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How To Decide Who Gets The Covid-19 Vaccine First

Last month, Moderna Health announced advancements in Covid-19 vaccine trials, prompting speculation that a vaccine might be available as early as next year. But with this increased optimism comes challenges in manufacturing and distribution. Vaccines take time to produce, and the initial supply might not meet US demands. As the race for a Covid-19 vaccine heats up, policymakers must confront a series of pressing questions: Who should get the vaccine first, and how should that decision be made?

Let’s assume the US government can effectively coordinate mass production and distribution of a Covid-19 vaccine by early 2021. There is already some consensus that front-line healthcare workers, who are most frequently exposed to infections, should be vaccinated first to stem the tide of the pandemic. But in the coming months, we will likely see various other advocacy organizations make the case that a given profession or group should be next in line. If we fail to learn from the mistakes of last spring, such as leaving states to outbid one another for lifesaving resources, Americans could be pitted against each other. Partisan competition, rather than cooperation, could define vaccine distribution.
In the runup to a Covid-19 vaccine, policymakers have a chance to do the right thing by listening to medical scientists and planning carefully. Three considerations can help these efforts.
First, vaccine allocation must be driven by health outcomes and based on sound evidence. Experts maintain that well-organized health surveillance can provide “accurate and comprehensive information about the size, distribution, and risk profiles of affected populations.” These data can ensure that vaccines go where they are needed most. Evidence-based distribution can also help avoid partisan wrangling. In early June, a Pew Research poll found increasing differences in attitudes among Republicans and Democrats about the threat of Covid-19. Conservatives reported less confidence in medical scientists than liberals, and views diverged about the effectiveness of measures to blunt the virus’s spread, such as physical distancing.
In reality, Covid-19 doesn’t care if you’re a Republican or a Democrat, and the effectiveness of a vaccine doesn’t depend on political ideology either. The modus operandi of a virus is the ease of transmission. It will affect those who contract it, regardless of whether they lean red or blue. This is no time to doubt experts. As top US public health officials argue, we need comprehensive testing and contact tracing in concert with vaccine distribution to assess how the virus is spreading throughout the country. These health-driven and evidence-based strategies can help policymakers maximize the benefits of a vaccine for all Americans.
Second, we must demand transparency and accountability. Policymakers have already made strides in this direction for vaccine development and distribution. In late March, Massachusetts Sen. Edward Markey and Rep. Ayanna Pressley pressed FEMA and the White House Coronavirus Task Force to account for failed decisions in distributing PPE. Just over a month later, Senate Democrats introduced the Medical Supply Transparency and Delivery Act, which explicitly calls for scaled-up vaccine production and regular public reporting on national critical resources and needs.
Similar efforts are also underway at the US Centers for Disease Control and Prevention (CDC). The Advisory Committee on Immunization Practices at the CDC began public discussions last month, focusing on how to distribute limited vaccines among at-risk populations. Their evidence-based guidance is crucial in the fight against Covid-19, but only if policymakers commit to transparency and put their recommendations into practice. Shining a light on national plans to distribute a Covid-19 vaccine will hold policymakers accountable and increase legitimacy in the decision-making process.
Third, we must strive for justice when allocating a Covid-19 vaccine. Some say that the pandemic is the great equalizer, but nothing is farther from the truth. Black Americans account for a disproportionate amount of Covid-related deaths. Indeed, the CDC reports that ethnic minorities are at an increased risk for hospitalization — and health disparities that result from structural inequality are only getting worse as the pandemic drags on.
Policymakers cannot ignore these realities. They should recognize that vaccine distribution is but one of many opportunities to address these long-standing injustices. Seeking input from affected communities and stakeholders on how to fairly distribute a vaccine is a first step toward justice, as it allows for diverse voices to be heard on how to protect health and well-being in the pandemic. But engaging affected communities is also important in the development of a vaccine. For clinical trials to be successful, we need diverse participants, including those from underserved communities. Meaningful engagement could mitigate distrust that has long characterized the relationship between people of color and medical institutions.
The United States is at a critical inflection point in history, with heightened attention to the systemic racism that has defined American policy for centuries. Policymakers must act swiftly and decisively so vaccine development and distribution do not become further examples of government-sponsored racial injustice.
The recent surge of Covid-19 cases across the United States has increased the urgency for a safe and effective vaccine. But, as public health officials all over the world can attest, planning for Covid-19 is no easy task. The situation changes daily as public behavior shifts, stay-at-home orders are imposed and lifted and the virus spreads. Yet no matter how hard planning is, policymakers must be prepared for vaccine distribution.
Developing transparent, health-driven procedures could prevent millions of future Covid-19 cases and deaths — other effectively implemented policies have already done so. The time for policymakers to act is now — guided by evidence, justice and the wisdom of medical scientists.

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