“The 360” shows different perspectives on the main stories and debates of the day.
What is happening
Public health officials in the United States spent months developing strategies to distribute the first precious doses of the coronavirus vaccine. But now, just a few weeks after the vaccine was launched, many of those initial plans have already been discarded.
In the beginning, most states reserved the vaccine for frontline health care workers and the elderly in long-term care facilities, anticipating that limited supplies would be the biggest obstacle to widespread vaccination. But logistical bottlenecks quickly proved to be another major challenge. Many states have struggled to find containers eligible for the vaccine supply they have, which takes life-saving doses and stays on the shelves and – in some cases – is thrown away. As of Wednesday, only 53 percent of the 44 million doses of vaccines that have been distributed to states have been used.
In mid-January, the Trump administration issued new guidelines recommending that eligibility be expanded to include everyone aged 65 and over and people with certain medical conditions – groups totaling more than 150 million people. More than half of the states followed suit, establishing eligibility criteria based on age. But this created its own challenges. In some parts of the country, demand has dramatically exceeded supply, causing long lines and confusion.
Why there is debate
The abrupt change in distribution plans highlights a central tension that health officials have struggled with when developing their strategies: should the goal be to protect those most at risk or to vaccinate as much as possible?
Proponents of a targeted strategy say the top priority should be to reduce the number of deaths. Although they represent a fraction of the country’s population, residents of long-term care institutions, such as nursing homes, account for more than 35 percent of COVID-19 deaths in the United States. Expanding the vaccine’s eligibility to other groups before the most vulnerable are protected can lead to thousands of unnecessary deaths, some argue. Eliminating job-based eligibility will also put essential workers at risk who are more likely to contract and spread the virus, they say.
Dramatically increasing the number of people seeking the vaccine creates space for injustice and even direct abuse, say others. Without targeted eligibility, well-connected people who may face a relatively low risk will be able to receive the vaccine, while people with less access to health care, who are disproportionately people of color, will not.
Others say that speed should be goal # 1, even if it means that protection doesn’t go to those most at risk. Overly complicated eligibility criteria based on people’s life situation or profession create confusion and hinder the process. With some 250 million Americans needing to be vaccinated to achieve collective immunity, anything that slows down distribution will make the pandemic last longer, they argue. There is also hope that the vaccine shortage will be less of a problem with Biden’s promise to buy 200 million more doses of the two vaccines currently in use and the potential that more vaccines may be available in the near future.
What is the next
Public health experts hope that the approval of new vaccines will help solve many of the supply problems plaguing the launch of vaccines in the United States. Special attention is being paid to a Johnson & Johnson vaccine candidate, which requires only a single dose, as opposed to the two doses required for Pfizer and Moderna vaccines already on the market. Johnson & Johnson reported promising results from its clinical trials on Friday and is expected to seek emergency approval for distribution in the U.S. as early as next week.
Perspectives
Focus on the most vulnerable
Accelerating vaccination does not mean abandoning all rules
“The increase in the volume of vaccines does not have to involve obtaining doses for people most at risk with Covid-19. Because it is important to ensure that vaccinated people meet current eligibility criteria, mass vaccination clinics can focus on people over 65, whose age can be easily verified ”. – Thomas J. Bollyky, Jennifer B. Nuzzo and Prasith Baccam, New York Times
With the virus spreading rapidly, limiting deaths should be a priority
“If the vaccine is released slowly, which is the case today, and if transmission in the community is high, which is also the case, then it will be better to prioritize adults over 60 to minimize mortality.” public health data Daniel Larremore for NPR
Elderly people face the greatest risk and should be the focus of vaccination efforts
“Coronavirus is not an equal opportunity killer. The vast majority of its victims are elderly ”. – Editorial, Las Vegas Review-Journal
Limiting eligibility will help prevent line skips
“In general, having a high demand for COVID-19 vaccines is a good problem. … But until we reach a point where there is more supply than demand, the small doses should go only to those who need protection the most, not to the highest bidder ”. – Editorial, Los Angeles Times
Broad eligibility will make racial health disparities worse
“The bottleneck is going to get worse and we fear that black communities will be left behind.” – Editorial, Baltimore Sun
Without targeted vaccinations, the most vulnerable will be left behind
“A ‘first come, first serve’ approach will leave out many of the most vulnerable, who may not be able to call a hotline as soon as they open or camp overnight to get a chance. Those with connections will almost certainly find a way to jump ahead, and access, rather than necessity, will determine someone’s place in the queue. ”- Leana S. Wen, Washington Post
Focus on speed
The goal should be to administer as many vaccines per day as possible
“The imperative of public health is to distribute vaccines quickly, even if the sequence is imperfect. … Our collective imperative is to put you in as many arms as possible to increase our cumulative defense while the virus is increasing. ”- Editorial, (Newark) Star-Ledger
Expand eligibility to avoid waste, but intensify efforts to vaccinate the most vulnerable
“We must release all available doses of Covid-19 vaccines – but we must go further, expanding the categories of who can receive the vaccine to avoid missed doses and, at the same time, increase funding and support to carry the vaccine in the arms of people in many ways that explicitly address equity considerations and don’t allow people to use their influence or resources to cut the line. ”- Megan Ranney, CNN
Overly complex criteria can lead to wasted doses
“Unfortunately, a complex layered approach presents a barrier to administering the vaccine. Who will ensure that a person is a critical worker or has a certain disease? Do you bring a paycheck or a medical certificate to the clinic or pharmacy? What qualifies as an underlying condition? This adds delay and can cause vaccine waste if vaccinators do not have enough people available to receive the injections before the doses expire. ” – Linn Goldberg and Louis Speizer, Oregonian
Strict eligibility criteria are lessening the effort to end the pandemic
“Americans have been warned … there will be a shortage of vaccines. Health workers were instructed to comply with a strict prioritization schedule and this created a ‘scarcity mentality’ that delayed the distribution of available vaccines. ”- Arielle Kane, The Hill
Protecting the vulnerable should be a goal, not a strict mandate
“The part that needs to change is strict adherence to the hierarchy. This is only a guideline, but it is being applied very strictly. … It is tragic that regulations are hindering immunizations ”. – Marc Siegel, Fox News
Broader criteria will help combat vaccine skepticism
“Ensuring that everyone already convinced of the vaccine’s effectiveness has access to inoculation should be our priority. Transitioning to a first-come, first-served model is the most efficient way to achieve this. It is the obvious first step in ensuring that an adequate number of the American population is vaccinated, as it relieves the burden of convincing skeptics ”. – Anthony DiMauro and Leonard Robinson, Business Insider
If the rules are too complicated, vulnerable people will get lost in confusion
“Prioritization schemes in many states are complicated and vague. All of this may seem like a way to guarantee justice, but in reality we know from similar programs that those with more connections, free time and know-how will be better able to navigate this maze while the process slows you down for everyone else – especially those who need. ”- Zeynep Tufekc, New York Times
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