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Sep 9 2020 (IPS) – Once safe and effective COVID-19 vaccines are available, tough choices will need to be made about who gets the first shots.
A committee of the National Academies of Sciences, Engineering, and Medicine – at the behest of the Centers for Disease Control and Prevention and National Institutes of Health – has proposed an .
They recommend first responders and health care workers take top priority. Older adults in congregate living situations would also be part of a first vaccination phase, according to the plan.
We are faculty at Johns Hopkins University and the University of Southern California who have spent decades studying . One of us is a member of the National Academy of Medicine.
Having seen firsthand , we disagree with some of the recommendations. Asymptomatic spread is and threatening surrounding communities.
We argue that this pandemic requires a different model for making vaccination choices. After taking care of essential workers, vaccinations should be given to the biggest transmitters of the virus – mostly the young – and only then to the most vulnerable.
Lessons from 2009 flu epidemic
The textbook vaccine model goes out the window when novel viruses emerge.
Some lessons can be drawn from the , which killed an estimated 500,000 people around the world. In the U.S, President Barack Obama declared the spread a national emergency.
Optimally, older people will drive down deaths by staying home in large numbers, and younger people will drive down infections by getting vaccinated in even larger numbers. It all works if the vaccine is effective and enough people take it
A vaccine was developed as early as the fall of 2009. However, only . The CDC was required to make some difficult decisions about allocation. Some states requested 10 times the amount they were allocated.
In the end, the CDC allocated the vaccine strictly in proportion to a state’s population – that is, on a per capita basis. States then allocated them, often with priority to infants and the elderly, along with people at high risk.
This priority – to protect the most frail – has been public policy since at least the .
Later studies, however, have shown that a was to control , which often has meant vaccinating school-age children early.
One of the lessons from these past pandemics is that early can avert multiple infections with others.
The superspreaders
The experience of the past few months has shown how important it is to check transmission with COVID-19. found that as few as 10% of those infected lead to 80% of the infection cases. What has made it more difficult is that up to at all.
Very few of the COVID-19 are elderly. It is the younger people who have a much greater propensity to resume social lives at schools and in other venues.
Among the young are a subset of highly social people with wide circles of friends who become the most fertile ground for the spread of COVID-19. These young people also have a much lower risk of death or even severe symptoms, which also means they are more likely to infect others.
Cases have been spiking in the 15- to 25-year-old age group, that they are propelling the spread of the virus. A recent outbreak on the infected at least 40 people.
The American Academy of Pediatrics and that at least 338,000 children have tested positive for the virus through July 30, with more than a quarter of that number having tested positive in just the last two weeks of that month.
More broadly, younger residents in the virus hot spot of Los Angeles County . In California, young people between 18 to 34 years of age account for .
Young versus old
Anticipating that young people will engage in activities that spread the virus, many universities . Some that decided to go after as little as a week on campus.
With or without a vaccine, , especially those with underlying medical conditions, is avoiding contact with potential carriers.
Optimally, older people will drive down deaths by staying home in large numbers, and younger people will drive down infections by getting vaccinated in even larger numbers. It all works if the vaccine is effective and enough people take it.
We predict the pressures and politics around prioritizing vaccine distribution will be intense. We argue that the key will be to take the most beneficial route, not the most obvious one. With a full-scale public health campaign behind it, that will mean prioritizing those who are driving transmission, not those who are most vulnerable.
As counterintuitive as such a strategy may appear, plenty of evidence shows this would be the right approach.
, Leonard D. Schaeffer Chair and Distinguished Professor of Public Policy, Pharmacy, and Economics, ; , Professor of Preventive Medicine and Associate Director for Data Science Integration, , and , Bloomberg Distinguished Professor of Economics and Business, Director of JHU s 21st Century Cities Initiative,
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