When Pfizer-BioNTech and Moderna announced COVID-19 vaccines with over 90% efficacy, many were filled with hope that the pandemic is over and life will go back to normal. However, the harsh reality is that not everyone will be able to get the vaccine right away.
In bioethics, an important question to ask is about resource allocation. When there is a scarcity of resources, medical professionals need to make considerations to guide the decision-making process of who gets what, and when. There are many competing philosophies regarding this prioritization, including giving preference to the most vulnerable or to those who contribute the most to society, for instance.
As Albert Jonsen, emeritus professor of ethics in medicine at the University of Washington, and Kelly Edwards, project coordinator of the Bioethics Education Project at the University of Washington, write, “Often scarcity of resources, such as equipment, beds, drugs, time or excessive numbers of persons in need make it difficult, if not impossible, to provide ‘the full measure of service and devotion.’” In other words, some people will be prioritized over others.
The Advisory Committee on Immunization Practices recommends that residents and employees of nursing homes and similar facilities be the first people in the United States to receive coronavirus vaccines, along with health care workers who are especially at risk of being exposed to the virus. Across the country, approximately 21 million people work in health care facilities, and approximately 3 million adults live in long-term care facilities, according to the Centers for Disease Control and Prevention.
In New York State, Gov. Andrew Cuomo said the state will receive the vaccine from Pfizer on Dec. 15 if all safety and efficacy approvals are granted. The doses will be enough for 170,000 New Yorkers. However, there are 85,000 nursing home residents and 130,000 nursing home staff in the state, according to ABC. Still, the state expects more shipments of the vaccine in the coming months.
Being that there are barely even enough vaccines for the extremely vulnerable populations, how and when will other demographics receive the vaccine? The next groups in the pipeline seem to be either the elderly or essential workers. As the New York Times puts it, “Ultimately, the choice comes down to whether preventing death or curbing the spread of the virus and returning to some semblance of normalcy is the highest priority.”
Rev. William J. Barber II, co-chairman of the Poor People’s Campaign, told the New York Times, “It’s damnable that we are even being placed in this position that we have to make these choices. But if we have to make the choice, we cannot once again leave poor and low-wealth essential workers to be last.” Scott Gottlieb, former Food and Drug Administration Coordinator, said on “Face the Nation,” “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans. 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.”
According to the “Find Your Place in the Vaccine Line” interactive from the New York Times, a 21-year-old in Tompkins County who is not an essential worker and does not have COVID-related health risks is in line behind 144.1 million people across the United States, behind 8.7 million people in New York State and behind 37,400 others in the county. This is visualized below, courtesy of the Times.
The line shortens slightly for a 21-year-old in the county who is an essential worker, who is estimated to be behind 126.5 million people across the United States, behind 7.6 million people in New York State and behind 32,300 others in the county. On the other hand, an 80-year-old in Tompkins County who is not an essential worker and has COVID-related health risks is in line behind 23 million people across the United States, behind 1.8 million people in New York State and behind 7,200 others in the county.
Cuomo also expressed concerns about the dissemination of the vaccine beyond the primary groups. Some challenges include getting federal funding, implementing outreach efforts and the social acceptance of the vaccine. Even amid the pandemic, there has been an increased number of individuals who are against receiving vaccines. A large reason for this is the spread of misinformation regarding COVID-19.
Even if everyone was willing to get the vaccine, there are a number of vulnerable populations who still may not have access for an undetermined amount of time. It is no secret that COVID-19 has disproportionately impacted Black individuals and other people of color, and due to systemic health inequities, it is unlikely that they will be fairly prioritized. Additionally, individuals who are homeless may face barriers in receiving the vaccination. It is unfortunate that governmental agencies need to jump through so many hoops to ensure the proper distribution of the vaccine. This circumstance speaks to the flaws in the nation’s healthcare system.
People need to understand that even though the vaccine is a step in the right direction, it is not an immediate remedy. Life will not return to normal anytime soon. Surely, the world is dealing with COVID-fatigue. Still, individuals must remain patient and realize that thousands of people are still dying from this virus every day.
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