Debate begins for who's first in line for COVID-19 vaccine

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 U.S. health authorities hope by late next month to have some draft guidance on how to ration initial doses, but it’s a vexing decision.

“t everybody’s going to like answer,” Dr. Francis Collins, director of National Institutes of Health, recently told one of visory groups government asked to help decide. “re will be many people who feel that y should have been at top of list.”

Tritionally, first in line for a scarce vaccine are health workers and people most vulnerable to targeted infection.

But Collins tossed new ideas into mix: Consider geography and give priority to people where an outbreak is hitting hardest.

And don’t forget volunteers in final st of vaccine testing who get dummy shots, comparison group needed to tell if real shots truly work.

“We owe m ... 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 next few months, equally large calls for volunteers will go out to test shots me by AstraZeneca, Johnson & Johnson and vavax. And some vaccines me in China are in smaller late-st studies in or countries.

For all promises of U.S. stockpiling millions of doses, hard truth: Even if a vaccine is declared safe and effective by year's end, re won’t be eugh for everyone who wants it right away -- especially as most potential vaccines require two doses.

It’s a global dilemma. World Health Organization is grappling with same who-goes-first question as it tries to ensure vaccines are fairly distributed to poor countries -- decisions me even harder as wealthy nations corner market for first doses.

In U.S., visory Committee on Immunization Practices, a group established by Centers for Disease Control and Prevention, is supposed to recommend who to vaccinate and when -- vice that government almost always follows.

But a COVID-19 vaccine decision is so tricky that this time around, ethicists and vaccine experts from National Acemy of Medicine, chartered by Congress to vise government, are being asked to weigh in, too.

Setting priorities will require “creative, moral common sense,” said Bill Foege, who devised vaccination strategy that led to global erication of smallpox. Foege is co-leing acemy’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 public must see vaccine allocation as “equitable, fair and transparent.”

How to decide? CDC’s opening suggestion: First vaccinate 12 million of most critical health, national security and or essential workers. Next would be 110 million people at high risk from coronavirus -- those over 65 who live in long-term care facilities, or those of any who are in poor health -- or who also are deemed essential workers. general population would come later.

CDC’s vaccine visers wanted to kw who’s really essential. “I wouldn’t consider myself a critical health care worker,” mitted Dr. Peter Szilagyi, a pediatrician at University of California, Los Angeles.

Indeed, risks for health workers today are far different than in pandemic’s early days. w, health workers in COVID-19 treatment units often are best protected; ors may be more at risk, committee members ted.

Beyond health and security fields, does “essential” mean poultry plant workers or schoolteachers? And what if 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, Lati and Native American populations disproportionately hit by coronavirus, failing to dress 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 urban poor who live in crowded conditions, have less access to health care and can’t work from home like more privileged Americans, ded Dr. Sharon Frey of St. Louis University.

And it may be worth vaccinating entire families rar than trying to single out just one high-risk person in a household, said Dr. Henry Bernstein of rthwell Health.

Whoever gets to go first, a mass vaccination campaign while people are supposed to be keeping ir distance is a tall order. During 2009 swine flu pandemic, families waited in long lines in parking lots and at health departments when ir turn came up, crowding that authorities kw y must avoid this time around.

Operation Warp Speed, Trump ministration’s effort to speed vaccine manufacturing and distribution, is working out how to rapidly transport right number of doses to wherever vaccinations are set to occur.

Drive-through vaccinations, pop-up clinics and or invative ideas are all on table, said CDC’s Dr. Nancy Messonnier.

As soon as a vaccine is declared effective, “we want to be able next day, frankly, to start se programs,” Messonnier said. “It’s a long ro.”