Post #812: Vaccine distribution: The National Academy of Medicine plan

Posted on September 13, 2020


Source: Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine, Committee on Equitable Allocation of Vaccine for the Novel Coronavirus, National Academies of Sciences, Engineering, and Medicine (September 1, 2020).

I almost missed this one, and thought I might bring it to your attention.

If reason prevails, the chart above, from this document, is going to determine how the earliest doses of coronavirus vaccine are distributed in the U.S.  (View the full report at this URL).

In a nutshell, they recommend prioritizing vaccine distribution in this order, from first to last:

  • High risk health care workers and first responders
  • Persons at high risk of poor outcomes if infected (due to existing comorbidities)
  • Persons in nursing homes and similar settings
  • Critical industry workers at high risk (read:  meat packers and such)
  • School teachers and staff
  • Persons at moderate high risk of poor outcomes if infected (due to existing comorbidities)
  • Disadvantaged persons in group quarters (homeless shelters, homes for the disabled, facilities for addiction recover)
  • Inmates and staff of prisons, jails, and similar
  • Young adults and chldren
  • Workers in essential industries not included above.
  • Everyone else

Even though I’m probably in that last group, to me, at first glance, this looks incredibly rational.  And I really can’t disagree with their reasoning.  As we would expect from the National Academies of Sciences, Engineering, and Medicine.

A little background follows.

Some bits of background

The back story:  NIH and CDC need to offer some guidance as to how the first shipments of coronavirus vaccine should be distributed.  They turned to the The National Academies of Sciences, Engineering, and Medicine to get an answer.  That’s what smart people in government do, when they want the best answer that the best of American technical talent has to offer.

Actually, that’s what smart people have done for more than 150 years.  The National Academies is a private, nonprofit organization chartered by President Lincoln in 1863. It was formed specifically to offer technical advice to the Federal government to support good government policy.  If there is a venerable and respected entity left in the US Federal government, they are it.

The only other item of note, to me, is how they very ably sidestepped the issues of race and ethnicity.  Earlier statements by an internal DHHS advisory committee had suggested that (e.g.) the very high rates of COVID-19 infection in Hispanics meant that you probably ought to give Hispanics priority in getting the vaccine.  Which is not irrational, but prioritizing based on ethnicity per se was surely going to be controversial.

This report, while recognizing the issue, took a far less direct approach.  To the extent that other factors are the identifiable risk factors, rely on those. (So, for example, if Hispanics are over-represented among hospital and nursing home staff, prioritizing those two professions will incidentally prioritize Hispanics.)  Then, at least as I read it, if a State recognizes that it has a problem in a (geographic) region, owing to the presence of a high number of presumed disadvantaged individuals, states should consider targeting those areas.

I guess if you’re a dyed-in-the-wool conservative, you’ll find much to object to in the proposed distribution strategy.  They key distinction to keep in mind here is that this isn’t being done on the basis of merit, it’s being done on the basis of benefit.  Biggest bang-for-the-buck, so to speak, where the “bang” is both the avoidance of morbidity and mortality, and the need to keep the economy moving.

For example, I don’t think that prison inmates, as a group, are particularly deserving of COVID-19 vaccine protection.  But they certainly are at high risk of infection and death.  So if you just ask a simple question — how many deaths can I avoid with 1000 doses of vaccine — they’d be high on the list.

Which is why prisoners would get this vaccine before Joe Schmoe would.  Not that they deserve it.  But that you save more lives by doing that.

I imagine when Fox News and similar get hold of this, it will become yet another propaganda tool for whipping up anger.  “Prisoners will get this vaccine before hard-working Americans.”  I doubt that the target audience there will stop and try to understand the simple reasoning behind these recommendations.  But I find it hard to deny the logic of what has been proposed, strictly from a public health standpoint.