Who gets the first shot when the coronavirus vaccine arrives?

One will have to decide who of the 7.8 billion people in the world will first notice when returning to a more normal life. Infectious disease specialists and medical ethicists have found that this highly complex decision is not only about who is at the highest risk of the virus and who is most likely to spread the virus, but also on national health and finance. It states that the most important person must also be emphasized to maintain soundness as its safety.

This pandemic also added new challenges. How colored people deal with the fact that they have a higher rate of serious illness and death than white people.

Harald Schmidt, a bioethicist at the University of Pennsylvania, commented on the prioritization process: There may be multiple types of vaccines. Certain groups, such as the elderly, may work better than others.

“We need to make this decision not only once, but multiple times for multiple vaccines,” Schmidt said. “Not all of them are there at the same time, they will have different profiles.”

Arthur Caplan, a bioethicist at New York University, rushes to bring the vaccine to market and may initially leave many questions unanswered about how well it works in different groups. He said that he has a high tendency. He sees the first official dose as an extension of clinical trials. It requires careful tracking of recipients. “We will continue to act as if the race for FDA approval is over,” he said. “I think it’s just the beginning.”

Vaccine development is proceeding at an astonishing rate, with a few candidates producing promising results. According to experts, the best scenario is that the vaccine will be generally available by the first quarter of 2021.

Traditionally, the US Centers for Disease Control and Prevention’s Advisory Committee on Vaccination Practices (ACIP) has recommended who should be vaccinated, and has been discussing ways to split new coronavirus shots since April. .. It is unclear whether Twar administration officials at Operation Warp Speed ​​on vaccine development likewise want this decision. “This is a black box,” said Paul Ofit, a vaccination expert at the Philadelphia Children’s Hospital. He believes Warp Speed ​​will probably focus on distribution. At the request of the National Institutes of Health, the National Academy of Medicine has also created an expert panel to study this issue.

Academy chairman Victor Zau said he was hoping for final recommendations from late September to early October at the panel’s first meeting on Friday 30 July. CDC Director Robert Redfield emphasized that it is important for Americans to consider vaccine allocation as “fair, fair, and transparent.”

Faced with criticism that it could add to the confusion of decision-making, the director of the National Institutes of Health, Francisco Linds, said the issue was very troublesome and could benefit from an extra “deep thinker.” It was

“This will be controversial,” he said. “Not everyone likes the answer.”

Kaplan supports an independent committee that includes both scientists and representatives of affected communities such as persons with disabilities and children. Anyone who makes a decision said, “It must be credible.”

Eddie Bresnitz, a former deputy director of the New Jersey Department of Health and current adviser on measures against coronaviruses, expects the White House’s Anti-Coronavirus Committee to also be considered, but the final decision is that the US Ministry of Health and Welfare.

The federal government has purchased vaccines and will distribute them to the states, Bresnitz said. States typically have some flexibility in interpreting federal guidance. New Jersey is already planning how the vaccine will be distributed, but it will depend on the dose available and the characteristics of the vaccine itself.

Nate Wardle, a spokesperson for the Pennsylvania Department of Health, said the federal government is ready to deliver vaccines to public and high-risk groups in a variety of settings, including doctors’ offices, pharmacies, and other distribution points in communities. I am doing it. The entire population is vaccinated against coronavirus. “

Priorities need to consider the multiple public health roles vaccines can play, said William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. In general, young people have the strongest immune response, said Schaffner, who represents the National Institute of Infectious Diseases as a liaison to the ACIP. They are now catching COVID-19 at a higher rate and spreading it to other more vulnerable groups. Vaccination of them can weaken the chain of transmission.

Although the elderly and people with chronic health problems are clearly ill, vaccines tend to be less effective in these groups. The third group is “people in society responsible for the most important functions,” Schaffner said. Health care workers, police, firefighters, people who manufacture, sell and distribute food.

Schaffner said it’s important not to create a narrow category where vaccines aren’t used in refrigerators. “Vaccines do not prevent disease,” he said. “Vaccination prevents disease.”

During the 2009 H1N1 influenza pandemic, ACIP created a five-tier priority list for vaccine distribution that constitutes current debate. First came important medical and public health personnel, pharmacists, emergency responders, police and firefighters, along with “deployed personnel.” The second tier included essential military support, national security forces, intelligence and other national security personnel, morgue workers, and telecommunications, IT, and utility people. High-risk adults were in Tier 4, healthy adults aged 19 to 64 were in the last group.

Children were a top priority in the plan, as the H1N1 hit the children more strongly. Schaffner said he will not be involved in the current vaccine trials, so it will be a low priority this time. In addition, infants appear to be less likely to spread the virus than older children and adults. Older children rarely have serious complications. However, pregnant women can remain in the priority group.

At the June meeting, ACIP had a preliminary discussion of what the new tier would look like, Schaffner said, saying authorities need to know available doses and who responds well to vaccines. Please remember. At the top of the list were high-risk healthcare, national security, and essential workers. Below that may be other healthcare and essential workers, along with people over the age of 65, living in long-term care settings, and those at high medical risk of severe COVID-19. there is. These groups include 122 million people.

Future discussions will focus on how to slice different categories.

Johnslo, an infectious disease specialist at Jefferson Health, said that he prioritizes those who are most likely to have direct contact with COVID-19 patients and people living in environments such as nursing homes and nursing homes. Low-wage workers with high public exposure and workers with conditions such as obesity, diabetes and heart disease that increase the risk of hospitalization for COVID-19 are also high on his list. Older people are prioritized over younger people.

Caplan’s list is similar to Zurlo’s list, with priority given to first responders, health care workers, nursing home staff and residents, but also adds representatives from groups that have not been adequately studied in clinical trials. I will. Then he started seeing hotspots. Maybe Houston will need more vaccine than Boise. We want to make sure that major foreign locations are controlled so that travelers don’t reintroduce the virus.

Members of the ACIP argued whether some racial groups should prefer vaccines, as blacks and Latins are more likely to die of COVID-19 and die.

Schmidt says race must be considered. Minority groups are at increased risk due to the high incidence of chronic medical problems, but due to socioeconomic conditions such as crowded homes, low-paid work without sick leave, and the need to use public transport. , Things get worse. Black and brown workers also struggle with important businesses such as hospitals, nursing homes and grocery stores.

“We need to understand that social justice has a major impact on vaccine allocation,” Penn’s bioethicist said. Although the government cannot legally prioritize by race, it does so by’social deprivation’, a means of ranking regions by combining data on income, education, employment and housing quality. I can do it.

It was clear that the vaccine should not be given on a first-come, first-served basis, he said. It will help “well connected and better”.

Schaffner believes that prioritizing essential workers and those with risk factors benefits non-white Americans. “I don’t like vaccination distribution by race,” he said. “I think doing it at risk is a much better way.”

Should political leaders draw a line? Bresnitz thinks it should be considered. “We don’t want our leadership destroyed,” he said. He could argue that civil servants may be more important than elected officials, he said.

Kaplan said he can assume that not everyone follows the rules. Inevitably there is a black market. “There will be people who buy access,” he said. “This is America.”

No one will be entirely satisfied with the final distribution scheme, except for those who may save these vital health care workers.

Bresnitz tells friends and family that they don’t think the vaccine will change everything — it will take a while before it proves effective. “Whatever vaccine we have, it will not obviate the need to continue to practice social distance and hygiene, and even wearing masks,” he said.

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