Vaccine rollout

[kjn]

With the new Covid vaccines available in limited numbers, I've been mulling a bit on the principles used for distribution. That health care personnel should get first dibs is a given for me, but this article shows that the same questions can arise within that group as well: Stanford apologizes after doctors protest vaccine plan that put frontline workers at back of line

There are at least three different principles that I can see guide the vaccine rollout for health care personnel:

1. People most exposed to the vaccine, e.g. those working in Covid wards. But since they are also the most exposed, other protective equipment and procedures can be used there, and no vaccine is 100% effective in any case. You will still need the protective equipment and procedures.


2. People who work with at-risk patients, e.g. like elderly care. But it takes more than a month for full effect for the vaccines that I know of (ten days for partial immunity to appear, then a second dose after a month, and another ten days for full effect), and it protects risk groups but doesn't do much to limit general spread in society.


3. People with lots of general contacts, e.g. primary care staff, pharmacy clerks, emergency care personnel, and so on. The goal here is to protect a group that has lots of contacts with other people, and thus runs both a high risk of unknowingly being exposed to and exposing others to the virus.

It's similar to the thinking I had for the general rollout, where a Swedish study of occupation and risk gave bus and taxi drivers a four to five times higher risk of contracting Covid than the general population. The goal here is to not only protect individual people, but to limit spread in society as quickly as possible.

Comments

[itlandm]

Here in Norway, there is a massive popular wish for health care workers to get vaccinated first, but the government says nay. The reason is that Pfizer has not documented that the vaccine prevents infection and retransmission, only sickness. So the rollout will start with care home residents, then 85+, 75+, 65+.

I have to say I am skeptical of the notion that this vaccine might behave differently from other vaccines over the past century. I believe the default assumption should be that it behaves like most vaccines.

[kjn]

Sweden seems to follow a similar strategy, though regional authorities can decide on a different one.

[madfilkentist]

I saw an article that suggested a point system. If you were a front-line worker and had risk factors, for example, then you'd get more points and a higher priority than someone who had just one or the other. The article also noted that allocating points would be a lot more complicated than the single-priority system now being used.

[kjn]

I think that would be a too complex thing to do, really. It also seems the Stanford vaccination plan outlined in the OP article followed that, so there is a risk of unintended biases creeping in.

[canyonwalker]

The allocation system at Stanford University was essentially a points system. The hospital administration designed an algorithm to score staff on risk factors such as their age and where they worked within the hospital. You can find a story without a paywall, BTW, at NPR News.

Despite the oversight at Stanford exposed by the protest (doctors-in-training, i.e. "residents" in American medical terminology, were assigned no location so they were zeroed out on that factor; coincidentally residents had no representative among the executive staff reviewing the algorithm's results before it was finalized 🙄) the idea of a points system is sound. Points systems are also necessary. As long as the initial production waves of the vaccine are too small to cover broad categories of people— like, "all medical staff treating patients potentially with Covid-19"— there needs to be some way to prioritize within those categories who is inoculated first. No matter whether you name it a "points" system, it's essentially going to be a points system.

[culfinriel]

As you're noting, there's no perfect system, but if we won't know if it prevents transmission until thousands get the vaccine, the most at risk of catching it/ the most frequently exposed are up there with the most likely to die when they catch it. So bus drivers and the like should be up on the list.

Overlooking the medical students, residents, and fellows surprises me zero. You're not a person. The whole system fails without you, but you don't exist. One of the many cracks/failings in the American medical system that this plague ought to be exposing to the light of day. Probably nothing substantive will be done to change anything, though. Ask me how I know some time.

[kjn]

Yup. Risk is really two things: severity if you get it, and chance of contracting the disease.

But the guidelines from the Swedish public health authority only considers the first level. I really hope they've taken the second into consideration too, as well, in their internal discussion.