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Debate
begins
for
who's
first in
line for
COVID-19
vaccine
By
LAURAN
NEERGAARD
apnews.com
Who
gets to
be first
in line
for a
COVID-19
vaccine?
U.S.
health
authorities
hope by
late
next
month to
have
some
draft
guidance
on how
to
ration
initial
doses,
but it’s
a vexing
decision.
“Not
everybody’s
going to
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
many
people
who feel
that
they
should
have
been at
the top
of the
list.”
Traditionally,
first in
line for
a scarce
vaccine
are
health
workers
and the
people
most
vulnerable
to the
targeted
infection.
But
Collins
tossed
new
ideas
into the
mix:
Consider
geography
and give
priority
to
people
where an
outbreak
is
hitting
hardest.
And
don’t
forget
volunteers
in the
final
stage of
vaccine
testing
who get
dummy
shots,
the
comparison
group
needed
to tell
if the
real
shots
truly
work.
“We
owe them
... some
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
tests
last
week
that
eventually
will
include
30,000
volunteers
each; in
the next
few
months,
equally
large
calls
for
volunteers
will go
out to
test
shots
made by
AstraZeneca,
Johnson
&
Johnson
and
Novavax.
And some
vaccines
made in
China
are in
smaller
late-stage
studies
in other
countries.
For
all the
promises
of the
U.S.
stockpiling
millions
of
doses,
the hard
truth:
Even if
a
vaccine
is
declared
safe and
effective
by
year’s
end,
there
won’t be
enough
for
everyone
who
wants it
right
away --
especially
as most
potential
vaccines
require
two
doses.
It’s
a global
dilemma.
The
World
Health
Organization
is
grappling
with the
same
who-goes-first
question
as it
tries to
ensure
vaccines
are
fairly
distributed
to poor
countries
--
decisions
made
even
harder
as
wealthy
nations
corner
the
market
for the
first
doses.
In
the
U.S.,
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
that the
government
almost
always
follows.
But
a
COVID-19
vaccine
decision
is so
tricky
that
this
time
around,
ethicists
and
vaccine
experts
from the
National
Academy
of
Medicine,
chartered
by
Congress
to
advise
the
government,
are
being
asked to
weigh
in, too.
Setting
priorities
will
require
“creative,
moral
common
sense,”
said
Bill
Foege,
who
devised
the
vaccination
strategy
that led
to
global
eradication
of
smallpox.
Foege is
co-leading
the
academy’s
deliberations,
calling
it “both
this
opportunity
and this
burden.”
With
vaccine
misinformation
abounding
and
fears
that
politics
might
intrude,
CDC
Director
Robert
Redfield
said the
public
must see
vaccine
allocation
as
“equitable,
fair and
transparent.”
How
to
decide?
The
CDC’s
opening
suggestion:
First
vaccinate
12
million
of the
most
critical
health,
national
security
and
other
essential
workers.
Next
would be
110
million
people
at high
risk
from the
coronavirus
-- those
over 65
who live
in
long-term
care
facilities,
or those
of any
age who
are in
poor
health
-- or
who also
are
deemed
essential
workers.
The
general
population
would
come
later.
CDC’s
vaccine
advisers
wanted
to know
who’s
really
essential.
“I
wouldn’t
consider
myself a
critical
health
care
worker,”
admitted
Dr.
Peter
Szilagyi,
a
pediatrician
at the
University
of
California,
Los
Angeles.
Indeed,
the
risks
for
health
workers
today
are far
different
than in
the
pandemic’s
early
days.
Now,
health
workers
in
COVID-19
treatment
units
often
are the
best
protected;
others
may be
more at
risk,
committee
members
noted.
Beyond
the
health
and
security
fields,
does
“essential”
mean
poultry
plant
workers
or
schoolteachers?
And what
if the
vaccine
doesn’t
work as
well
among
vulnerable
populations
as among
younger,
healthier
people?
It’s a
real
worry,
given
that
older
people’s
immune
systems
don’t
rev up
as well
to flu
vaccine.
With
Black,
Latino
and
Native
American
populations
disproportionately
hit by
the
coronavirus,
failing
to
address
that
diversity
means
“whatever
comes
out of
our
group
will be
looked
at very
suspiciously,”
said
ACIP
chairman
Dr. Jose
Romero,
Arkansas’
interim
health
secretary.
Consider
the
urban
poor who
live in
crowded
conditions,
have
less
access
to
health
care and
can’t
work
from
home
like
more
privileged
Americans,
added
Dr.
Sharon
Frey of
St.
Louis
University.
And
it may
be worth
vaccinating
entire
families
rather
than
trying
to
single
out just
one
high-risk
person
in a
household,
said Dr.
Henry
Bernstein
of
Northwell
Health.
Whoever
gets to
go
first, a
mass
vaccination
campaign
while
people
are
supposed
to be
keeping
their
distance
is a
tall
order.
During
the 2009
swine
flu
pandemic,
families
waited
in long
lines in
parking
lots and
at
health
departments
when
their
turn
came up,
crowding
that
authorities
know
they
must
avoid
this
time
around.
Operation
Warp
Speed,
the
Trump
administration’s
effort
to speed
vaccine
manufacturing
and
distribution,
is
working
out how
to
rapidly
transport
the
right
number
of doses
to
wherever
vaccinations
are set
to
occur.
Drive-through
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
road.”
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