The COVID-19 Pandemic: Vaccines are here—who gets them?Dec 7, 2020
Vaccines against SARS-CoV-2 have been produced with extraordinary rapidity, reflecting technological advances and the urgency of the pandemic. The toll in the United States and globally is staggering: on December 5, there were 2,190 deaths and more than 205,000 cases across the United States. For perspective, the daily death count at present is equivalent to about three deaths every two minutes. Last week, per the Institute for Health Metrics and Evaluation, COVID-19 surpassed ischemic heart disease as the leading cause of death. In Colorado, deaths rose across November, but we don't yet have the current picture due to reporting lags. There is some good news for the state—the number of COVID-19 hospitalizations has dropped over the last several days, but the impact of the Thanksgiving holiday looms.
In this tragic context of the out-of-control pandemic, the anticipated approval of vaccines brings hope and the prospect for a “new normal” may not be far off. The FDA’s Vaccine and Related Biological Products Advisory Committee meets on December 10 to consider Emergency Use Authorization for the Pfizer-BioNTech COVID-19 Vaccine, and on December 17 to review the Moderna Inc. COVID-19 Vaccine. Vaccination could begin immediately as preparations for doing so have been underway, including the implementation of the challenging, very cold supply chain needed for the Pfizer vaccine.
Now, we need to equitably allocate the vaccines. In October, the National Academies of Sciences, Engineering and Medicine released its report on equitable allocation, calling for four phases. The CDC also offers guidelines and principles, and has a useful listing of frameworks for vaccination priorities. Both the CDC and the National Academies give first priority to frontline healthcare workers with the CDC also giving equivalent highest priority to residents of long-term care facilities. After these two groups, there are many others deserving priority with the underlying principles of these frameworks: older individuals, those with underlying disease, essential workers, the homeless, and those imprisoned. Already, there is contention about priority designation for some groups, e.g., prisoners. Hopefully, rapid availability of sufficient vaccines will mute debate.
We may have unrealistic expectations as to how quickly vaccination will slow the epidemic. The latest estimates from the Institute for Health Metrics and Evaluation show limited impact of vaccination on mortality through April 2021. Beyond the logistical barriers, the problem of vaccine hesitancy remains. Facebook survey data continue to show reluctance to accept vaccination, with responses from a few states indicating that less than 70% will accept vaccination. For SARS-CoV-2, we reach herd immunity when approximately 70% of the population is no longer susceptible.
In spite of the grim statistics that are now reinforced by the stories of ill friends and family members, resistance to infection control measures persists nationwide. Measures in place vary across the states, reflecting the predominant political party. Read, for example, this New York Times story about the Dakotas. Once again, restaurants are closed in many locales for indoor dining, launching interviews with employers, staff, and customers about the economic consequences. An integrated pandemic control approach, seemingly unachievable, would couple policy measures to control transmission with subsidies to address the economic consequences of the measures. Congress appears poised (finally) to act in a bipartisan fashion to provide support as the economic consequences of the latest surge take hold.
Hang in through the tough months ahead,