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I’ve been having this discussion with my spouse, who is engaged in patient care, but not for Covid patients. Part of the reason all health workers are first in line is that many (though not all) of them are logistically easier to reach. https://twitter.com/jabarocas/status/1338125298240524289
There are absolutely ethical & public health criteria that justify putting all health workers 1st in line. But something we’re not discussing enough is how logistical realities are likely to trump well-reasoned criteria in many, many cases.
Some health workers who aren’t engaged in covid care - or even urgently time-sensitive care - may get vaxxed before some who *are* engaged in covid care, merely because the former are more reachable (affiliated w/ lg hospital systems rather than smaller, more remote facilities)
Some in lower risk groups may be offered vax before some nursing home residents simply because LTC residents are spread out in groups far smaller than the 1000 doses in the smallest vax pack. Many LTC are small & far from the major hospital systems equipped to split up packs.
Overall, I expect phase 1A (health workers & LTC residents) to go quite smoothly compared to what may happen in 1B and beyond.
Congress has not funded mass distribution. As a result, we’re depending heavily on large, private hospital systems to handle distribution themselves. It’s not something they’ll be able to make a lot of $ on. Privately, they’re are signs they don’t want this responsibility,.
In phase 1B and beyond, I expect hospitals will treat doses like hot potatoes. Get them in the arms of anyone who arguably meets the allocation criteria ASAP. Speed is good, but given scarcity, return to normalcy may come sooner with more careful & rational allocation.
There are no real plans & there is no real financing for rational distribution based on criteria that will end the pandemic faster. Many will be offered vax based on their connection to a regular source of care that’s affiliated with a large hospital system. Equity will suffer.
