California and other states are discussing how to disseminate COVID-19 vaccinations and who will be offered them first. The state’s plan says when California gets its first batch of vaccines that health care workers who interact with patients at acute care, psychiatric and correctional facility hospitals, workers at skilled nursing facilities, paramedics, and workers at dialysis centers will be the ‘tier one’ priorities.
The U.S. Food and Drug Administration (FDA) is meeting to consider an emergency use authorization for Pfizer’s coronavirus vaccine and then the Moderna vaccine’s authorization is scheduled to be considered next week. If the vaccines are approved by FDA, California expects to have some supplies quickly.
“We are anticipating 327,000 doses of the vaccine, Pfizer, to come in within the next few weeks,” California Gov. Gavin Newsom said recently.
Unfortunately, that’s not enough vaccines for even the state’s first tier of health care workers.
The decision to prioritize health care workers who may treat COVID-19 patients is non-controversial. Keeping hospitals fully staffed during a surge of admissions may prevent the health care system from being further overwhelmed this winter, although with limited vaccine supplies it might be useful to differentiate amongst California’s 1.7 million health care workers by recognizing the risks for those dealing with patients and families are far higher than those for hospital administrators and others who are less likely to come in contact with infectious patients.
Once we move beyond health care workers, however, choices generally come with tradeoffs and pros and cons. The California Department of Public Health recently announced its Community Vaccine Advisory Committee which “will help guide the state’s decision making and build equity into decisions about vaccine distribution and allocation.”
The committee includes representatives from at least 64 non-governmental organizations (NGOs), many of which advocate for specific demographic or interest groups. Unionized public employee interests are represented by AFSCME and SEIU, for example, but it is not clear who is advocating for other workers, like those driving and delivering food for app-based companies like Uber or working at non-unionized home improvement, food, and convenience stores.
Setting priorities for the vaccines while supplies are limited is a necessarily subjective process but it also comes with real drawbacks. An uncertain percentage of individuals in priority groups (aside from health care workers) may decline or delay receiving the vaccine due to fears of side effects or because they have been persuaded by arguments from anti-vaxxers or others. It is difficult to predict how many members of any given priority group will quickly show up for their vaccinations.
If the prioritization process slows down the distribution of vaccines, that delay would likely increase the number of infections and deaths. In extreme, worst-case scenarios, errors, and power failures, for example, could destroy doses that need to be kept in exceptionally cold storage. So quickly distributing vaccine doses as soon as they are received has real advantages that an overly complex prioritization and allocation scheme might limit.
In fact, a recent report in Health Affairs by Yale and Harvard researchers said, “Using a mathematical simulation of vaccination, we find that factors related to implementation will contribute more to the success of vaccination programs than a vaccine’s efficacy as determined in clinical trials. The benefits of a vaccine will decline substantially in the event of manufacturing or deployment delays, significant vaccine hesitancy, or greater epidemic severity.”
A better focus for the state’s public policy and health leaders is to figure out how California can procure and distribute more doses of safe and effective vaccines more quickly. One way to do that would be to encourage the FDA to speed up its process and to also assess vaccines being developed in China, India, and other countries. If these alternative vaccines are judged worthy by health authorities, they could potentially be purchased and imported in large quantities.
Rather than conduct an open-ended and ultimately counterproductive debate over who is the most worthy of being immunized, and in which order, we should think in terms of how we can prioritize all Californians who want the vaccination as soon as possible.
A version of this article previously appeared in the Orange County Register.