Determining where various groups of people will stand in the line to get the COVID vaccine (and the processes for making those decisions) will be the most contentious and revealing issues of the next six months. We’re already starting to hear rumblings in the media, but once we get past the Inauguration and initial appointments/policy statements, this set of questions will give us some significant clues as to what kind of country and what kind of world we live in. The answers may not be surprising, but will certainly be instructive.
Of course, much will depend on the progress developing/approving the Pfizer, Moderna, and Oxford vaccines and the others that are coming along. There will be major issues around manufacturing, distribution, and pricing. Some will work better with some populations and distribution chains than others, but the composition of The List will engender political/moral debate at both the national and global levels.
Not everyone can be first. A two-dose vaccine will require 15 billion doses. The world’s largest vaccine manufacturer has estimated that it could well be 2024 before there is complete global coverage. So The List is important and, in our current world, its construction will be (generally) public and political. Even in the US, the (present) Administration has said that allocation will be done by the states (but how are the doses to be allocated to the states?)
Various groups will be proposed for priority treatment, each with plausible arguments behind them: (not in any order)
- The elderly (oldest first)
- Health care workers
- Political Leaders and those politically connected
- Sports Teams (why not artists?)
- People with ‘co-morbidities’
- "Essential” workers
- Rich people
- People from countries that
- paid for the vaccine in advance
- are powerful and rich
- have been hardest hit
- steal the vaccine formula
- paid for the vaccine in advance
I don’t propose to resolve this debate. Polling companies are likely already ramping up to take the figurative pulse of the nation (and the world). I do think it would be interesting to put people who have washed their hands a lot and always worn a mask at the top of The List. And, we can assume that ‘anti-vaxxers’ will not be interested in any event (that’s another problem).
Regardless of the result, I will be curious to see the claims/arguments from those who downplayed the pandemic. Will they manufacture reasons for immediate self-protection? Perhaps voluntarily go to the back of the line, since the pandemic was a liberal/media hoax, so there’s no rush?
Similarly, I wonder about those who are vehemently anti-government. It seems pretty clear that governments will be in charge of this. So, especially if you are a die-hard Ayn Rand fan, arguing for an entirely market-based solution (vaccine auction anyone?), you will have something to complain about. Cost issues will come up here, too. Will those opposed to “excessive” government spending also argue for everyone to pay their own way? One of the big arguments against Obamacare and “socialized medicine” in general, was that governments shouldn’t ration health care (Sarah Palin’s diatribe against “death panels”). But, in an important sense, that’s what we’re going to have. For those people whose closest contact with triage was watching episodes of M*A*S*H, this could be a wake-up call.
There is another layer of issues at the global level. Should World Health Organization make the decisions about country-by-country allocation? What about those who quit the WHO? There is a group of 156 countries called COVAX (under the WHO’s auspices) which is working this out (guess who’s not in). Wow, if you hate government and socialized medicine in the US, the thought of a bunch of furriners putting the US of A at the back of the line is pretty appalling. Maybe we should send in a SEAL team to scoop some up?
Even without military action, the rich countries have gotten used to running things globally (e.g. IMF, WTO), usually with the US in the lead. But lately, we haven’t been at the table and even when we go back, it’s likely the others won’t be as deferential as they have been in the past. A new spin in international organization/governance may be one long-lasting result.
It will take a year to get everyone in the US covered. In the meantime, there will be another interesting situation: the potential for different social status between those with vaccinated/certified immunity and those without. What is the public health rationale to require vaxxers to wear masks? (New joke line: If a vaxxer and a non-vaxxer walk into a bar…?) Do they have to go to different rooms? Will they get other preferential treatment? Will vaxxers be allowed to wear a badge as an exemption? When some inevitably lazy/sociopathic guy decides to forge an ID card or badge even though they haven’t been vaccinated, will they be subject to criminal charges?
Generally, though, it will be an interesting exercise to make your own list. Which groups should go first? Why? How do your preferences correlate with your own demographics? Can I persuade you that seniors and teachers (and their friends) should be very high up on The List?