As groups clamor for vaccine, see how Alaska will decide who is next in line

Vaccines from pharmaceutical companies Pfizer and Moderna are being hailed as a revolutionary weapon in the fight against COVID-19, which killed more than 180 Alaskan people and infected tens of thousands of people.

But in the coming months, there will be far fewer doses of vaccine available than people who want to receive them. And that poses the difficult question of who should take action first.

Republican Governor Mike Dunleavy has the final authority to decide, according to officials in his administration. But so far, the state has followed the recommendations of a new advisory committee composed largely of health professionals, saying they are better suited to consider the science and data surrounding the vaccine.

The committee’s initial task of distributing vaccines to different groups of healthcare professionals was limited and attracted relatively little scrutiny from the general public, as the first shipment of 35,000 doses comes from pharmaceutical companies Pfizer and BioNTech.

But his work is now entering a more delicate phase, as additional doses become available. And letters are coming in to emphasize the risks of difficult dilemmas that some committee members did not know they would be asked to consider.

Those looking to secure their place in the Alaskan vaccine line include nonprofits, trade associations and even state agencies.

State legislative leaders want legislators and officials to be appointed essential workers, citing its importance for the state’s economic recovery and the old Capitol building’s reputation as a “Petri dish” for communicable diseases.

These requests represent only a fraction of what the committee has received so far, and are set to request more public testimony at a meeting later this month.

Alaskans should know that the committee is approaching work with humanity and sincerity, said Mark Carr, a regional ethics expert at Providence Health & Services Alaska and one of the committee’s 24 members. He emphasized that members are not making value judgments or applying some kind of “moral algorithm”.

“Northing could be further from the truth,” he said. “We are going to identify a certain part of our structural system that we must keep functioning, so that we have a society, so that we have a structure that allows groceries to be on the shelf and for people to drive to the hospital.”

It’s not what they signed

A separate federal committee recommended that frontline health professionals and facility residents such as nursing homes be the first to receive the vaccine, in what is known as “Phase 1a”.

But the state wanted advice on how to apply the recommendations to Alaska and help decide exactly which health care providers should go first, as there was not enough vaccine for all of them.

Committee members include hospital executives, doctors, nursing home managers, pharmacists Fred Meyer and leaders of Alaskan tribal health care providers. They finally recommended, and Dunleavy’s administration agreed, to start with two levels of vaccination within Phase 1a.

The first level consists of residents and nursing home staff, as well as frontline health professionals based in hospitals “at greatest risk”. The second level includes emergency medical first responders, people who administer vaccines and community health workers.

At a meeting on Sunday, the federal advisory committee voted that the next phase, 1b, will include 19 million Americans aged 75 and over, along with some 30 million essential frontline workers in places like schools, supermarkets, prisons and public transport networks. He also said that Phase 1c would include a second, broader group of essential workers, in addition to adults with pre-existing medical conditions and people aged 65-74.

The Alaska allocation committee will now have to consider how to translate these national guidelines into specific state recommendations.

Of several committee members recently contacted by phone, all but Carr declined to be interviewed. Kosin said the group’s role is likely to have taken on a much higher profile than many of its volunteer members initially predicted.

“People did not necessarily sign up for this, nor do we foresee this,” said Kosin. “They are people who are doing rounds in hospitals, caregivers in nursing homes, ordinary doctors and others who have jobs that are just coming together to try to help with the public good and give advice.”

Navigating an “impossible task”

Now that the vaccine has arrived in Alaska, the committee has received about two dozen letters about the distribution, according to a list provided by Kosin. Defenders from different organizations also spoke at the committee’s first round of public testimony Thursday night.

Among them was the Office of Children’s Services, part of Dunleavy’s administration, which wants its employees to be considered the first to respond. The Alaska section of the American Civil Liberties Union, meanwhile, called for prisoners to be prioritized, citing the massive outbreaks of COVID-19 in state correctional buildings.

Then there is the Coastal Villages Region Fund, a non-profit organization that has fishing rights in the Bering Sea, which it uses to pay social and economic programs in 20 rural villages in southwest Alaska – some of which have had a large number of infections by COVID-19.

CVRF asked the allocation committee to recognize the unique challenges in the region, such as dense multifamily housing, few health clinics and the lack of running water and sewage systems in some places. The idea is not without precedent: in Tennessee, the state’s draft vaccination plan provided for 5% of doses to be reserved for areas with high scores on the CDC’s “social vulnerability index”.

So perhaps rural residents of southwest Alaska should be vaccinated at the same time as the doses allocated by Alaskans because of medical conditions that put them at greater risk for serious illnesses caused by COVID-19, said Eric Deakin, president- CVRF executive.

“I think most of our communities are at risk,” said Deakin in an interview. “We don’t think that population centers should have priority over rural areas when they distribute the vaccine.”

Committee members are aware of the challenges facing rural Alaska, said Carr, the ethics expert. But the allocation dilemma remains of particular concern because Alaskans and other Americans are not used to struggling with scarce resources, he added.

“It is not what we do. We are not who we are, ”said Carr. “Alaskans believe that our resources are absolutely unlimited.”

The committee is trying to avoid using the word “prioritize” because it suggests that members value certain groups over others, said Carr. Instead, the overall goal of the allocation process is to maximize the health and well-being of Alaskans, said Dr. Anne Zink, Alaska’s medical director.

That’s one reason the initial round of the vaccine goes to people who keep Alaskan hospitals running and facilities like nursing homes, said Zink.

It is not that these workers and residents are more valuable than others in the health care system, she said.

The fact is that if hospitals are overloaded because employees are sick, deaths among the general public begin to increase much more quickly, added Zink. Vaccination of nursing home residents means that fewer of them will end up seriously ill and overburden hospitals as well, and will allow the state to redirect its virus testing efforts away from these facilities and to places like schools and restaurants, she said.

However, Zink acknowledged that many Alaskans are unlikely to be satisfied with the state’s allocation decisions.

“I would like to have better words to comfort Alaskans, to say that we are trying to do this in the fairest and most equitable way possible. But it is an impossible task and I know it will not seem fair to many, ”she said. “I totally sympathize with that and I can understand why people feel that way. But I can’t do much more about it than looking at data and science and trying to be as transparent as possible. “