The Big Decision of the World - Who Will Get the Covid-19 Vaccine First?
In theory, everyone in the world who wants it should eventually be able to get immunized. But for much of 2021, demand for the coronavirus vaccine will outstrip supply, presenting a massive dilemma for governments, which must decide who gets the vaccine first or early, and who must wait.
The U.S. federal government’s world-leading “Operation Warp Speed” vaccine program plans to over 6 million doses within 24 hours of regulatory clearance. But even this initial effort to immunize front-line health-care workers risks wasted doses and that’s just Step 1, in one country.Many disputes over prioritization will play out in the fine print of government plans. Is a hospital worker more at risk than a suburban pediatrician? Is a bus driver’s super-spreading danger a greater priority than the risk faced by a 50-year old with diabetes?
“You want to target the highest risk, because this will get you the biggest benefit,” said Tom Kenyon, a former director of CDC’s Center for Global Health, who cited the example of bus drivers in Africa being identified as key spreaders of the virus.
Serious questions also arise around equity. “We will not have succeeded if a healthy 20-year old in US is getting vaccinated before a frontline health care worker in South Sudan,” said senior vaccines policy adviser for Doctors Without Borders’ Access Campaign.
With the vaccine likely to be administered outside hospitals in many instances — in pharmacies, from mobile van facilities — verifying that recipients have certain health conditions will rely on either huge databases or an honor system.
Many governments are keeping their options open until final details of vaccine efficacy and delivery timelines are available. Here are the most relevant elements of those plans:
Government officials say it will be April before most people could get vaccinated. A government committee (ACIP) is prepared to issue its prioritization guidance around December 10. But HHS Secretary Alex Azar said this week the federal government won't wait for ACIP recommendations if a vaccine is authorized before then.
While federal and state officials agree that the nation’s 21 million health care workers should be first in line for the vaccine, there is no consensus about how to balance the needs of other high-risk groups. Azar said this week states will have the "final say" in prioritizing Covid vaccinations, and that the shots will be apportioned according to the size of adult populations.European Union
Xavier Bettel, prime minister of Luxembourg, said in an interview that the EU has a difficult starting position when it comes to Covid-19 vaccinations: “There is not one country where over 60 percent of people want to get vaccinated.”
However, a tug-of-war between Brussels-based EU institutions and national governments over how to source and deliver vaccines appears to have ended happily: European Commission President Ursula von der Leyen confirmed this week that the EU has secured vaccines for 430 million people — enough for virtually every EU resident. It would have created a “nightmare” if the EU failed to coordinate distribution, Bettel said.
Among a series of priority measures, the European Centre for Disease Prevention and Control said it will deploy the vaccine to “control active outbreaks”.
Germany’s Standing Committee on Vaccination recommends prioritization be guided by “urgency of preventive health protection,” aiming to reduce cases most likely to lead to hospitalization or death, and to ensure “maintenance of essential state functions and public life,” which includes police, firefighters and teachers, in addition to healthcare workers.
The U.K.'s Joint Committee on Vaccination and Immunisation has an 11 step plan to priotarize. After healthcare workers, the priorities are older adults in care homes, then older Britons, starting with the eldest and descending in 5-year age brackets.
Japan’s top priority is older citizens with chronic conditions. Citizens will be given coupons indicating their order of priority, Japan’s Health, Labor and Welfare Ministry said.
Class and geographic divides have produced significant variations in India’s death rates. 80-year-olds in some states are surviving more often than 60-year-olds in others.. The government’s response: set a lower age threshold than most Western countries — 50 years — for priority access.
The task is massive. There are 260 million Indians of age 50 or older, and around 20 million frontline workers. The government is concerned about confusion over who is entitled to priority access. A National Expert Group on Vaccine Administration has worked with state governments to create a new "digital platform for vaccine administration and distribution" the group said in a statement.
South Korea and Taiwan
As standout performers in controlling Covid-19, the two East Asian nations also share an unusual vaccine deployment approach: They’re relatively relaxed about it. As members of the COVAX facility-which is pooling the resources of 186 country to accelerate vaccine development and distribution — both governments are prioritizing buying the vaccine at the right price, rather than as soon as possible. Each plans to buy enough vaccines for only around 60 percent of their populations.
While Taiwan has a history of high demand for vaccines — the Taiwan Centers for Disease Control reported an average 98 vaccination rate in 2019 — the government is not afraid to ration vaccines. In November, the government banned people aged 50 to 64 from receiving state-funded influenza vaccines, in order to prioritize more vulnerable groups.
The world’s most populous Muslim nation stands apart for its decision to prioritize young workers of age between 18 and 59 for the vaccine, once healthcare workers have been inoculated. Indonesian government ministers told Reuters they expect the country’s independent drugs agency will approve China's Sinovac and Sinopharm vaccines in the first week of December.
Australia and New Zealand
An Australian government issued an official list of most exposed workers, including those in prisons and group care homes. After that, Australia is likely to prioritize older people, those with preexisting conditions and indigenous Australians, who typically have far worse health outcomes than the population overall, according to the Australian Technical Advisory Group.
New Zealand’s model is similar to Australia’s, including close partnerships with its indigenous Maori communities. The government said its vaccine prioritization will be guided by WHO advice and says it has an “obligation” to ensure even distribution of the vaccine among neighboring Pacific Island nations.
After seeing at least one of its cities overwhelmed with the number of deaths caused by the virus earlier this year, Ecuador will focus on first responders. The government’s vaccination plan — which WHO boss Tedros Adhanom Ghebreyesus praised in a press conference this week — includes priority for firefighters, trash collectors and people working in the food chain as well as healthcare workers, according to local media./Politico
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