Read on Twitter
Lately I've seen people say that deviations from "ethical queues" for vaccination are NBD, that we should focus on getting the vaccine into as many arms as possible as fast as possible. If you care about deaths and years of life lost, the math doesn't really back this view up.
See, for instance, https://www.medrxiv.org/content/10.1101/2020.09.08.20190629v2
What especially troubles me is that we're seeing departures from priority groups at research-rich academic medical centers. After immunizing high-risk HCWs, they sometimes move on to loosely affiliated low-priority groups (e.g., my computational, remote, young-ish, low-risk lab).
I don't know if these institutions cannot return vaccines to the city/county and feel they have no way to immunize high-risk patients or even high-risk non-medical employees more systematically. This urgently needs to be worked out.
I've not modeled this, but my intuition is that it would indeed be better for a vaccine to sit on the freezer shelf for a week if it were then to go into the arm of a nursing home resident instead of mine.
Obviously, we can't afford to be too precise. Our work suggests that a robust strategy is to prioritize by age group after key occupations/settings. Once again in this pandemic, it hurts to contemplate the impact of mangled logistics, especially on lives that have been on hold.
I hope leaders and those in positions to influence leaders--especially at privileged institutions--can do what they can to direct vaccines to the populations in most urgent need of them, and who have suffered disproportionately.
