DOCTORS ' LOUNGE
COVID-19 VACCINE FROM MANUFACTURE TO IMMUNIZATION AUTHOR Stanley Gall , MD
In the January issue of Louisville Medicine ( 2021:68 ; 7-8 ), I presented the article “ Road to the COVID-19 Vaccine ” through Operation Warp Speed ( OWS ) 1 , a partnership of the Department of Health and Human services ( HHS ), the Department of Defense ( DoD ), and private industry . At this time , two vaccines have been approved for Emergency Use Authorization ( EUA ) by the FDA . Two additional vaccines are awaiting FDA Emergency Use Approval .
The general vaccination plan was planned and proposed by the Centers for Disease Control and Prevention ( CDC ) and is listed for states to implement or to alter as they desire ( Table 1 ).
The plan proposed by the state of Kentucky and the CDC is based on occupation and health factors , however its guidelines are arbitrary . Since nursing home residents have the highest infection rates and deaths , it is logical for these persons to be first in line for
the COVID-19 vaccine . Also , health care workers who actually have contact with patients should be first in line to receive the vaccine . The most important group to receive the vaccine are the persons 70 years of age and older . In fact , the mortality rate from COVID-19 infection is almost universally age based . Therefore the phase-in of vaccine administration should be age based at increments of five years starting at age 70 and progressively going to age 65 , then to 60 , etc . By using these criteria , each of us will know when it ’ s our turn .
To satisfy political goals , the CDC has also come up with an extensive list of “ frontline essential workers .” Remember , whenever the government is in charge of allocating a scarce good resource in high demand , there will be rationing and political jockeying .
The CDC extends the concept of “ essential workers ” to include unspecified underlying medical conditions which increase the risk of serious complications from acute COVID-19 illness . 2 Additionally , the CDC extends the concept to include people who work in transportation , food services , housing , construction , finance , information technology , communication , energy , law , media , public safety and public health . The question is “ Who is not essential ?” The answer is “ Everyone is essential .”
The CDC then extended the guidelines to “ preserve functioning of society ” and reduce the extra burden of COVID-19 on people facing disparities . These two concepts involve political judgements . In addition , while states have given priority to firefighters , teacher unions are trying to cut in front of the line and refusing to re-open schools . Teachers and childcare workers face less risk than other front-line workers since children are much less likely to transmit the COVID-19 virus . Private schools that have been operative inschool have few cases of COVID-19 transmission and have a student population who is being properly educated .
Requiring “ essential workers ” to prove their eligibility creates a bureaucratic nightmare inducing falsification of records if they are collected at all . Basing eligibility for receiving the COVID-19 vaccine on age , oldest to youngest , is simple , scientific and fair . People will not have to wonder if they are ever going to get an appointment to obtain the vaccine . You do not have to prove you are an essential worker or that you have a serious medical condition .
With vaccine supply starting to increase rapidly and additional new vaccines being authorized for emergency use by the FDA , the supply of vaccine and demand for vaccination will come into balance soon . For a short period of time , the vaccine will be easier to obtain . However , will there be a COVID-19 vaccine glut ? A recent study using an online survey of about 50 questions to 1,878 people who responded showed : 3
About 52 % were very likely to get COVID-19 vaccine About 27 % were somewhat likely About 15 % were not likely About 7 % were definitely not getting one
Of the 1,978 respondents : 52 % women , 74 % white , 81 % non-Hispanic , 44 % age 26-40 , 77 % had a bachelor ’ s or higher degree . The researchers found vaccine hesitancy higher among African Americans ( 34.8 %), Hispanics ( 29 %), people living in rural areas ( 29 %), those who had children living at home ( 25 %), and people living in the northeastern US ( 25 %).
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