvantaged people against COVID-19.” — Public health legal expert Larry Gostin to Associated Press

Vaccines should go to people most likely to spread the virus

“Super-spreading makes the virus especially confounding. It explains why some places had huge outbreaks while others were spared. … But it’s also the virus’s weakness: Eliminate the super-spreaders and you end the pandemic.” — Christopher Cox, Wired

It doesn’t matter what the details of the plan are if it’s not carried out effectively

“We cannot let vaccine access become a repeat of the free-for-alls and backdoor dealings that resulted from limited PPE supply, when rich and powerful stakeholders got what they needed while the less well-connected went begging. Before vaccine distribution begins, the government needs to set clear, comprehensive guidelines for who receives the earliest available doses.” — Daniel L. Liebman and Nisarg A. Patel, Los Angeles Times

Logistical hurdles could prevent parts of the country from receiving early vaccine doses

“Distribution will come down to details like which vaccines are available when. Specific storage and handling requirements for different vaccines — like the Pfizer shot’s ultra-cold storage needs — could also impact equitable distribution, especially in hard-to-reach areas.” — Sarah Owermohle, Politico

Poor countries must be given equal access

“Not making the vaccine affordable for these nations would be morally wrong. It would also be short-sighted, because, as infectious-disease researchers often say, an outbreak anywhere is an outbreak everywhere.” — Editorial, Nature

Vaccines should be sent to the places that need them most

“Most of the best distribution methods are blatantly unfair. In this context, however, fairness is overrated. Priority should be given to methods that will save more lives and bring back the economy more rapidly. A central yet neglected point is that vaccines should not be sent to each and every part of the U.S. Instead, it would be better to concentrate distribution in a small number of places where the vaccines can have a greater impact.” — Tyler Cowen, Bloomberg. /YN