Waiting for your turn can be frustrating, especially when it comes to COVID-19 vaccinations. But prioritizing who receives the limited supply of vaccines available saves lives and reduces spread of infection, according to a study published today in the journal PNAS from the University of California, Davis.
While there is mostly universal agreement that older people should be prioritized, debates are currently underway about prioritizing a variety of other groups. Still others argue against targeting at all.
“Prioritization has benefits because people differ in at least two key ways – their risk of infection and the likelihood of serious consequences from infection,” said senior author Michael Springborn, a UC Davis professor in the Department Environmental Studies and an economist focused on environmental risk, including infectious disease.
“We know that front-line essential workers have less capacity to socially distance and thus an elevated risk, while seniors are more seriously impacted by infection. Accounting for this substantially increases the benefits of vaccination.”
For the study, the researchers modeled COVID-19 transmission rates and the optimal allocation of an initially limited vaccine supply in the U.S. under a variety of scenarios. They found that deaths, years of life lost and infections were between 17 to 44 percent lower when vaccinations targeted vulnerable populations – particularly seniors and essential workers – rather than an alternative approach where everyone is equally likely to be vaccinated.
“We also found that in regions where there was a faster increase in infections, and where there is less masking and social distancing occurring, targeting was even more important in avoiding those outcomes,” said lead author Jack Buckner, a Ph.D. candidate in the UC Davis Graduate Group in Ecology.
Building on the standard approach in modeling analyses to account for age groups, the study is the first to include front-line essential workers as their own category. In doing so, the researchers identified that such workers should be a vaccination priority along with or shortly after seniors. Policies that target based on both age and essential worker status substantially outperformed those that consider age only.
Prioritizing essential workers versus seniors depends on the conditions. For instance, when there is a good supply of effective vaccines and the outbreak is relatively under control, targeting essential workers first to help reduce overall spread can be ideal.
But if vaccine supply is limited and cases and deaths are surging, targeting seniors and the most vulnerable directly may be the better strategy.
Previous studies have assumed that a given prioritization strategy remains constant over time. This study uniquely allows for prioritization to evolve as conditions change, such as when more people in certain groups become vaccinated.
“There is a substantial value to prioritization, at least for the first few months of the vaccine rollout,” Springborn said.
“Once a large proportion of the most vulnerable people or the most likely to be exposed have been vaccinated, it becomes less important who gets it,” said Buckner.
Still much to learn
The authors say that while the scientific community and public have learned a lot about SARS-CoV-2, the virus that causes COVID-19, there are still many uncertainties to address. This includes how well vaccines impede transmission, how much individuals will relax their protective measures as vaccinations progress, and how durable immunity will be given the rise of new variants.
The authors took a general approach that is adaptable for future disease outbreaks.
“The analytic approach put forward in this study to assess the optimal dynamic allocation of vaccines adds to the methodological toolkit with applications beyond the COVID-19 pandemic,” said study author Gerardo Chowell, a professor of epidemiology and biostatistics at Georgia State University.
A recent correspondence pointed out that indigenous people and other ethnic communities should be included in the rollout of the COVID-19 vaccine.1 Indigenous communities carry a unique set of cultural beliefs and traditions that need to be preserved.2 However, the marginalized include sectors beyond indigenous peoples.
This article claims that other marginalized sectors, such as fisherfolk, farmers and landless rural workers, workers in the informal sector, women and children, persons with disabilities, victims of disasters and calamities, must also be prioritized by the government’s COVID-19 vaccination plan.
The United Nations, in promoting Good-Health and Well-Being as one of the Sustainable Development Goals,3 is aware that these sectors have reduced capacities for health provisions due to socio-economic boundaries and represent vulnerable households whose survival depends on the fitness to work of the family’s breadwinner.
Therefore, it is essential for governments and institutions to improve the access of the marginalized to essential medicines and vaccines.
An approach to essential health provisions that include the marginalized is seen by the World Health Organization as essential in preventing the ‘spiral from ill-health to poverty’.4 This approach allows persons in vulnerable sectors to increase access to health services and maintain good health, keeping the person’s capacity of the provision of essential goods for the survival of their families.
Furthermore, a recent article that discussed the government financial assistance in the Philippine setting5 poses the question of how resources can be allocated fairly. The article considers that the government should identify the least-advantaged during a pandemic due to their being denied society’s basic primary goods. In relation, COVID-19 vaccines are now an important resource and are essential for the survival and health of society.
The distribution of COVID-19 vaccines should not exclude the vulnerable marginalized sectors. For governments and institutions to fail in this aspect will be contrary to the promotion of justice and fairness, denying the marginalized with requisite capacities6 for a normal and complete life.
Also, a recent article discussed solidarity as a companion virtue to compassion in response to the COVID-19 pandemic.7 It argued that solidarity, the idea that each person is responsible for all, promotes the awareness of our interdependence on one another, most especially during this time of a pandemic.
This remains true most especially in the distribution of the COVID-19 vaccines. These vaccines are not merely a solution to a problem; instead, they uphold the inalienable worth of a person, regardless of the lack of financial and political capacities and that each life is needed to collectively solve the pandemic.
Finally, even before the COVID-19 pandemic, international health developmental efforts,3 supported by local efforts,8 have been working toward the increased healthcare opportunities of the marginalized. And as the COVID-19 pandemic continues to bring death and suffering to all, especially to the marginalized sectors, the efforts to reduce inequalities through health provisions are all the more relevant.
More information: Jack H. Buckner et al, Dynamic prioritization of COVID-19 vaccines when social distancing is limited for essential workers, Proceedings of the National Academy of Sciences (2021). DOI: 10.1073/pnas.2025786118