Hopefully this NYT article is not behind a paywall but part of their free Covid-19 coverage. However the quotes give the problems,.
The Elderly vs. Essential Workers:
Who Should Get the Coronavirus Vaccine First?
The C.D.C. will soon decide which group to recommend next, and the debate over the trade-offs is growing heated. Ultimately, states will determine whom to include.It’s a question increasingly guided by concerns over the inequities laid bare by the pandemic, from disproportionately high rates of infection and death among poor people and people of color to disparate access to testing, child care and technology for online schooling.Ultimately, the choice comes down to whether preventing death or curbing the spread of the virus and returning to some semblance of normalcy is the highest priority. “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, said recently. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”The trade-off between the two is muddied by the fact that the definition of “essential workers” used by the C.D.C. comprises nearly 70 percent of the American work force, sweeping in not just grocery store clerks and emergency responders, but tugboat operators, exterminators and nuclear energy workers. Some labor economists and public health officials consider the category overbroad and say it should be narrowed to only those who interact in person with the public.
Certainly I agree that disproportionately high rates of infection and death among poor people and people of color needs to be addressed. However the disproportionately high rates of severe illness and death among the elderly and those with special conditions also needs to be addressed.
I suspect targeting the vaccine on essential workers no matter how defined (whether 50% or 70% of the population) will still leave out many of the most vulnerable poor, people of color, elderly and those with special medical conditions.
What has increasing become apparent is that many Americans, including many of our leaders, are prioritizing the economy over the protection of health and human life. That is why unlike other countries we are not shutting down our economy much. The States want to protect their taxes and the bishops want to protect their collections.
Increasing I am seeing self isolation as an elderly person with limited contacts among other elderly people who also practice self isolation as the way of the future. I don't plan to return to in person church or shopping until there are at least two months of zero cases in my county, my metropolitan area and my state. We old people need to get organized to protect and help one another.
I am elderly and immune compromised, but I am retired and can isolate pretty easily. I would be happy to wait to get a vaccine and have working people with a lot of person-to-person contact--health care professionals, school staff, and essential workers (grocery stores, pharmacies, janitors)--get vaccinated first.
ReplyDeleteThe reason death rates are astronomically high in nursing homes and prisons is because they are full of populations no one cares about and run by for-profit enterprises. Residents are crammed into tight spaces, the facilities are understaffed, and isolation units are inadequate. In past years, nursing home residents are sitting ducks for every do-gooder organization that wants to drag in sick kids to sing at them, give them magazines and trinkets, and hand out germy cookies. Their flu and pneumonia rates are astronomical every year, but nobody cares. I wish the pandemic would force legislators to crack down on these places, but I doubt it will.
Frankly, I think there will be all kinds of confusion and shortages in the distribution of the vaccine. What happened with the Shingrex vaccine will happen on a grand scale with the covid vaccines, I expect. I would be astonished if I could get a vaccine out here in the cornfield before May.
End rant.
My call is health care workers first. Since many elderly require medical appointments and emergency care, immunizing health care workers protects the most vulnerable elderly as well and is therefore doubly effective. After that, people with pre-existing conditions. Then, front line workers. Then everyone. When they tell me I can get inoculated, I will.
ReplyDeleteThat's a good point. Those employees in areas where people unavoidably congregate--including churches--would decrease spread.
DeleteI think it is counterproductive to get too hung up on "who is on first". We just need to start somewhere and do it. Health care workers should get first crack. And after that, follow WHO guidelines. I suppose we could do it by lottery with birthdays like they did for the Vietnam draft for those who didn't get in on the first wave. I'm like Jean, I'm willing to wait and take my turn after the essential workers. But it sounds like by midsummer they should be able to cover everyone.
ReplyDeleteActually I am more worried that there will be too many people who refuse the vaccine. To get herd immunity they need at least 60-80% to be vaccinated. With the anti-vaxxers and conspiracy theorists, we may be hard put to get to the critical mass.
And now the latest; Rudy Giuliani has Covid. Souns like he caught it from his son.
ReplyDeleteAs a Registered Old Fart I firmly support health care workers, nursing home attendants and first responders being first in line for the vaccine. I have been sheltering in place (I live in the San Francisco Bay Area and we are under total lockdown starting today) for so long, even though I am 80 and a diabetic, I am more than happy to wait after the essential workers are covered by both tranches of the vaccine.
ReplyDeleteHere is a link to the Catholic Health Association's thoughts, from this past July. In working from Catholic social teaching principles, it notes that, if one is guided by the Preferential Option for the Poor, one would prioritize the elderly and racial minorities. On the other hand, if one is guided by the Common Good, one would prioritize health care workers. Here are a couple of snippets:
ReplyDelete"We learned from the H1N1 influenza pandemic in 2009 that serious problems occur if no consensus is reached on the principles and structures for the just distribution of vaccines. Pharmaceutical companies cannot produce vaccines quickly enough to meet initial worldwide demand during a pandemic, resulting in global economic competition that favors wealthier nations over the developing world.[1] The result is that, initially, powerful nations control the distribution of limited supplies. While recognizing that financial investments are essential for the development of effective vaccines, any that are developed should be considered the inheritance of the entire human community, rather than a specific country or company.[2] It is unjust to perpetuate a system where persons who have the greatest need are denied vital, lifesaving resources by a privileged few...
"Once there is assurance that safe vaccines are available, distribution should first consider populations identified as most at risk for suffering negative health outcomes from COVID-19. At-risk populations will vary from place to place.
"In many areas, we know that elderly, racial and ethnic minorities bear the greatest burdens. State and local officials, in conjunction with health care providers and community leaders, should identify which populations are most at risk in their jurisdictions, and they should act to protect them.
"The Common Good requires the maintenance of essential services for the well-being of the community. Therefore, there may be a necessity for prioritization of front line health and essential service workers so that our health care system remains able to continue to provide treatments in the midst of this pandemic ...
"After the prioritized groups are served, randomization brings fairness and equity to the process. Randomization can also bring fairness if done within priority groups too. One suggested way to do this is a national lottery that randomly orders dates of the year. Those whose birthday is first, get first access, etc. "
https://www.chausa.org/newsroom/news-releases/2020/07/27/vaccine-equity-and-catholic-principles-for-the-common-good
Thanks for the link, Jim. I had not yet read that statement. I was surprised that they said the same thing as my "Vietnam lottery" idea.
DeleteI see there is now a move among some employers to require vaccination, which is deemed legal with some variance on the grounds of health and religious belief. Istm that employees required to get vax as a requirement of employment should be able to jump the line in a plan distributing at random.
DeleteI am one of the fortunate who is able to do his work from home. My employer hasn't announced a vaccination policy yet, but our office sites worldwide have been shut down for many months now, and the expectation has been set that this will continue for at least several months into the new year. It's quite possible that the company will make vaccination a pre-condition to return to the office (although, as I say, nothing has been said about this so far). Any employer is going to look at the liability, i.e., "Who will sue us if our workspaces become spreader sites?"
DeleteBeyond my company, thinking about the larger world of employment: for jobs which require an employee to be at a worksite, if a hirer has two equally desirable candidates for an open position, except one is vaccinated and the other isn't, the hiring decision becomes a no-brainer.
Word is that there will be, or already are, smartphone apps that give your vaccination status. At least one airline, Quantas, is considering incorporating it into their ticket purchasing software. They're ahead of the conspiracy theorists who predict that the vaccine will implant a microchip in you. Your phone already has one.
DeleteVaccine status surely would be classified as PHI (Protected Health Information) and therefore protected from disclosure? Of course, if the patient agrees to provide it, that would seem to be ok. But if the patient is coerced to provide it as a precondition for boarding a plane? Seems like something a few thousand lawyers would love to spend a couple of billable years hashing out!
DeleteJim, I agree there are sticky problems here. I can see airlines enforcing a mask mandate in order to board more than a vaccine one. I can see them maybe giving some "perks" to passengers who show proof of vaccination, positive reinforcement.
DeleteGot a message from one of my cancer group people this morning. She works in a nursing home and is being required to get vaccinated as soon as available. She is upset about it, and I understand completely. It's one thing to be asked to get a vaccine with a proven track record, another to have someone dump a vaccine developed with new tech into your already compromised system without knowing specifically how it affects people with a rare incurable condition. She would have to disclose the fact that she has cancer to her employer if she wants to get permission to decline or delay her shot. Or she can be fired if she refuses to get it. Her doc has told her that he feels the benefits outweigh the risks, but he acknowledges that it's a gamble.
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