In a pandemic marked by surprise, improvisation and shaky rollout, decisions on priority access to COVID-19 vaccines would have to be different. The development and testing of candidates for vaccines, even at a skewed speed, has given health experts, medical ethicists and state health agencies months to reflect on the order in which scarce doses should be dispensed.
Then all their careful planning was set aside.
Amid growing criticism that so few shots were fired at U.S. guns, the U.S. Department of Health and Human Services abruptly announced changes to the rules this week. Federal officials have said they will stop holding back the second dose of vaccination for every person who gets it for the first time. They have expanded the suitability for all senior citizens aged 65 and older, as well as younger adults with medical conditions that increase their risk for a severe case of COVID-19. And they said that the more doses of vaccine they administer, the more new doses they are likely to get.
Meanwhile, scientists at the Centers for Disease Control and Prevention warned on Friday that the highly transmissible coronavirus strain that arrived from the UK a few weeks ago could cause a new surge of infections. But the boom could be suppressed, or even reversed, by an aggressive vaccination campaign that reached 1 million Americans a day.
The goal could be further achieved according to a plan by President-elect Joe Biden, who endorses the decision to open the vaccines. The Biden Administration will call on the Federal Emergency Management Administration and the National Guard to step up vaccinations and ensure that people receive all the recommended doses. Retail pharmacies can help put the effort into action.
All of this makes state and local health departments scramble to deliver vaccinations as quickly as possible. Which raises questions.
Does that mean more vaccine is available?
Not really.
With 38 million doses produced so far and 12 million already administered, about 26 million doses are available, with several million more doses in the coming week.
Most of them have already been shipped or are spoken by states. Production did not increase. However, the freezers at the 14,000 places to which the doses were sent will no longer be filled with vials available for second doses.
Doses will also not be withheld for people in priority groups who are supposed to get them, but who did not show up – says a nursing home guard who is not convinced that the rapidly developing vaccines are safe.
Instead, all of these doses will now be released for general use. It’s safe to do so because the federal government has delivered 31 million doses of vaccine “essentially without problems,” health secretary Alex Azar said this week. And “with the case we are now facing, there is absolutely no time to waste. We need doses where it is applied quickly, and where it will protect the most vulnerable. ”
So the goal is still to give everyone two doses of vaccine?
Yes. When U.S. officials began hearing about British plans to make first doses available without promising a second dose three to four weeks later, they quickly moved to stop accepting such an idea here.
The federal government is “100% committed to ensuring that a second dose is available to every American who receives a first dose,” Azar said. ‘Based on the science and evidence we have, it’s essential that people receive their second doses on time. This is what science says, and ignoring it would be reckless. ”
Dr Peter Marks, who oversees the evaluation of new vaccines and medicines at the Food and Drug Administration, warned that there is no data indicating how good or how long a single survey of the Pfizer-BioNTech vaccine or the one of Moderna would not protect anyone who develops COVID-19. People who receive a single dose may “assume that they are fully protected if they do not, and therefore change their behavior to take unnecessary risks.” The unequal effectiveness of the vaccines given under such conditions could undermine public confidence in vaccination efforts, he said.
Who is vaccinated next?
Azar effectively opened the line to about 261 million people. He has already invited 47 million Americans aged 65 and older who are not in long-term care facilities to step forward for their shots. And he said they should vaccinate more than 100 million adults with one or more chronic health conditions that make them more vulnerable to a serious case of COVID-19. (These conditions include obesity, diabetes, coronary artery disease and cancer.)
This was a dramatic departure from the CDC’s recommendations for which groups should first receive scarce doses of vaccine. After ten public meetings, an advisory panel concludes that the country’s 21 million health workers and 6 million residents of nursing homes and other group settings should follow first, followed by 87 million essential frontline workers – a category that includes teachers and bus drivers first responders, groceries and postal workers, correctional officers and people working in the manufacturing and food service industries.
Frontline workers are prioritized over seniors because they are less able to protect themselves from infection by staying home. But it was also an explicit attempt to deviate from a long-standing reality of health care in the United States: that scarce resources come first to the prosperous, educated, and socially connected, and lastly to people with less money, less education, and less access to a doctor goes.
What’s wrong with that?
Many of these workers are difficult to reach. They struggle to find the time, transportation, and access to a physician they need to get a COVID-19 vaccine. And they are not so sure they want it. Due to a long history of abuse by the medical institution, many Black Americans are wary that early access to vaccines is merely a use to use them as medical guinea pigs.
To overcome these obstacles, you need mass vaccination, outreach campaigns, advertising and other help. And it requires money and manpower that most states simply did not have.
But they have it now (and the Biden transition team has promised to get even more funds). After months of partisan wrestling, President Trump signed a bill on Dec. 27 handing out $ 87.5 billion to states for the distribution of vaccines, including $ 300 million for a “targeted effort to distribute and dispense vaccines” serves high-risk and underserved populations, including racial and ethnic minority populations and rural communities. ”
It is not surprising that these efforts barely came off the ground.
Is that why things are so chaotic?
Yup. With 261 million Americans eligible for the vaccines, but only about 31 million available, it’s free.
Azar said this week that efforts to prioritize essential workers “stand in the way of vaccines to reach a wider section of the vulnerable population more quickly.”
“It’s time to move on to the next phase of the vaccination campaign,” he adds, comparing it to an airplane. If groups 1 and 2 had their chance to board, but some of the passengers did not get in line, it is OK to move on to group 3.
Many Americans are perfectly fine with it. In a Harris poll, 31% of respondents said they prefer a first-come-first-served approach over one that gives priority to certain groups.
But does that not make sense?
This makes more sense in light of a new development: the emergence of the more transmissible coronavirus strain. As the British tribe digs up, the number of new infections is expected to be higher than ever before – and with it hospitalizations and deaths.
Vaccination is not the only way to eradicate that onslaught, because there are no more draconian social health measures for which there is public patience or political will. The more Americans get some protection, albeit in part, the more downward pressure the country can place on new infections.
Three studies published in the Annals of Internal Medicine last week provided evidence that new infections can be prevented by expelling the first doses faster and reducing the case.
One of the modeling exercises examined the compromise between velocity and the more limited effectiveness of a single dose. Stanford researchers concluded that it made sense not to tie second doses in refrigerators, but to push them out instead.
The Stanford team has estimated that approximately 24 million people would receive at least a first dose of vaccine in eight weeks. And based on the scarcely available data, the team assumed that a single dose would reduce the recipient’s risk of developing COVID-19 by just over 50%.
Under the circumstances, the number of people developing COVID-19 could be reduced by 23% to 29% compared to a strategy of now holding back half of all doses to be on hand as second doses, according to the researchers.
“This is not a great solution,” said co-author Joshua A. Salomon, a senior fellow at Stanford’s Center for Health Policy. If the supply of vaccines collapses in the coming months, Americans may be vulnerable, among other things, because the immunity of a single-dose vaccine may not last very long.
But for now, he said it was clear the shots should come in arms: ‘We need to get an aggressive offer to states. And states need to increase delivery. Both really need to happen. ”
What is wrong with giving vaccines to the elderly and people with underlying health conditions?
Good question. After all, these are the people who are likely to get very sick and die. And they are more willing to seek out the vaccine, show up to get it and return for their second dose than many of the essential front-line workers who were supposed to come before them. Their eagerness is indeed why so many scheduling sites are crashing at the moment.
If they are vaccinated in large quantities, hospitalization and mortality rates are likely to decline rapidly. And they will not only protect themselves, but also prevent them from preventing secondary infections – those that are transmitted to the people they come in contact with, and the people who in turn come into contact with the people.
So the new plan may be less fair, but more effective in delaying the pandemic?
In principle yes. Black and colored communities will now compete for scarce vaccine doses with motivated communities of older white people with a better resource. It’s hardly an equal playing field.
At this point, we may never know whether the reluctance of Black Americans to get the vaccine early could be overcome, or that vaccine uptake could be increased by focusing the distribution efforts on communities of color. Such efforts did not come off the ground fast enough.
At the same time, if people who are more likely to occupy hospital beds or die are vaccinated in large numbers, medical resources can be released to care for everyone.
“People are going to be unhappy, no matter what you do,” said Dr. Paul Offit, a pediatrician at Philadelphia Children’s Hospital who served on the CDC’s vaccine advisory committee, said. ‘There is a limited amount of vaccine, and many will die. This is a Titanic situation: everyone has to get off the ship as fast as possible and there are not enough lifeboats. ”