Who Gets the First COVID-19 Vaccines?

Officials debate the needs of the elderly vs. those of essential workers.

December 08, 2020

ALEXANDRIA, Va.—As the country’s COVID-19 immunization program prepares to launch, the question on everyone’s mind is, “Who gets the vaccine first?” The elderly and people with serious medical conditions, who are dying of the virus at the highest rates, or essential workers, a large group of people who have borne the greatest risk of infection?

According to the New York Times, health-care workers and the frailest of the elderly will almost certainly receive the first shots, under guidelines released last week by the U.S. Centers for Disease Control and Prevention. Vaccinations are expected to start this month, and federal and state health officials are trying to determine who will be next.

“It’s damnable that we are even being placed in this position that we have to make these choices,” said the Rev. William J. Barber II, a co-chairman of the Poor People’s Campaign, a national coalition that calls attention to the challenges of the working poor. “We cannot once again leave poor and low-wealth essential workers to be last.”

Ultimately, the choice comes down to determining the highest priority: death or curbing the spread of the virus and returning to some semblance of normalcy.

“If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” said Dr. Scott Gottlieb, former Food and Drug Administration commissioner. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So, it depends what impact you’re trying to achieve.”

The controversy is muddied by the fact that the definition of “essential workers” used by the CDC comprises nearly 70% of American workers and includes everyone from grocery clerks and emergency responders to tugboat operators, exterminators and nuclear energy workers. Some labor economists and public health officials say the category should be narrowed to only those who interact in person with the public.

There are about 90 million essential workers nationwide. And because there won’t be enough doses for everyone right way, states are preparing to make tough decisions. At this early point, many state plans put at least some older people who live independently, or those with medical conditions, ahead of most essential workers. But that could change after the CDC committee makes a formal recommendation on the next phase.

In September, researchers analyzed the Department of Homeland Security’s list of essential workers and proposed a narrower, more vulnerable category—“frontline workers,” such as food deliverers, cashiers and emergency medical technicians, who are at greater risk of contracting the virus. Essential workers on the federal list make up nearly 70% of the U.S. labor force, the researchers said, compared with 42% for frontline workers.

Some health policy experts say that to prioritize death prevention rather than reducing virus transmission is simply a pragmatic choice, because there won’t be enough vaccines initially to make an impact on infection. A more effective use of limited quantities, they say, is to save the lives of those most vulnerable.

The CDC’s own “social vulnerability index” includes 15 measures derived from the census to help determine how urgently a community needs health support, with the goal of reducing inequities. Some of those measures are overcrowded housing, lack of vehicle access and poverty. At least 18 states have indicated that they intend to apply the index when distributing the vaccine.

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