The risk of death after infection from COVID-19 for a 65 year old is roughly 140 times higher compared to a 25 year old.

It's ~460 times higher in a 75 year old vs. a 25 year old.

And its 1,500 times higher in a 85 year old vs. a 25 year old.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721859/

The issue of vaccination prioritization is difficult. And truth be told, I feel hypocritical joining the chorus arguing for greater prioritization based on age given that I've personally been prioritized for vaccination based on occupation (despite low health risk).

I'm also sensitive to the need to ensure equity, and the ways that an "age first" paradigm neglects other real health and social risks. But we have to acknowledge the fact that there is an exponential relationship between age and mortality that is unique.

Once we vaccinate every older adult, deaths will plummet, even if we remain far from "herd immunity." There's 54 million adults 65 and older in the US, and we could theoretically vaccinate almost all of them by the end of January.

This is a balancing act — and I won't claim to know the exact right approach. But we'll minimize loss of life by prioritizing identifiable groups with the highest risk of death defined in absolute not relative terms.

For point of comparison, here’s the NHS’ approach for Phase 1, groups they they estimate together account for 99% of preventable mortality from COVID:

https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020

And here’s Massachusetts’ prioritization:

It’s not clear to me that our approach (with the important exception of prioritizing corrections) will lead to greater equity of outcomes. For instance, the uninsured and underinsured (disproportionately POC) are more likely to have undiagnosed medical conditions ...

... Hence, they may be less able to provide documentation of 2+ “comorbidities”. It’s also more difficult to proactively identify those with 2+ comorbidities, which will no doubt favor those with more resources.

On the contrary, it would be very nice to broadcast everywhere in January: “Everyone who is 70 years or older in Massachusetts, it’s time for your vaccine. It will be free. No one will ask about your immigration status,” or something like that.

The proof will be in the pudding, however. We’ll see how the US vaccination approach stacks up against the UK in terms of racial/economic equity and efficiency in saving lives and curtailing the pandemic. I’m skeptical we’re going to come out ahead, however.

But if we’re not vaccinating the elderly in Massachusetts until the spring I’m very worried. Obnoxious people sometimes make points obnoxiously, but it doesn’t always mean the ideas are totally wrong.

The better way to ensure vaccine equity, in my mind, would be to pour large amounts of resources into working class and racial/ethnic minority communities for vaccination distribution and logistics.

Also, pass Medicare for All.

Arguably, even people like me shouldn’t have been so heavily prioritized. I understand the need to ensure we’re able to work (and not infecting vulnerable patients) until this is over, however. And I do think everyone should be vaccinated when it’s offered – this is about policy