Who is first in line for a COVID-19 vaccine? U.S. health officials hope to have draft guidelines on how to ration initial doses by the end of next month, but it’s a vexing decision.
“Not everyone will like the answer,” Dr. Francis Collins, director of the National Institutes of Health, recently told one of the advisory groups the government asked to help decide. “There will be a lot of people who feel they should have been at the top of the list.”
Traditionally, health workers and those most vulnerable to targeted infection have been on the front lines for a rare vaccine.
But Collins threw some new ideas into the mix: consider geography and prioritize people where an epidemic strikes the hardest.
And don’t forget about volunteers at the final stage of vaccine testing who get dummy injections, the comparison group had to say if real injections really work.
“We owe them… a special priority,” Collins said.
Huge studies this summer aim to prove which of several experimental COVID-19 vaccines are safe and effective. Moderna Inc. and Pfizer Inc. began testing last week that will eventually include 30,000 volunteers each; In the coming months, equally important calls for volunteers will be launched to test the images taken by AstraZeneca, Johnson & Johnson and Novavax. And some vaccines made in China are the subject of smaller studies in other countries.
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Despite all the promises made by the United States to stockpile millions of doses, the hard truth is: even if a vaccine is declared safe and effective at the end of the year, there won’t be enough for everyone who wants it. right away – especially since most potential vaccines require it. two doses.
It is a global dilemma. The World Health Organization is grappling with the same question that goes first to trying to ensure that vaccines are distributed equitably to poor countries – decisions made even more difficult as rich countries corner the market for the first. doses.
In the United States, the Advisory Committee on Immunization Practices, a group established by the Centers for Disease Control and Prevention, is supposed to recommend who to vaccinate and when – advice the government almost always follows.
But a decision regarding the COVID-19 vaccine is so delicate that this time around, ethicists and vaccine experts from the National Academy of Medicine, licensed by Congress to advise the government, are also being asked to step in.
Prioritization will require “good creative and moral sense,” said Bill Foege, who designed the immunization strategy that led to the global eradication of smallpox. Foege co-directs the academy’s deliberations, calling it “both this opportunity and this burden.”
With the abundance of misinformation about vaccines and fears that politics could interfere, CDC Director Robert Redfield said the public must see vaccine allocation as “fair, just and transparent.”
How to decide? CDC opening suggestion: Vaccinate 12 million of the most critical health, national security and other essential workers first. Next are 110 million people at high risk for coronavirus – those over 65 who live in long-term care facilities, or those of any age who are in poor health – or who are also considered essential workers. The general population would come later.
CDC vaccine advisers wanted to know who is really essential. “I wouldn’t consider myself a critical health worker,” admitted Dr. Peter Szilagyi, a pediatrician at the University of California, Los Angeles.
Indeed, the risks for health workers are very different today from those of the first days of the pandemic. Now, health workers in COVID-19 treatment units are often the best protected; others may be more at risk, committee members noted.
Beyond the areas of health and safety, does “essential” mean poultry factory workers or teachers? What if the vaccine does not work as well in vulnerable populations as it does in younger, healthier people? This is a real concern, given that the immune system of the elderly does not improve as well when faced with the flu shot.
With black, Latin American and Native American populations disproportionately affected by the coronavirus, failing to address this diversity means that “anything that comes out of our group will be looked at in a very suspicious manner,” said ACIP President, Dr. Jose Romero, Acting Secretary of Health for Arkansas.
Think of the urban poor who live in crowded conditions, have less access to health care and cannot work from home like more privileged Americans, added Dr. Sharon Frey of the University of St. Louis.
And it may be worth it to vaccinate entire families rather than trying to single out a single high-risk person in a household, said Dr Henry Bernstein of Northwell Health.
Whoever has to start, a mass vaccination campaign when people are supposed to keep their distance is a tall order. During the 2009 swine flu pandemic, families lined up in parking lots and health departments when their turn arrived, prompting authorities to know they must avoid this time.
Operation Warp Speed, the Trump administration’s effort to speed up vaccine manufacturing and distribution, seeks to quickly transport the right number of doses to where vaccinations are scheduled.
Drive-thru vaccinations, pop-up clinics and other innovative ideas are all on the table, said CDC’s Dr Nancy Messonnier.
As soon as a vaccine is declared effective, “we want to be able the next day, frankly, to start these programs,” Messonnier said. “It’s a long way.”
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