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Prioritization vs speed is a false choice that ignores that we’re expecting to transition from vaccine scarcity to abundance over the course of the year (in the US, very different scenarios in different countries, some have abundance now, others have nothing w/ no end in sight)
When we have more supply, speed will skyrocket. Non-scarce doses can be pushed to multiple outlets (public clinics, pharmacies, doctors offices , workplaces, schools, etc) in addition to huge mass vax sites. 2, 3, 4, 5 million shots/day could be feasible when doses = abundant.
But right now, doses are scarce. Reporting on gaps between shipped/in-arms makes it seem like there are millions on the shelf or being tossed out because we’re “trying too hard” to reach the most exposed/vulnerable. No.
For Jan-March, we don’t have enough doses to widely distribute them to every doctors office, walk-in clinic, etc. where infrastructure is already in place. Most states are dumping most doses into a small # of sites while giving “access” to huge groups that far outstrip supply.
A better approach when doses are scarce is to scale up mobile efforts to send doses (& jabbers) directly to hot-spot workplaces & residences & vax everyone on-site who’s willing. That’s what the federal nursing home program was supposed to do, but it lacked funding & oversight.
The WV nursing home program (they opted out of the fed disaster) provides a model for scaling up mobile vax teams to target scarce doses. Local health departments play matchmaker between employers/housing authorities/etc & pharmacy teams & provide financing, logistics & oversight
An active/mobile strategy won’t get us above 1 million a day, but that’s ok when 1 million a day keeps pretty good pace with supply. As supply expands, we’ll use vastly more diffuse outlets (vaccines available EVERYWHERE) to dramatically increase speed.
Prioritization is critical to reducing hospitalizations & deaths ASAP. The difference b/w getting vaxxed today vs. summer is massive for, eg, people w/ high-risk conditions whose work/family members’ work is high exposure. The rest of us can/should wait a few more months.
What is this trickle-down nonsense?Disproportionately allocating doses too scarce to achieve herd immunity to wealthier, whiter retirees & folks working from home w/ time to hit refresh on a website will not protect elders living in crowded conditions w/ frontline workers.
Arguing that prioritization of scarce doses based on risk/exposure is inconsistent with the public health goal of achieving population immunity ASAP reflects a misguided understanding of both public health & the situation on the ground. https://www.thehastingscenter.org/ethics-supports-seeking-population-immunity-not-immunizing-priority-groups/
