Most Essential or Vulnerable: Who should get the coronavirus vaccine first?

This weekend comes the possible decision of the advisory panel of the Centers for Disease Control and Prevention on which organizations to prioritize in the next phase of Covid-19 vaccine rollout. Thousands of lives hang in the balance.

Other states and regions have the final say, but most have followed the CDC guidelines for Phrase 1a. And thank God, because the CDC Advisory Committee on Vaccine Practices made a wonderful recommendation: Prioritize frontline health care workers and nursing home residents.

This was miraculous just because it put the most vulnerable first: Front workers are always exposed to the virus, and nursing home residents are somewhere between 40 and 50 percent of deaths related to Covid. (This does not count the thousands of residents who have died of loneliness and neglect as the pandemic places additional responsibilities on nursing homes.) From the perspective of Catholic social teaching, this was the best possible result.

This weekend, the CDC advisory panel may decide which group should get the Covid-19 vaccine next. Thousands of lives hang in the balance.

Now comes Stage 1b. There are three main groups that most biologists think are playing: 1) essential workers; 2) adults with high-risk medical conditions; and 3) adults over 65.

In deciding how to handle these groups, one might think that the ACIP would prioritize the most vulnerable. But there are signs that something else could be going on. The framework that appears to be used for ACIP to determine a priority for Level 1b does not refer to anything like the vulnerable ones.

For reasons that are not clear, ACIP decided to measure three main factors equally: 1) science; 2) implementation; and 3) ethics. A document from the ACIP working group assigns up to three points to each group on each of these factors.

Under “Science,” the advisory committee focused on the number of deaths that could have been avoided by prioritizing each of the three groups mentioned above. According to the modeling itself, prioritizing adults over 65 will result in between 0.5 and 2 per cent more deaths in a disease-preventing vaccine case, and between 2 and 6.5 per cent more deaths in the case of a vaccine that prevents disease, which takes precedence over either of the other groups.

Frontline workers are always exposed to the virus, and nursing home residents are somewhere between 40 and 50 percent of Covid-related deaths.

Osbarr is 5 percent: Given that we are close to a daily average of 4,000 deaths, this type of move would save an additional 200 lives each day. Over a month, it would save an additional 6,000 lives. So adults over 65 do not seem to have priority in Phrase 1b.

However, ACIP states that differences in the “Science” analysis are “very small” and gives the three groups a total of three points.

The next factor is “Activation,” and here the panel gives the group over 65 a total of three points and the other two just two points each, these groups are probably larger and not not covered by existing pharmacy programs. Factor: “Ethics.” If you think we were already in ethical matters then that is very understandable. However, in private, the committee selects three principles for consideration in “Ethics”:

a) Increase the benefits and reduce the harm
b) Promote Justice
c) Recognize health inequalities

The three principles are measured equally and, again, the three groups receive one to three points for each principle. When it comes to (a), adults over 65 get all three total points because the vaccine significantly reduces morbidity and mortality. Adults with high-risk medical conditions get only two points because, overall, they are still not as high-risk as adults over 65.

But now something strange is happening: Turning to a necessary workforce, instead of focusing on the pros and cons of that population itself (healthy people under 65 who are not frontline health care workers at low risk for morbidity and mortality), ACIP adapts to think about social causing harm and benefits (i.e., retaining essential services). Importantly, it never considers the social harms and benefits associated with the other two groups.

Under “Promote Justice,” the panel rightly states that essential workers cannot work from home but then raises questions of justice for the other two departments, simply referring to the fact that some in each group have limited or no access to care. What about the fundamental injustice of age-culture and competence? What about the painful, systematic isolation of these populations during the pandemic?

They are not appreciated. This provides a 6 point to 5 point guide for key workers (can you believe we are making ethics like this?) Entering the principle of final ethics: “Notice health inequalities . ”

Necessary workers destroy the other two groups in this area, three points to one point each for the other two. ACIP notes that an unequal percentage of ethnic and ethnic minorities and economically vulnerable people are essential workers. Furthermore, it is noteworthy that even recognizing someone with a health condition means that they have access to care. It also confirms that ethnic and minority groups are under-represented among adults over 65.

This is an awful ethical analysis. I’ve already raised a number of deep issues, but here’s one very important one: refusing to consistently implement someone’s ideas.

Racial justice is an essential principle here, but it is only invoked for one group.

Racial justice is an essential principle here, but it is only invoked for one group. An unequal percentage of people with high-risk medical conditions are also ethnic and ethnic minorities as are those in the most vulnerable group: people over 65 have high-risk conditions). But this is not considered in the analysis. Also, we are not given any reason, in the ethical analysis, that the three principles are measured separately and equally. And we have no reason why these three particular principles have been chosen.

With ethics as the main conclusion, the ACIP preview gave a total of eight points to critical staff; adults with high-risk medical conditions, six points; and adults 65 and older, seven points.

Of ACIP’s 14 voting members, 12 declared back in November in an unopposed vote that they supported this order of precedence. Sunday’s vote seems to reflect this view.

This is harassment. Critical workers should be an important priority (they should go before professors and journalists), but the CDC’s recommendation is that young and healthy essential workers go ahead of older people vulnerable to comorbidities.

A similar recommendation of the CDC is that young and healthy essential workers go in front of vulnerable older people with comorbidities.

The result, from the CDC’s own data, is that thousands more people will die.

During this pandemic, I have been a questionable critic of our practices towards vulnerable and disabled older people but I have also been hopeful that our mistakes finally We drew our attention to the fundamental injustices perpetrated by age and potential consumptive culture, one that strikes the older and disabled Blacks and Hispanics the hardest.

We got off to a good start in Phase 1a when we prioritized people living in nursing homes. I am very concerned, however, that if the CDC does as it is going to do, we will have taken two steps back from our one step forward.

Here’s hoping I’m wrong. And, if I’m not mistaken, other states and local jurisdictions are simply evading the guidance of the CDC and instead prioritizing the most vulnerable.

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