COVID VACCINE – WHO GETS PRIORITY?

It should be simple. It should be a “no-brainer.” Broadly speaking, the equitable and logical procedure should be to give priority to (1) medical personnel who are on the front lines, (2) residents and staff of assisted living and nursing homes, (3) the elderly and (4) those with compromised immune systems. Makes sense. Right? They are the ones with the greatest risk of dying from COVID. Right? Well, not so fast. Various groups have been making a case that they should be considered “essential” and therefore should be prioritized. Obviously, everybody cannot receive priority, and this has created perhaps the most intense lobbying campaign in memory. More on this later.

Let’s start with some facts. Facts have been in short supply regarding COVID, but I have ascertained a few courtesy of various media outlets, such as the NY Times, the NY Post, STAT, AARP, Cal Matters, Fox News and CNN:

1. The CDC’s Advisory Committee regarding COVID has made various broad-based recommendations with respect to the vaccine distribution. Following an emergency meeting last Sunday it stated that its overall goal was to strike a balance between minimizing illness and death and maintaining societal functioning and equity. Fine objectives, but very difficult to achieve.
2. The CDCAC announced that to date some 5oo,ooo persons had received the Pfizer vaccination. The goal is to have vaccinated 100 million persons with either the Pfizer or Moderna vaccines by the end of February.
3. The CDCAC stressed that the states need more federal funding. It is estimated that $8 billion will be required to support the inoculation program, and the feds have provided less than $500 million so far. One committee member explained the situation thusly: “Operation Warp Speed has delivered two Cadillac vaccines to us. But they’ve come with empty gas tanks, and we have a long and difficult road ahead of us.”
4. According to AARP, the CDCAC compiled five groups or phases. Phase 1a includes healthcare personnel and residents and staff of long-term care facilities [24 million persons]. There seems to be little dispute regarding this group. The composition of the other groups is not as clear-cut.
5. Phase 1b includes frontline essential workers and persons 75 and older [49 million].
6. Phase 1c includes persons age 65 – 74, persons 16 – 64 with “high-risk conditions,” and other essential workers not included in Phase 1b [129 million].
7. Phase 2 includes all other persons age 16 and older.
8. Once the vaccines have been delivered to the individual states, however, these states have the authority to make the final determination as to priority. They are free to make subjective judgments and refinements. This is where the “fun” will begin. The Kaiser Family Foundation has opined that the order “has yet to be resolved in …. a majority of …. states.” Robert Mujica, NYS budget director, stated that priority will be based on the “risk and the number of contacts … and the risk profile of the individual.” NY Governor Andrew Cuomo has reiterated again and again that “there will be no political favoritism.” I would hope not, but based on past performance I have my doubts. We shall see.

As I said above, many groups have been lobbying hard to receive priority. For example in NY Uber, Con Ed, the financial institutions, the Retail, Wholesale and Department Store Union, the transit union, the hospitality union, school nurses, truck drivers, morticians, zookeepers, and even a presidential elector are just some of the groups that have petitioned either directly or through their lobbyists for status as “essential.” They have made reasonable cases, but, as I said, not everyone can receive priority. The math simply does not allow it. Some people will have to wait. One state official characterized this as “the big fight.” There will be winners and losers, and no one wants to be a loser. No final determinations have been made. According to the NY Times emergency responders such as police officers, transit workers and those who maintain the power grids will likely receive priority.

Some states will be prioritizing workers in industries that are important to the local economy. For instance, Colorado has decided that ski industry personnel residing in congregate areas will be included as essential; and Georgia and Arkansas intend to give priority to meatpackers and food processors. In a somewhat controversial decision the NY Post has reported that MA Rep. Ayanna Pressley has successfully convinced the State of Massachusetts to grant priority to prison inmates and include them in Phase 1b. Her chief argument was that the prison population consists disproportionally of poor people and people of color and that to deny them priority would constitute racism. Thus, at least in MA, violent felons of all ages will get inoculated ahead of people who are elderly or at-risk. Equally disturbing are reports that some well-heeled individuals have been offering bribes to medical personnel to “jump the line.” Some states, such as Illinois, have announced they are waiting for additional guidance from the CDC beyond the initial wave.

Many congresspersons have already been inoculated. Ironically, some of them such as Biden, Kamala Harris, and AOC, among many others, are the same ones who during the campaign were denigrating the virus and casting doubt on its efficacy. They did not trust it since it was being produced by the Trump Administration and expressed reluctance to take it (as if he was personally stirring it up in a huge caldron in the White House basement). Now that the election is over their attitude has changed. What a surprise! By the way, hats off to Rep. Tulci Gabbard (Hawaii) and some others who have stated that they would not get vaccinated until all at-risk persons had been inoculated.

The distribution plans have been compounded by the fact that, to date, states have been allocated an amount of doses which is far less than the demand. For instance, NY’s initial allocation of the Pfizer vaccine was 170,000 doses, and it is expecting a shipment of 346,000 doses of the Moderna vaccine shortly. That is a substantial amount of doses, but it will not cover the Phase 1 demand of some 1.8 million persons.

Quiz:

As a sidebar, Joe Biden has been making a habit of blurting out non-sequiturs. Some find these entertaining and harmless; others cite them as examples of his declining cognitive functionality. During the campaign he called one voter a “lying dog-faced pony soldier.” Recently, he called a reporter a “one-horse pony.” Does anyone know what these mean, if anything, or are they figments of a confused mind? See below.

CONCLUSION

This would be a good time to remind ourselves to return to that tired mantra – “follow the facts; follow the science.” Many groups can and have presented compelling cases as to why they should receive priority. However, as I said above, not everyone can be prioritized. The CDC has set a goal of 100 million inoculations by March. That is a lot, but not nearly enough in a country with a total population of 328 million. Tough decisions will have to be made. These should be based, not on power and influence, not on racial or gender guidelines, and not on quotas, but simply on who is most at risk of dying. To me, those at the greatest risk of dying should go to the top of the list. Luckily, we can determine that objectively. So far, in the US overall roughly 1.5% of those who have contracted COVID have died. Some 40% of those fatalities have been nursing home residents. Some 80% of all fatalities have been persons over the age of 65. Thus, those not in those high-risk groups, although they may get sick, are not in any realistic danger of dying. FL and TX are cognizant of this and are prioritizing those groups. Clearly, that should be the universal approach. Individual states can determine the rest of the order.

A final thought, many people, perhaps as many as 20% according to Fox, have expressed reluctance to get vaccinated. Some of this is based on mistrust that the vaccine will work, fear of vaccines, in general, possible allergic reactions, and/or that it has been developed under the Trump Administration. As Americans, that is their right. However, be advised that that decision will impact the rest of us as it may prevent us from achieving “herd immunity,” which medical experts have been saying would be the ultimate protection against the virus. Moreover, according to Rogge Dunn, a Dallas-based employment attorney, the law permits employers to fire employees who refuse to be vaccinated. Furthermore, I do not think it is too farfetched to foresee a time when those who have not been vaccinated could be barred from certain places, such as restaurants, theatres and airplanes.

This is a very fluid situation, so stay tuned for prospective developments

Quiz answers:

1. “Lying dog-faced pony soldier.” Biden has attributed this to John Wayne in one of his movies, but no one has been able to verify it.
2. “One-horse pony.” It appears that Biden may have conflated two expressions: “one-horse town” and “one-trick pony.”