POLICY BRIEFING – WEEK IN REVIEW
In early September, the National Academies of Science, Engineering, and Medicine unveiled draft guidance for a phased vaccine rollout schedule. This week the final framework was published. The paper acknowledges that many of these recommendations are being made despite a number of undetermined variables, such as vaccine efficacy in subpopulations, other mitigation efforts and the ever-changing nature of the covid-19 pandemic. Because of such questions, the steps delineated require flexibility and ease of implementation.
The paper outlines that given the anticipation of limited quantities at the outset of a vaccine release, allocation plans must be equitable and perceived as such. The highlighted principles of the plan include ensuring maximum benefit, mitigation of health inequities, fairness, transparency and evidence-based practice.
Finally, in determining allocation of vaccines, the following risks were considered: that of acquiring infection, severe morbidity and mortality, negative societal impact and the risk of transmitting infection to others.
With these variables in mind, the following phased approach of vaccine allocation has been recommended:
- Phase 1a: high-risk healthcare workers and first responders.
- Phase 1b: people of all ages with comorbidities that put them at significantly higher risk; older adults in aggregated living facilities.
- Phase 2: K-12 teachers, staff, and child care workers; critical workers in high-risk settings; people of all ages with comorbidities that put them at moderately higher risk; people in homeless shelters or group homes for individuals with disabilities; people and staff in jails, detention centers, prisons, and the like; all older adults not in Phase 1.
- Phase 3: young adults; children; workers in industries important to the functioning of society not included in Phase 1 or 2.
- Phase 4: everyone else who did not qualify in previous phases.
The paper concludes by discussing the various scenarios under which this framework may need to be implemented. It focuses on time scales of vaccine availability, efficacy, acceptance by the public, number of different vaccines, distribution networks, pandemic status and the social, economic and legal contexts. The authors have admirably tried to address every possibility against every backdrop but acknowledge the limitations in forecasting every scenario. The National Academies of Science, Engineering, and Medicine. 30 October 2020.
The numbers are stark. In nearly every state covid-19 cases are climbing. The average number of deaths per day is up ten percent. The White House Chief of Staff has said the virus is "beyond control." But even this does not paint the entire picture. Cases have been surging for the past few weeks, and public health experts agree that death counts are a lagging indicator, often trailing several weeks behind the current case data. As the weather turns colder, the fear is another surge of need for hospitalization and critical care that threaten to swamp hospitals.
But the danger is not just in the lack of physical resources; rural centers have been hit especially hard with healthcare worker infections, further limiting already strained systems without a ready source of replacement personnel. Discussions are already underway regarding again limiting elective procedures and clinic visits, but there is no way to compensate for staff quarantines. With a vaccine candidate likely not available until early next year, the one option available is finally taking seriously the long-standing social distancing and masking guidelines advocated for by leading experts. Various. 28 October 2020.