Science

Who “Deserves” COVID-19 Vaccine Priority?

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Well, the United States is now approving COVID-19 vaccines for distribution, so the pandemic is over, right? Yeah. No. 

This is about to be the biggest public health project in our nation’s history, as an ineffectual and apathetic federal government oversees the campaign to make sure about 330 million people get access to a vaccine for a virus that the same federal government has spent the past 9 months telling them isn’t a big deal. By the way, as of this recording 300,000 Americans have died from this disease. No big deal.

The logistics of getting 330 million people vaccinated would be overwhelming regardless, but this is definitely not the best of all possible worlds. There’s the federal government, but there are also many states led by conservatives who refuse to admit that this virus is a problem and so we already know they will be incompetent, if not actively detrimental, in this effort. Take Kim Reynolds, governor of Iowa, who resisted taking any measures to stop the spread of COVID and bragged about it on election night, saying that the Republican win in the state “was a validation of our balanced response to Covid-19…One that is mindful of both public health and economic health.” They reported 25 COVID deaths on election day, but last week they recorded nearly 200 deaths in one day, with thousands of new cases appearing each day. Reynolds has finally agreed that a mask mandate might be helpful. Oh, you don’t say?

And this genius is now in charge of making sure 3 million Iowans get vaccinated. Yikes.

Conservatives aside, there’s one other big stumbling block in the path of this rollout: determining who gets the vaccine first. Because you can’t just simultaneously inject 330 million people, even if you already had that many vaccines to hand out (which we definitely do not). I’ve already seen people get on edge about this — one doctor on Twitter wrote “Everyone needs to follow the COVID vaccine prioritization in every state. If elites and athletes get it earlier than prioritized, it will erode public trust.” Which is true! No one should get the vaccine “earlier than prioritized,” but it’s a bit trickier than that. Who decides who gets prioritized in the first place?

Well, that’s left up to each state to decide. We’re hoping that all of them will adhere to the CDC’s guidelines, which say that the first doses should go to frontline healthcare workers and people in long-term care facilities. The former group is most likely to be exposed to the virus since they’re actively treating people who have it, and the latter are people most likely to die from the virus if they do get exposed. COVID-19 has torn through senior living facilities and absolutely decimated our elderly population, who are already at high risk due to age and other illnesses, and then they end up trapped in a small space with an infectious disease.

After that, though, things get tricky. If we are just basing it on who is most at risk, the next group should probably be prisoners. Prisoners are similar to those in long-term care, in that they are trapped in an unsafe environment where the virus can spread easily. But Americans tend to absolutely hate prisoners, in part because our country has a capitalist system in which rich people make more money off of sending poor people to prison, leading to a culture where we are taught to look down upon criminals, expect people to go to prison regardless of what law they break, and once they’re in prison we have no sympathy for them. We see them as less than human.

Even people who follow me on Twitter expressed concern that prisoners would get the vaccine before others, a sentiment shared by the governor of Colorado, who said “There’s no way it’s going to go to prisoners before it goes to people who haven’t committed any crime.” That speaks to a certain gut instinct of “fairness” — well, that guy committed a crime. I did not. He shouldn’t get something that I can’t get.

But we already give prisoners things we don’t give average law-abiding Americans, like housing and food and healthcare. We accept that if we are going to force someone into a prison, we have a certain expectation to keep them to a certain standard of living. We even look down on countries where the prisons are hellholes, even though our prisons are often not much better.

So when we decide that someone needs to go to prison, the understanding is that they will have a minimum of care there. We do not, or should not, sentence people to prison with the understanding that they will die horrible untimely deaths there, or that they will contract debilitating illnesses there. They are humans. That is inhumane. I already have more rights than the average prisoner — I have the right to live in my own home, to vote in elections, to move about freely while wearing a mask for my safety and the safety of those around me. And because of those freedoms, I enjoy a very low risk of getting COVID-19. Prisoners should get the vaccine before me.

And if it helps, it’s not just for basic reasons of humanity. When COVID-19 spreads around a prison, it inevitably makes its way into the community at large via prison workers. A study published in the journal Health Affairs found that back in April, about one in six COVID-19 cases in Illinois were linked to an outbreak at Cook County Jail

The same is true of athletes: the initial Tweet I was responding to mentioned that if elites AND ATHLETES get the vaccine earlier than prioritized, public trust will be lost. I think it’s telling that they lumped athletes in with elites — it’s true that professional athletes have a certain amount of privilege based on how much money they make as well as their celebrity status. However, there are richer people than them who made the ultimate decision to reinstate professional sports. By doing so, the owners of the teams and the media companies that broadcast the games didn’t risk their health, but the athletes certainly have. While the risk of contracting COVID-19 while playing outdoors may be low, and leagues such as the NBA and NHL tried to insist upon a bubble environment, there have still been outbreaks as athletes inevitably hang out indoors, eat together, and interact with people outside the bubble while not playing

Dozens of athletes across sports declined to return to play due to the pandemic, often incurring financial loss to do so. Elena Delle Donne got a doctor’s recommendation to skip the WNBA bubble, but the league rejected her request and insisted they wouldn’t pay her. It’s worth noting that Donne’s reason for requesting a medical opt-out was due to chronic Lyme’s Disease, which does not exist as I’ve talked about in the past. It’s a made-up disease but it doesn’t matter — COVID-19 can kill anyone whether they have comorbidities or not, and even if death isn’t the result there’s a lot of evidence suggesting that recovered patients may end up with lifelong heart complications, something no one wants, let alone a professional athlete.

So we, as a society, pressured professional athletes to risk their health for our entertainment. But because they’re rich celebrities, we are upset if they get too high of a priority with the vaccine.

Here’s the straight dope: this virus doesn’t care about “fairness,” or whatever your gut is telling you is moral and ethical. If someone is at high risk of catching this virus, dying from it, or passing it on, they should get priority because that is what will stop this pandemic most quickly. Have you heard of a pyrrhic victory? That’s where you “win” but the course you took to win left you with such a devastating toll that you really didn’t win at all. That’s what will happen if we get bogged down in arguing things like “prisoners don’t deserve the vaccine.” It’s not about who deserves what. It’s about stopping the pandemic as soon as possible, and giving the vaccine to prisoners early will do that. If you “win” by deciding that only the righteous get the vaccine first, you will in fact lose as the virus continues to race unhindered through prisons and stadiums, and through frat houses where a bunch of privileged assholes are still doing keg-stands, and through Walmarts where ignorant conservatives go without masks and breathe their virus-laden breath into the essential workers who are forced to stand there and process their credit cards. All of those people need the vaccine, and they need it way earlier than righteous little me, who has been sitting quietly in my home for the past nine months getting groceries delivered and learning to make sourdough bread.

Please keep that in mind as people and news organizations and podcast hosts continue to politicize what should be apolitical. Please don’t fall into the trap of weighing who “deserves” what, and whether or not you are being treated fairly. Nothing about this is fair. So let’s use science and rational thinking to end it now.

Rebecca Watson

Rebecca is a writer, speaker, YouTube personality, and unrepentant science nerd. In addition to founding and continuing to run Skepchick, she hosts Quiz-o-Tron, a monthly science-themed quiz show and podcast that pits comedians against nerds. There is an asteroid named in her honor.

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One Comment

  1. Rebecca, I am glad you have thought about this problem of priorities because I think the situation is even worse than you have stated here.

    98% of covid deaths occur in the age >60 y population. Those >65y make up ~15% of the population or nearly 50 million in the US.

    For maximum impact on death rate, this group must be immunised ASAP. Anything that detracts from that will result in a further massive death toll.

    Add to that the fact that there is NO evidence whatsoever that the Pfizer vaccine will prevent asymptomatic transmission.

    Everybody outside that >60 or >65y age group makes up the remaining 2% of deaths. This includes medical workers, carers, first responders, firemen, social workers, teachers, “the vulnerable”, everybody on the list of deserving people that I have seen proposed for priority vaccination.

    There is a golden moment here, perhaps 2-3 months, where the death toll and the number of hospitalisations can be cut by a factor of >95% – recall that in the Phase 3 trials there were NO deaths and NO serious covid in the vaccinated group.

    Yet what do we see but the first covid vax in the US being delivered to a medical worker who quoted “I am glad that I will not catch covid and bring it back to my family”. Uh, NO, WRONG, you can still catch it and pass it on to anybody, but now you will have very mild symptoms and be almost impossible to detect.

    Has anybody thought how to prioritise testing when everybody is asymptomartic? Plus ofc you all realise that antibody testing will now become meaningless.

    No, top priority should go to the aged population exclusively.

    I am sure that my view will be unpopular but it is totally based on minimising mortality and hospital admissions. That in itself would end the nightmare for medical workers.

    While we are at it the US has 5% of the population infected and a doubling time of ~60 days. At that rate the whole nation will double 4 more times and reach natural herd immunity by around the 4th of July, long before everybody can be vaccinated. So maybe the priorities need to be sorted a bit better right now.

    These remarks apply not only to the US but also to the UK and other Anglo nations including my own.

    Do I accuse governments of ageism? HELL YEAH!

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