COVID-19 Vaccine: You May Have to Wait in a Very Long Line

You might be thinking, “I’m sick and tired of staying at home all the time. I hate wearing a mask. I want to hug grandma. Where the hell is the vaccine?” There’s good news and bad news. The good news is that according to a recent statement by Dr. Anthony Fauci, widely respected top infectious disease expert in the United States, one or more vaccines may be distributed in the US as soon as late December or early January. The bad news is you might be assigned a low priority and be stuck in line for months before you actually get it. 

The Background

Early last summer the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC), were scrambling to come up with a plan about how to distribute a COVID-19 vaccine to the American people, once approved for distribution. The major problem was this: in the initial weeks or months of distribution there would not be enough vaccine for everyone who wanted it. Consequently, some groups or classifications of people would get it first, and all others would be denied until such time more vaccine was produced. In an overwhelmed emergency room this would be the dreaded “triage.” In the less frenetic halls of public health, these are “priorities.”

As you might imagine the whole subject has the potential for becoming extremely controversial and contentious, so the CDC and NIH did what I would have done – they handed this hot potato to someone else. They gave it to the National Academies of Sciences, Engineering, and Medicine. The National Academies accepted the challenge, established a committee to do the work, and held their first meeting August 21, 2020, followed by a public hearing and additional meetings into September. The final report was released October 2, “Framework for Equitable Allocation of COVID-19 Vaccine.”

The first order of business was to establish guiding “ethical and procedural principles.” Agreed-upon ethical principles included:

• The obligation to protect and promote the public’s health and its socioeconomic well-being in the short and long term.
• The obligation to consider and treat every person as having equal dignity, worth, and value.
• The obligation to explicitly address the higher burden of COVID-19 experienced by the populations affected most heavily, given their exposure and compounding health inequities.

Procedural principles included:

• Fairness: Decisions should incorporate input from affected groups, especially those disproportionately affected by the pandemic. Once informed by public input, decisions should be data-driven and made by impartial decision makers, such as public health officials.
• Transparency: The obligation to communicate with the public openly, clearly, accurately, and straightforwardly about the vaccine allocation criteria and framework, as they are being developed and deployed.
• Evidence-based: Vaccination phases, specifying who receives the vaccine when, should be based on the best available scientific evidence, regarding risk of disease, transmission, and societal impact.

Once the “Foundational Principles” were established, the next step was the hard part – determining who gets the vaccine when. The priorities are referred to as “allocation phases.” Here’s what the National Academies committee came up with:

• Phase 1a: High-risk health workers and first responders (approximately 5% of the population)
• Phase 1b: People with significant preexisting medical conditions (defined as having two or more); and older adults in congregate or overcrowded settings (approximately 10% of the population)
• Phase 2: K-12 teachers and school staff and child care workers; critical workers in high-risk settings; people with moderate comorbid [pre-existing medical] conditions; people in homeless shelters or group homes and staff; incarcerated/detained people and staff; and all older adults (approximately 30-35% of the population)
• Phase 3: Young adults; children; workers in industries important to the functioning of society (approximately 40-45% of the population)
• Phase 4: All other individuals residing in the United States who are interested in receiving the vaccine for personal protection. 

Meanwhile, late last August the US Centers for Disease Control and Prevention (CDC) alerted public health officials in Alaska and across the nation to prepare to distribute a coronavirus vaccine as soon as late October. According to a September 2 article by the New York Times,

The guidance noted that health care professionals, including long-term care employees, would be among the first to receive the product, along with other essential workers and national security employees. People 65 or older, as well as Native Americans and those who are from “racial and ethnic minority populations” or incarcerated — all communities known to be at greater risk of contracting the virus and experiencing severe disease — were also prioritized in the documents.

The Alaska COVID-19 Vaccination Plan

On October 16 The Alaska Department of Health and Social Services (DHSS) submitted Alaska’s draft “COVID-19 Vaccination Plan” to the Centers for Disease Control and Prevention (CDC) for review. The Alaska plan was prepared by the COVID-19 Vaccine Task Force, a partnership between DHSS and the Alaska Native Tribal Health Consortium (ANTHC). The plan itself was announced to the public in a DHSS press release October 20.

The Alaska vaccine distribution plan is divided into 15 sections which address issues such as preparedness planning, communications, recruiting providers, safety monitoring, etc. But we’ll dive directly into Section 3: Phased Approach to COVID-19 Vaccination. Alaska is preparing for a three-phased approach to vaccine distribution:

• Phase 1: Potentially limited supply of COVID-19 vaccines doses available. Focus initial efforts on reaching the critical populations [not specified in this planning document].
• Phase 2: Larger number of vaccine doses available. Focus on ensuring vaccination Phase 1 critical populations who were not yet vaccinated as well as for the general population.
• Phase 3: Sufficient supply of vaccine doses for entire population. Focus on ensuring equitable vaccination access across the entire population. 
• Alaska plans to administer vaccine through: Commercial and private sector partners (pharmacies, doctors’ offices, clinics); Public health sites (mobile clinics, Federally Qualified Health Centers [FQHCs], public health clinics, temporary/off-site clinics).

It Does Not Inspire Confidence

As you can see, there is very little detail in the Alaska plan about exactly who is in what phase for vaccine distribution. It is true that “DRAFT” is printed on every page of the plan, but considering that the actual release of the vaccine may be only weeks away, the rudimentary nature of this document does not inspire confidence. There is no date on the document. There are no authors or contact persons listed on the document. In fact, there are no named people in the document at all. As a stand-alone document it is eerily anonymous, despite the fact that a separate press release lists media contacts and a couple Task Force members. The document does not indicate that there has been an opportunity for public input in the past, nor does it indicate any will be solicited in the future. Perhaps a considerably more detailed document and opportunities for public input are just around the corner. Hope springs eternal...

Originally published in Anchorage Press.